Kaiser change form 2026

1. Click ‘Get Form’ to open the Kaiser Change Form in the editor.
2. Begin by completing the employer section at the top, including the company name, group number, hire date, and effective enrollment/change date.
3. In Section A, select your enrollment/change reason. If you are a new hire or making changes due to loss of coverage, ensure you complete all relevant fields.
4. Proceed to Section B where you will provide personal details such as your name, birth date, and contact information. Be sure to include your Social Security number if known.
5. In Section C, list any dependents you wish to add or delete. Include their names and relationships. If applicable, specify any former last names.
6. Finally, review all sections for accuracy and sign in Section D. Make sure to date your signature before submitting.

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