Child Health Plan
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Apply for Child Health Plan


      Thank you for your interest in Kaiser Permanente Child Health Plan.

      Southern California
      Please note that Kaiser is temporarily suspending acceptance of new Child Health Plan applications and will not accept any new applications from Wednesday, February 27 through May 24 from the following Southern California counties:

      •Los Angeles
      •Orange
      •Riverside
      •San Bernardino
      •San Diego

      Any applications received during this time will be returned.  After May 24, please contact the agency♦ where you applied for Child Health Plan or contact Member Services for further updates about Child Health Plan in Southern California. Child Health Plan remains closed to new enrollment in Kern and Ventura Counties, as well as Antelope Valley in Los Angeles County.

      Northern California
      •If your child resides in the Northern California region,  you  can obtain an enrollment kit by calling Member Services to request one  or you can download an application below.  

      Download a Child Health Plan application

      1. Download the Child Health application below. Complete it, sign it, and date it.
      Child Health Plan Application (English) 
      Child Health Plan Application (Spanish) 

      2. Make copies of proof of income showing salary from the past four weeks. If you are self-employed, complete a Profit & Loss Form (English and Spanish) form.

      3. If you are not the child’s biological parent/legal guardian, provide proof of guardianship.

      4. Mail the completed application*, copies of proof of income (or Profit & Loss form, if self-employed) to:

      Child Health Plan
      Kaiser Permanente
      PO Box 12904
      Oakland, CA 94604-9923

      Please do not fax applications.

      Please keep a copy of your application for your records as you may not receive a postcard confirming that Kaiser received your application.

      *Please note that it may take at least 45 business days to process your application. Completion of this application does not guarantee enrollment in Kaiser Permanente Child Health Plan. And you may be asked to provide additional information to confirm your child(ren)’s eligibility.

      Contact Member Services at:

      • 800-464-4000 (toll free)
      • 800-777-1370 (toll-free TTY for the hearing/speech impaired)