Small Business

Employer Forms

Enrollment form for new or existing groups
KPSA Group Enrollment Form

Quoting Tools

Customer Rate Request Form
Quoting_Intake_Form

Broker Support Documents

Employer designation and authorization letter
Get a quote for small groups

Other Forms and Support

Contact Sheet
COBRA Election Form
COBRA Delegation Form

Large Business

View or print commonly used forms.

Enrollment Forms

Enrollment form for new groups
Enrollment forms for existing groups
KPSA Group Enrollment Form

Quoting Tools

Customer rate request form (51+ eligibles)
Employee Census Grid

Broker Support Documents

Employer designation and authorization letter

Other Forms and Support

Contact Sheet
Kaiser Permanente on-the-Job Employee Referral Form
COBRA Election Form
COBRA Delegation Form

Individual and Family

View or print commonly used forms.

Enrollment Materials

KPIF Enrollment Guide
KPIF Application
KPIF SEP Guide
KPIF SEP Proof of Triggering Event Form
KPIF Account Change Form

Broker Support Documents

Broker Support Services

For a list of KPIF telephone and online solutions, download this reference sheet.

Official logo from Kaiser Permanente Brand Center

Advertise your status as a Kaiser Permanente Authorized Agent.

Client Inquiry Form: Application Status and Billing
Client Inquiry Form: Compensation
HIPAA Authorization Form

Other Forms and Support

If you have questions, please email the Broker Services Team at KPIF@kp.org or call 1-844-394-3978.