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Instructions for CA FEHB Sub Enrollment Change form 2026
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- Click ‘Get Form’ to open the Instructions for CA FEHB Sub Enrollment Change form in the editor.
- In section B, indicate the changes you are requesting by checking the appropriate boxes. This includes adding or removing dependents, changing names, or updating your address.
- Proceed to section C to fill in your subscriber/employee information. Ensure all required fields marked with an asterisk (*) are completed accurately, including your Social Security number and date of birth.
- Sign in section D where indicated. Your signature is essential for processing any enrollment or change requests.
- If applicable, complete section E for dependent information. You can add multiple dependents by using additional pages if necessary.
- Once all sections are filled out, review your entries for accuracy before submitting the form directly to Kaiser Permanente via mail or fax as instructed.
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Related links
Use this form to: Switch designated eligible family member; or Enroll or reenroll in the FEHB Program; or Change your FEHB enrollment;
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