Child Health Plan
three kids
grandpa with child

Apply for the Kaiser Permanente Child Health Program



      Apply in 3 steps

      1. Fill out this application for health coverage

      Kaiser Permanente for Individual and Families Application - English
      Kaiser Permanente for Individual and Families Application - Spanish

      2. Fill out this form that determines your eligibility. (Be sure to include proof of income.)
      Kaiser Permanente Subsidy Eligibility form - English
      Kaiser Permanente Subsidy Eligibility form - Spanish

      Need help with this form? The Enrollment Assistance flyer lists organizations near you that can help.

      To figure out how to show your proof of income check the table below:

       

      If you… We need…
      get a paycheck or direct deposit • your last 3 paycheck stubs, or
      • your most recent W-2, or
      • your most recent wage or tax statement
      work for yourself • a Schedule C and page 1 of your last federal tax return (showing your adjusted gross income), or
      • a completed Profit and Loss Statement form
      get paid in cash • a signed letter of income from your employer on company letterhead
      Have income from other sources (e.g., social security, unemployment benefits) • include documentation showing proof

      3. Mail your completed forms and proof of income to:

      Charitable Health Coverage Operations
      Kaiser Permanente
      PO Box 12904
      Oakland, CA  94604-2904

      Note: Mailing your forms to us does not guarantee that your children will be approved for the Kaiser Permanente subsidy. We may ask you for more information to make sure your child can get on the Child Health Program.

      Need more help filling out the applications?

      The Child Health Program Instructions Guide gives specific instructions.

      Child Health Program Instructions Guide - English

      Child Health Program Instructions Guide - Spanish

      Have questions?

      Call our Member Service Contact Center at 1-800-464-4000 - TTY users call 711. We are available 24 hours a day, 7 days a week (closed holidays). 

      When you'll hear from us

      We'll let you know if we can include your child in the Child Healthy Program after we receive and review your completed forms and proof of income - this can take 45-60 business days.

      If you need other health coverage options

      If your children are not eligible for the Child Health Program, but you live in a Kaiser Permanente service area you can still sign them up for Kaiser Permanente health coverage. You'll have to pay regular premiums (a health plan's monthly payment amount).

      To find out if you live in a Kaiser Permanente service area, visit the Child Health Program's Service Areas page

      If you want to sign up your children for a Kaiser Permanente for Individuals and Families plan, call our National Direct Sales Center at 1-800-307-5945. You can also talk to them about other health coverage choices you might have with Kasier Permanente.