Individual and Family Insurance Applications
To apply online, click below:
Small Groups Insurance Applications
To apply online, click below:

Login to an Existing Application

To finish an online Individual and Family application you previously started, click Login.

Print Applications

To apply by fax, email, or mail, click below:

Small Group Eligibility

Small businesses with at least 2 people on some type of group insurance qualify. Self-employed and Husband-wife businesses often qualify. Call 1-877-752-4731 option 3 or click small group health insurance for more details.

Large Group Health Insurance (51+ employees)

Notes Regarding Additional Enrollment Forms: Businesses with 51 or more employees looking to apply will need to first complete a large group quote request form and submit census data. If you are looking for a Kaiser Permanente job application, click here for general information.

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What is the quickest way to apply?

An application for health insurance can be submitted either online, by fax, mail, or email. Whenever an online enrollment method is available, go that route for the most expedient turnaround. In cases where an online option is not offered, the next fastest method would be to fax the completed paperwork.

One of the best ways you can help speed up your application is by simply verifying that all requested information and supporting documents, if required, are provided. Also, watch for special requirements for children ages 0 to 18; in some cases, carriers require additional paperwork to be submitted, so be sure to check the company requirements. Providing the requested information will help you meet deadlines, avoid any unnecessary delays, and could even save your child-only applications from getting surcharged or cancelled.

How does the enrollment process work?

After you apply with Kaiser Permanente, an underwriter will review your enrollment forms or online application for eligibility. If medical records or other additional information is needed, you will be contacted. Be sure to provide any requested information as soon as possible; otherwise, underwriting could cancel the application. As soon as eligibility is determined, you will be sent an email or a letter in the mail.

Your enrollment forms will be reviewed to verify that all the paperwork is in place. If anything more is needed, you will be contacted by phone or email. Otherwise, look to receive a letter or email congratulating you on your approval for membership. If your application is not approved, you can appeal the decision or look into other alternatives for medical coverage.

Where do I submit my Kaiser application?

Enrollment for private health insurance may be completed online. Again, check for special instructions on child-only applications.

All other enrollment forms can be handled, per below:

Fax: 1-866-439-9993

Mail: KaiserQuotes.com – Enrollment 750 Mendocino Avenue, Suite 4 Santa Rosa, CA 95401

For live support regarding a Kaiser Permanente application, call a benefits specialist at 1-877-752-4737.

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