New group enrollment

How to enroll

To help us process your client's enrollment accurately, please be sure all the items listed below are completed by your Kaiser Permanente sales team before the effective date of coverage.

Steps Small groups Large groups

New Group/Purchaser Application

The employer must complete and sign the New Group/Purchaser Application. If the application is submitted without the employer's signature, it will be returned, delaying implementation of the group's enrollment and payment of the commission.



Employee enrollment applications

Make sure all the employees complete, sign, and date their applications.



Declination of coverage/waiver forms

All eligible employees who voluntarily decline to enroll in the Kaiser Permanente health plan offered by their employer during the enrollment period must complete and sign this form, providing their reason for declining.



DE 9C (quarterly wage report) or payroll report

A copy of the most recent quarterly wage or payroll report is required. Important note: Please provide the status for each employee listed on the DE 9C or payroll report. Write one of the following abbreviations nest to each employee's name:


Kaiser Permanente




Declining coverage


In waiting period



If another carrier is being offered alongside Kaiser Permanente, indicate the name of the carrier and which employees are selecting that carrier. For all new employees whose names don't appear, provide copies of their New Employee Eligibility forms and write their names at the end of the DE 9C or payroll report.



Owner Officer Eligibility form

This form must be completed for each owner/partner/corporate officer enrolling who is not listed on the DE 9C or payroll report.



Electronic Transfer for Initial Payment

The estimated first month's premium check, payable to "Kaiser Permanente." Write the purchaser number on the check before mailing. The check must be issued by the group or the broker's trust account.

For small groups, mail your check to:

Kaiser Foundation Health Plan, Inc.
File #5915
Los Angeles, CA 90074-5915

Submit a copy of the premium check to your sales team with the new group enrollment documents.

For Southern and Northern California large groups (100 or more employees), mail your check to your sales team.

For more information, contact the California Service Center, 800-731-4661.



Broker's life agent license

If you are not already an established Kaiser Permanente broker, please submit a copy of your firm's life agent insurance license with tax ID number, or your individual life agent license with your Social Security number, along with your mailing address.



For small groups

Mail all the items listed above that apply, with the exception of the original check, to your sales associate at:

Kaiser Permanente, Small Business Unit
P.O. Box 7104
Pasadena, CA 91109

Or ship via delivery service to the attention of your sales associate

Kaiser Permanente, Small Business Unit
3100 Thornton Ave.
Burbank, CA 91504



For large groups

Mail all the items listed above that apply to your sales team.

For more information, contact the California Service Center, 800-731-4661.



Please keep copies of all documents for your records.



Simplify the enrollment process for you and your clients

Help your clients move through enrollment more effectively and with fewer setbacks just by applying some of these tips:

  • Thoroughly explain the details of new-hire eligibility with your clients.
  • Explain your clients plan options (e.g., copayment versus deductible).
  • Take time with your clients to make sure they understand the process.
  • Remind your clients to provide all necessary information for each member, including name, date of birth, date of hire, employee signature, effective date, and dependent information. Missing or conflicting information may result in a delay.

After you submit the application

After you submit your clients application by fax or mail:

  • It will be electronically archived by the California Service Center.
  • You'll receive copies of general information thats sent to your clients.
  • Renewals will be mailed to you at least two weeks before they're mailed to your clients. If you need a more flexible schedule, call the California Service Center.

Billing tips

Your clients first billing statement will generate within 30 days from the setup of their contract.

  • To ensure the first bill is accurate, please make sure your client provides all required enrollment information for their employees and their employees dependents on the enrollment application.
  • They have 60 days to contact the California Service Center at 800-731-4661 (toll free) to make any membership changes not reflected in their initial statement.