Individual and family

Application and change form

2021

The 2021 Kaiser Permanente for Individuals and Families Health Coverage Application is for effectivedates beginning January 1, 2021. To download the Maryland and/or Virginia applications, click on thelinks below. In D.C., coverage can only be purchased through the marketplace at dchealthlink.com.

2020

The 2020 Kaiser Permanente for Individuals and Families Health Coverage Application is for effective dates beginning January 1, 2020. To download the Maryland and/or Virginia applications, click on the links below. In D.C., coverage can only be purchased through the marketplace at dchealthlink.com.

Enrollment guide

The enrollment guide is designed to provide your clients with important information about Kaiser Permanente for Individuals and Families, to help them select the right plans for their needs and provide the tools they need to apply for coverage. Within the guide, they will find an overview of Kaiser Permanente, a map of our facilities, information on when and how to enroll in a plan (including details on special enrollment periods), health plan details and comparisons, rate information, important details and notices, and exclusions and limitations.

To download complete versions of the enrollment guides, click on the links below.

2020

The guides are also available to download in Spanish, using the links below:

Special Enrollment Period (SEP)

To apply for coverage as a result of a triggering event, the Documentation of Triggering Event form must be completed and submitted with copies of supporting documents and other applicable application materials. To download the Maryland and/or Virginia forms, click on the links below. In DC, coverage can only be purchased through the marketplace at dchealthlink.com .

2021

Find 2021 Maryland and/or Virginia Kaiser Permanente Triggering Event forms below. D.C. coverage can only be purchased through dchealthlink.com.

2020

Find 2020 Maryland and/or Virginia Kaiser Permanente Triggering Event forms below. D.C. coverage can only be purchased through dchealthlink.com.

Dental

Included: Preventive Dental Services

Kaiser Permanente health plans provide essential health benefits, including pediatric dental benefits for those 18 and younger, in addition to a Preventive Dental Plan for adults 19 and older. Dental benefits are administered through Dominion National (Dominion).

Optional: Total Cosmetic Dental Services™

Kaiser Permanente's Total Cosmetic Dental Services™ is a discount dental program, available to Kaiser Permanente members and non-members. It offers discounted, fixed fees for cosmetic and other dental procedures, such as teeth whitening, crowns, veneers, bonding, Invisalign, and more, 1with no deductibles or annual maximums.

For more information, visit kp.org/totalcosmeticdentalservices.

This program is not insurance.

1When services are received from our contracted dental provider network.