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Individual and Family

Individual and Family forms and materials

View, download, and print commonly used forms.

Review the 2024 GA KPIF Broker Training Guide (PDF) to get the updates you need for 2024 Open Enrollment, including plan and product updates, an overview of KPIF sales tools and enhancements, compensation details and more.

Enrollment and plan change materials below are in market on November 1, 2023, for January 1, 2024 effective dates.

Application

KPIF Application

SEP

KPIF Special Enrollment Period Guide
KPIF Special Enrollment Triggering Period Proof of Triggering Event Form

Enrollment Guide

KPIF Enrollment Guide

Small Business

View, download, and print commonly used forms.

Employer Forms

Consolidated Appropriations Act and Transparency in Coverage LOA
Small Group List Enrollment

For new business only

Small Group Employer Application
Small Group 1099 Validation Form
Small Group PEO Verification Form
Small Group Electronic Transfer for Initial and Recurring Payment
Group Size Attestation Form
Small Group Account Change Form

Employee Forms

Small Group Employee Enrollment Form

Use our new electronic signature form – completed documents will route directly to KP for processing

2022 English (PDF) | 2023 English (PDF)

Waiver of Coverage

Broker Support Forms

Small Group Sold Group Checklist
Small Group Underwriting Guidelines
Small Group Termination Form

Large Business

Mid & Large business

View, download, and print commonly used forms.

Enrollment Forms

Mid Group Employee Enrollment Form with Medical Review (51-99 Employees)
Large Group Employer Application
Large Group Employee Enrollment & Change Form

Other Forms and Support

Consolidated Appropriations Act and Transparency in Coverage LOA