Apply for Kaiser Permanente's Child Health Program
See the Child Health Program Instruction Guide for detailed instructions on how to apply for Kaiser Permanente’s CHP (Child Health Program).
3 steps to apply
1. Fill out the KPIF (Kaiser Permanente for Individuals and Families) Application for health coverage
2. Fill out Kaiser Permanente's Subsidy Eligibility Form. Be sure to include proof of income
Kaiser Permanente Subsidy Eligibility form - English♦
Kaiser Permanente Subsidy Eligibility form - Spanish♦
You will need to provide proof of your most current household gross income:
• If employer paid – include your last 3 paycheck stubs, or your most recent W-2 form or wage and/or tax statement.
• If self-employed – include Schedule C and page 1 (the adjusted gross income page) of last year's federal income tax return or complete the Kaiser Permanente Profit & Loss Statement form♦.
• If paid in cash – include a signed letter of income from your employer on company letterhead
For help filling out these documents, please see the Enrollment Assistance flyer♦ to locate an enrollment assistant near you.
3. Mail completed documents to:
Charitable Health Coverage Operations
PO Box 12904
Oakland, CA 94604-2904
Completing and submitting these documents does not guarantee that your children will be approved for the Kaiser Permanente subsidy. You may be asked to provide additional information to confirm your children's eligibility.
For questions, contact our Member Service Contact Center at 1-800-464-4000. We are available 24 hours a day, 7 days a week (closed holidays). TTY users call 711.
If your children are not eligible for CHP, you can still enroll them in a KPIF plan, but you will have to pay the full price of the premium. You can enroll your children in a KPIF plan as long as you live in one of the Kaiser Foundation Health Plan, Inc. service areas.
For more information about Kaiser Foundation Health Plan, Inc. service areas, go to: http://info.kaiserpermanente.org/html/childhealthprogram/serviceareas.html.
If you wish to enroll your children in a KPIF plan, please call our National Direct Sales Center at 1-800-307-5945 to get more information about plan choices.
Notification of eligibility
You will be notified of your children’s eligibility once we have reviewed your completed documents. Completed forms can take 45-60 business days to process as long as all required documentation is included.