Kaiser Permanente Individual Applications

Apply today for Kaiser Permanente health insurance coverage for individuals and families. There is no application fee and in most cases, no payment is needed up front. To qualify, you must complete a paper or online enrollment form and meet the eligibility criteria. The application will ask for medical history, but no physical examinations are necessary to apply. Kaiser Permanente requires a Social Security Number or Tax ID Number for those over the age of six months. This requirement does not pertain to babies under six months of age.

Couple Looking at Forms

How do I apply?

To apply for private health insurance with Kaiser Permanente, use the links below. If you are seeking to enroll a child under age 19, please note that as a result of the Health Reform mandate, not all states are accepting child-only applications. Find state specific special instructions below.

To apply online, click on the name of the state. Please note that applications in Spanish are available in paper format only. See below for a copy.

  California

Note:
  • Applicants in California must complete a separate application for each individual.

  Colorado

Notes:
  • If you are enrolling a minor, please note that an application for a child will be accepted only if one of the situations below is applicable:
    • The child is applying together with at least one parent, or a legal guardian.
    • If there is a qualifying event, then, the minor may enroll on an single subscriber basis. A qualifying event is an extenuating circumstance that necessitated obtaining new or replacement health insurance. Some examples are: a new baby, adoption, or loss of coverage. 
    • During open enrollment, when children can apply on a single subscriber basis without a qualifying event requirement. Open enrollment is in January for a March 1st effective date, and in July for a September 1st effective date. 

  Georgia

Note:
  • A kid younger than 19 may enroll under a family application only. At least one parent or a legal guardian must also apply.

To apply by fax or mail, click the name of the state and print the application.

  California

  Colorado

  Georgia

 

Paper applications can be submitted as follows:

  • Fax: 1-866-439-9993
  • Mail: KaiserQuotes.com, 750 Mendocino Avenue, Suite 4, Santa Rosa, CA 95401
  • Scan and email to: support@kaiserquotes.com

When is the deadline to submit my application?

Deadlines are listed below. We recommend applying well in advance of the deadline date to give underwriting enough time to evaluate your application. Be aware that health insurance denials are still allowed on adult applications for private health insurance.

The available effective dates and corresponding deadlines vary by state. See below for details.

California Applicants For coverage to be effective on this date: You must submit the application by this deadline:
Adult applicants
  • 1st of the month
  • 15th of the month
  • 23rd of the month prior
  • 8th of the same month
Children under age 19
  • 1st of the month
  • 15th of the month prior
Colorado Applicants For coverage to be effective on this date: You must submit the application by this deadline:
Adult applicants
  • 1st of the month
  • 15th of the month
  • 23rd of the month prior
  • 8th of the same month
Children under age 19

Three options for children on a private health plan:

  • During open enrollment, apply in January for a March 1st effective date, or in July for a September 1st effective date.
  • Family Application: The effective dates and deadlines are the same as the parent’s/legal guardian’s.
  • Qualifying Event: The event date must be within 30 days of the effective date, which will be the 1st of the month.
Georgia Applicants For coverage to be effective on this date: You must submit the application by this deadline:
Adult applicants
  • 1st of the month
  • 15th of the month
  • 25th of the month prior
  • 10th of the same month
Children under age 19
  • If applying on a family application, the effective date and deadline are the same as the parent’s/legal guardian’s.

    Note: Child-only applications are currently not being accepted.

 
 
 
 
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