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Brochures & Forms

View or download plan information and commonly used forms here.

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View 2021 Plan Documents

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    2021 Enrollment Guide

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    2021 Benefits & Rates

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    2021 FEHB Brochure (RI 73-003)

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    2021 Summary of Benefits and Coverage

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    2021 CA Dental Programs for KP FEHB Members

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View 2021 Medicare Plan Documents

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    2021 FEHB Guide to Medicare

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    Senior Advantage Enrollment Kit

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    Senior Advantage 2 Enrollment Form

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    Senior Advantage 2 Program Description

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    Senior Advantage 2 Reimbursement Instruction Flyer

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    2020 FEHB Senior Advantage 2 Annual Documentation Submission Form

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    Silver&Fit Exercise and Healthy Aging Program flyer

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    2021 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.

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    Enrollment Change Form

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Other forms and publications

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    Care away from home

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    Visiting Member Services

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    FEHB Claims Appeal Form

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    Uniform Glossary of Health Coverage and Medical Terms

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