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Small Business

Employer Forms

Consolidated Appropriations Act and Transparency in Coverage LOA
Enrollment form for existing groups

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

Quoting Tools

2024 Customer Rate Request Form
2023 Customer Rate Request Form
Quoting_Intake_Form

Broker Support Documents

Employer designation and authorization letter
Get a quote for small groups
Employee Assistance Program (EAP) from TELUS Health:

Other Forms and Support

Contact Sheet
Electronic Fund Transfer Form for Initial and Recurring Payments
COBRA Election Form
COBRA Delegation Form
Creditable Coverage Status

Large Business

View or print commonly used forms.

Enrollment Forms

Enrollment form for new groups
Enrollment forms for existing groups

Quoting Tools

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

Broker Support Documents

Employer designation and authorization letter
Employee Assistance Program (EAP) from TELUS Health:

Other Forms and Support

Electronic Fund Transfer Form for Initial and Recurring Payments
Consolidated Appropriations Act and Transparency in Coverage LOA
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.

2024 Enrollment Materials

Review the 2024 Hawaii KPIF Broker Training Guide 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.

2024 KPIF Enrollment Guide
2024 KPIF Rate Chart Guide
2024 KPIF Application
2024 KPIF SEP Guide
2024 KPIF SEP Proof of Triggering Event/Qualifying Life Event Form
2024 KPIF Account Change Form
2024 KPIF Account Change Form for Grandfathered Plans

2023 Enrollment Materials

KPIF Enrollment Guide
KPIF Application
KPIF SEP Guide
KPIF SEP Proof of Qualifying Life Event Form
KPIF Account Change Form
2023 KPIF Account Change Form for Grandfathered Plans

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.