Apply for Child Health Plan
Thank you for your interest in Kaiser Permanente Child Health Plan.
Please note that Kaiser has suspended acceptance of new Child Health Plan applications indefinitely from Southern California. We will not accept any new applications from the following counties:
• Los Angeles
• San Bernardino
• San Diego
Applications received from these counties will be returned.
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.
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
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)