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Prior to Applying
 

Note: If you choose to complete an online application, you can save your application at any point in the process and return later to complete it.

 
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Application Checklist
 
Please enter the ZIP code for your primary residence
 
* ZIP Code :
 
State: 

County: 
 
How will the application be completed?
Select the method in which the application will be completed.
You may choose to complete the application online or on paper. If you choose to complete the application electronically (online), you also agree to receive a response from Kaiser Permanente electronically. You will have an opportunity to print a copy of your completed application and Kaiser Permanente's responses for your records.
 
  • You will complete the application online.
  • You will be able to download the paper application to complete.
Application Instructions
1. Provide Your Personal Information and Medical History
    Depending on the type of plan you're applying for, you may need to have the following information on hand.
  • Medical History information for applicants, including medications and treating physician information
1. Sign the Application
    You'll need to sign the application with an e-signature letting us know that you understand the agreements and authorizations of the application. The signature of each Applicant who is an adult will be required to personally submit an electronic signature on his or her own behalf to sign the application.
   
2. Mailing Instructions
    If you select to download and complete a paper application, please mail your application to:

Kaiser Permanente
California Service Center - KPIF
P.O. Box 23219
San Diego, CA 92193-9921