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 Child Health Program (CHP).
Three steps to apply
1. Fill out the Kaiser Permanente for Individuals and Families (KPIF) 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♦
Proof of your most current household gross income:
• If employer paid – include your last 3 paycheck stubs, W-2 forms or wage and/or tax statements.
• 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
3. Mail completed documents to:
Charitable Health Coverage Operations
PO Box 12904
Oakland, CA 94604-2904
Completion of these documents does not guarantee that you will be approved for the Kaiser Permanente subsidy. You may be asked to provide additional information to confirm your children's eligibility for the subsidy.
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, and closed after 10 p.m. PT the day after Thanksgiving, Christmas Eve, and New Year's Eve). TTY users call 1-800-777-1370 or 711.
If your children are not eligible for CHP, you can still enroll them in a Kaiser Permanente Individuals and Families (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 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.