Kaiser Permanente small business enrollment forms come as a set: one employer application that opens the group account, plus a separate employee enrollment form for each worker who joins. Submit both together, correctly completed, and coverage starts on the first of the month you requested. Miss a field or mismatch a plan code and underwriting sends the package back.
Before You Start
Confirm your business is in a Kaiser Permanente service area. The carrier sells small group coverage in California, Colorado, Georgia, Hawaii, Maryland, Oregon, Virginia, Washington, and the District of Columbia. You need a physical office or employee work site in that state. A P.O. box or registered agent address will not qualify.1Centers for Medicare & Medicaid Services. Small Business Health Options Program
Check your size. In most Kaiser Permanente states, “small group” means one to 50 full-time equivalent employees.2Kaiser Permanente. 2026 Oregon Small Group Employer Application California goes up to 100 FTEs.3Kaiser Permanente. California Small Group Employer Application Only W-2 employees count and only W-2 employees can enroll. Independent contractors on a 1099 are not eligible.
You can start a group any time of year. There is no annual window the way individual marketplace plans have one. The coverage effective date, however, must land on the first of a month.4Kaiser Permanente. Small Business Employee Enrollment Form After the group is set up, employees added mid-year generally need a qualifying life event such as a new hire date, marriage, or birth.5HealthCare.gov. Qualifying Life Event – Glossary
Download the version of the application that matches your state from the Kaiser Permanente business portal or request it through your broker. The forms are state-specific, so a California application cannot be used to open an Oregon group.
The Employer Application
This is the form the business owner or benefits administrator completes. It sets up the group account and is separate from the individual enrollment forms the employees fill out.
Business Identity
Enter the legal business name exactly as it appears on your business license, quarterly wage and tax report, or incorporation documents.2Kaiser Permanente. 2026 Oregon Small Group Employer Application A separate DBA field captures any trade name. Use a physical street address; P.O. boxes are rejected because Kaiser Permanente verifies you fall inside its network area.
You will need your Federal Tax ID (EIN) and a six-digit NAICS code for your industry.3Kaiser Permanente. California Small Group Employer Application If you don’t know your NAICS code, look it up at naics.com before you start the form. The current applications use NAICS, not older SIC codes.
Employee Count and Eligibility Rules
The application asks for your total employee count nationwide and how many are eligible to enroll. You set the minimum weekly hours a worker must put in to qualify. Most employers pick 20 or 30 hours. You also indicate whether dependents (spouse, children, domestic partners) can be covered.
If you have affiliated companies that could file a combined state tax return, they may be treated as a single employer for group size.3Kaiser Permanente. California Small Group Employer Application Flag this if it applies, because it changes whether you fit the small group definition.
Waiting Period
Specify how long a new hire must wait before coverage begins. Federal law caps the waiting period at 90 days; you can go shorter but not longer.6eCFR. 45 CFR 147.116 – Prohibition on Waiting Periods That Exceed 90 Days Whatever you choose has to line up with the effective date you list for each enrolling employee.
Employer Contribution
State how much of the premium the business will pay. Kaiser Permanente requires at least 50% of the employee-only monthly premium for the lowest-cost medical plan you offer.3Kaiser Permanente. California Small Group Employer Application You can express the contribution as a flat percentage or a fixed dollar amount.
Plan Selection
Pick which medical plans (and optional dental plans) your employees will choose from. Each plan has a specific code. The codes on the employer application must match the quote you were issued, and they must match the codes employees write on their enrollment forms. A mismatch here is one of the most common reasons applications bounce.
Compliance Disclosures
Several short sections toward the end are easy to skip past. Don’t.
- Workers’ compensation. In California, you certify that you carry workers’ comp for all employees unless legally exempt.3Kaiser Permanente. California Small Group Employer Application
- ERISA status. Indicate whether your health plan is governed by ERISA. Most private-sector plans are.
- Medicare Secondary Payer. If you had 20 or more employees on at least half the workdays last calendar year, your group plan is primary and Medicare is secondary for workers 65 and older.
- Prior coverage. Disclose any current or past Kaiser Permanente group coverage and any other carriers you currently use.
The Employee Enrollment Form
Every employee joining the plan fills out their own form. The employer usually distributes blank forms, collects the completed ones, and sends them in with the employer application.
The top of the form captures the company name, group ID if one has been assigned, and the requested effective date. The employee then provides full legal name, Social Security number, date of birth, home address, and hire date.4Kaiser Permanente. Small Business Employee Enrollment Form The home address matters because Kaiser Permanente confirms each member lives inside the plan’s service area.
A family section follows for dependents being enrolled: spouses, domestic partners, and children. Each dependent needs a full name, date of birth, and Social Security number so Kaiser Permanente can issue individual member ID cards.
The employee then selects which of the employer’s offered plans they want. Check the plan code against the employer application before you submit. If the code on the enrollment form isn’t one of the plans the employer selected, that enrollment is rejected even if everything else is correct.
Waivers From Employees Who Decline
Some eligible employees won’t want the plan because they already have coverage through a spouse, a parent, or a government program. Have each of them sign a waiver. The waiver confirms coverage was offered, confirms the employee understands what they are turning down, and records the reason, such as other qualifying coverage.
Signed waivers do two things for you. They let you meet minimum participation requirements, which in most states means at least 70% of eligible employees must either enroll or document other qualifying coverage.7CMS Agent/Broker FAQ. What Is the Minimum Participation Rate (MPR) Requirement Workers with documented other coverage are generally excluded from the participation math, but only when you have the paperwork to prove it. Waivers also show, in an audit, that you offered coverage to everyone and did not pick and choose.
Submitting the Package
When you have the employer application, individual enrollment forms for every participating employee, and signed waivers from anyone declining, you are ready to send everything in together.
The California employee enrollment form lists two methods: email the completed forms as a PDF to the designated service center address, or fax them to 855-355-5334.4Kaiser Permanente. Small Business Employee Enrollment Form Submission contacts vary by state, so follow the instructions printed on the version of the form you are using.
Kaiser Permanente also runs a business portal at business.kaiserpermanente.org for employers and brokers. Many brokers submit the paperwork on the employer’s behalf, through that portal or their own channels. If you are using a broker, settle in advance who is sending the forms so nothing falls between you.
Keep copies of everything you submit along with any confirmation numbers, email receipts, or fax transmission reports. If there is ever a dispute about your effective date, those records are the proof that your package arrived on time.
After You Submit
Kaiser Permanente’s underwriting team reviews the employer application and the employee census to confirm the group meets eligibility and participation rules. A complete application typically takes 10 to 15 business days. Missing Social Security numbers, mismatched plan codes, or unsigned sections send the package back, and the clock restarts when you resubmit.
Once approved, the employer gets a welcome packet with the group contract and plan documents, followed by the first premium invoice. Pay that first invoice by the stated deadline. If you miss it, coverage does not activate regardless of what the application said.
After activation, Kaiser Permanente mails member ID cards to each enrolled employee and dependent. Administrators can track enrollment status through the business portal. New hires added later use the same employee enrollment form, and their effective date follows whatever waiting period you set on the original employer application.