Brochures & Forms
View or download plan information and commonly used forms here.
View 2024 Plan Documents
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View2024 Enrollment Guide
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View2024 Benefits & Rates
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View2024 FEHB Brochure (RI 73-003)
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View2024 Summary of Benefits and Coverage High Option
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View2024 Summary of Benefits and Coverage Standard Option
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View2024 Summary of Benefits and Coverage Prosper
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View2024 CA Dental Programs for KP FEHB Members
View 2024 Medicare Plan Documents
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View2024 FEHB Guide to Medicare
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View2024 Senior Advantage Enrollment Kit
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View2024 Senior Advantage 2 Enrollment Application
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ViewSenior Advantage 2 Program Description
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ViewSenior Advantage 2 Part B Premium Reimbursement Instruction Flyer
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View2024 Senior Advantage 2 Proof of Part B Premium Submission Form
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ViewSilver&Fit Exercise and Health Aging Program flyer
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ViewOver-the-Counter Wellness Benefit Flyer
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ViewNon-Emergency Transportation Benefit Flyer
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ViewMeal Delivery Benefit Flyer
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View2024 Northern California FEHB Senior Advantage EOC
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.
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ViewEnrollment Change Form
Other forms and publications
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ViewGetting Care While Traveling for Federal Members
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ViewVisiting Member Services
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ViewFEHB Claims Appeal Form
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ViewGlossary of Health Coverage and Medical Terms
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ViewBariatric Surgery Criteria Overview
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ViewKaiser Permanente FEHB Plans Infertility Coverage
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ViewTransgender Care and Coverage for FEHB Members
