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Kaiser Disabled Dependent Application - per lacity 2026
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- Click ‘Get Form’ to open the Kaiser Disabled Dependent Application in the editor.
- Begin by filling out Part A, which includes your personal information as the subscriber. Ensure you provide your full name, address, and contact details.
- Next, enter your dependent's information including their name, social security number, and medical record number. This section is crucial for identifying the dependent.
- Complete the Subscriber Questionnaire in Section IV. Answer each question with a 'Yes' or 'No' and provide any necessary explanations regarding your dependent’s living situation and support.
- Ensure that Part B is completed by a physician. This section requires detailed medical information about the dependent's condition and must be signed by the attending physician.
- Attach all required supporting documentation such as proof of expenses and tax returns as specified in the instructions. Review everything for accuracy before submission.
- Once completed, save your document and submit it via mail or fax using the provided contact details on the form.
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Related links
May 5, 2006 Some are certified for a little as six months. Kaiser Permanente verifies disabled dependent eligibility every 2 years if temporary and every 4Read more
A Disabled Dependent Certification form completed by the subscriber and the disabled dependents physician must be submitted within 31 days of the date theRead more