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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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