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Self Employed Kaiser Package for Association Members
THE KAISER PERMANENTE HEALTH CARE PACKAGE:
Includes: Kaiser Medical and Prescription Drug
Click on the links below to download the forms.
To apply, please download, read and complete the following forms, and provide any other information requested in the Administrative Rules and Underwriting Requirements to CGIS, 819 S. Beretania Street; Honolulu, Hawaii 96813.
Note: You and your eligible dependents may enroll if you are living in the Hawaii service area of Oahu, Maui and Hawaii (except zip codes 96718, 96772, and 96777). After enrollment, you must continue to live in the Hawaii service area.
Includes: Kaiser Medical and Prescription Drug
Click on the links below to download the forms.
1) Plan Rates
2) Benefits Summary
To apply, please download, read and complete the following forms, and provide any other information requested in the Administrative Rules and Underwriting Requirements to CGIS, 819 S. Beretania Street; Honolulu, Hawaii 96813.
A. Enrollment Form & Administrative Rules and Underwriting Requirements
B. Medical Questionnaire
Note: You and your eligible dependents may enroll if you are living in the Hawaii service area of Oahu, Maui and Hawaii (except zip codes 96718, 96772, and 96777). After enrollment, you must continue to live in the Hawaii service area.
