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Brochures & Forms

View or download plan information and commonly used forms here.

View 2022 Plan Documents

  • 2022 Enrollment Guide

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  • 2022 Benefits & Rates

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  • 2022 FEHB Brochure (RI 73-003)

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  • 2022 Summary of Benefits and Coverage High Option

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  • 2022 Summary of Benefits and Coverage Standard Option

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  • 2022 Summary of Benefits and Coverage Prosper

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  • 2022 CA Dental Programs for KP FEHB Members

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View 2022 Medicare Plan Documents

  • 2022 FEHB Guide to Medicare

    View
  • 2022 Senior Advantage Enrollment Kit

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  • 2022 Senior Advantage 2 Enrollment Application

    View
  • 2022 Senior Advantage 2 Program Description

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  • 2022 Senior Advantage 2 Part B Premium Reimbursement Instruction Flyer

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  • 2022 Senior Advantage 2 Proof of Part B Premium Submission Form

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  • Silver&Fit Exercise and Health Aging Program flyer

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  • 2022 Northern California FEHB Senior Advantage EOC

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Enrollment Change Form

Use this form to add or remove an eligible dependent if you currently have Kaiser Permanente Self and Family coverage and adding or removing a dependent will not change your FEHB plan, plan option or enrollment type.

  • Enrollment Change Form

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Other forms and publications

  • Getting Care While Traveling for Federal Members

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  • Visiting Member Services

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  • FEHB Claims Appeal Form

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  • Glossary of Health Coverage and Medical Terms

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