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We will verify the eligibility of these dependents during the enrollment process. California Region Group Enrollment/Change Form Please print or type in black ink only. See instructions on reverse before completing this form. Make a copy for your records. 5. The employee/subscriber must complete Sections A and B. See right column for detailed instructions. 6. Be sure to sign and date the bottom of the form. 7. Once the form is complete including employer section the subscriber should make a cop ...

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Versions	Form popularity	Fillable & printable
2011	4.9 Satisfied (59 Votes)
2008	4 Satisfied (23 Votes)

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Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

Can I switch my Medi-cal to Kaiser?

After you've been approved for Medi-Cal, you may be able to choose Kaiser Permanente as your Medi-Cal managed care plan.

How do I change my legal name with Kaiser?

To change your name, date of birth, Social Security Number, or gender: Complete an Account Change Form (available below) and follow the instructions. Note: Updating your address or date of birth may cause your plan rates to change.

Can my boyfriend add me to his health insurance?

Most insurance companies allow unmarried couples to combine coverage\u2014and thereby get discounts and other valuable benefits. But again, not all insurance agents or companies will offer these benefits to an unmarried couple.

Can I add a girlfriend to my health insurance?

In most cases, adding a spouse to your health insurance plan is acceptable. After getting married, you usually have up to 60 days to enroll in a new plan, or add your spouse as a dependent.

Can I add my girlfriend to my Kaiser health insurance?

All eligible dependents must enroll on the original effective date. Dependents will not be added for a later effective date unless newly eligible. Eligible dependents include legal spouse or domestic partner and unmarried children to age 19 or 25 if enrolled in an accredited school, college or university.

kaiser small business employee enrollment form 2023

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Can I add a girlfriend to my health insurance?

In most cases, adding a spouse to your health insurance plan is acceptable. After getting married, you usually have up to 60 days to enroll in a new plan, or add your spouse as a dependent.

How do I remove someone from my Kaiser insurance?

It's based in Oakland, California, and employs over twenty thousand physicians....Canceling Kaiser Permanente via Phone Call Dial 800-464-4000 or 800-443-0815 if you're a Medicaid member. Ask to speak to an agent. Request that your coverage is canceled.

How do I change my medical provider to Kaiser?

Complete an application. You can go to www.coveredca.com for an application, or contact your county Health and Human Services. Check the status of your application by contacting the county where you applied. Once you are approved by the county, select your health care plan and/or provider through the State.

How do I change my primary care physician in Kaiser Southern California?

You may change your primary care doctor at any time. Sign in, go to that provider's profile page in the Provider Directory, and select the blue \u201cChoose Me\u201d button. You also may change your primary care provider by calling Member Services. See also Choose or change your doctor.

Can I add girlfriend to health insurance California?

To expand Californians' options to enter into legally protected relationships. Domestic partnerships are not the only for same sex couples, it has been expanded to include opposite sex couples. Can my domestic partner be added to my benefits? Yes.

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Can I switch my Medi-cal to Kaiser?

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Can I add a girlfriend to my health insurance?

Can I add my girlfriend to my Kaiser health insurance?

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Can I add a girlfriend to my health insurance?

How do I remove someone from my Kaiser insurance?

How do I change my medical provider to Kaiser?

How do I change my primary care physician in Kaiser Southern California?

Can I add girlfriend to health insurance California?

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