Your path to enrollment

Quality doctors. Great care. Convenient options.

The right choice for a healthier you.

To enroll for Kaiser Permanente health coverage, make changes, or determine eligibility, contact your benefits advisor/coordinator.


Want to enroll:
Fill out the application and email it to your administrator Gabriela Cisneros.
Phone Number: (626) 732-2616

Enrollment Applications English

Please note:  If you are enrolling more than 2 dependents, please print out page 2 of the enrollment form,  fill out the additional dependent and submit along with the rest of the completed enrollment form.

Enrollment Application Spanish

Nota: Si estas inscribiendo/aumentando mas de 2 dependientes, favor de imprimir la pagina #2 de la forma de inscripcion, agrega tus dependientes restantes y mandalas con el resto the la aplicacion.

HIPAA Authorization or Disclosure of Patient Health Information

HIPAA Autorizacion or Divulgacion de Information Medica del Paciente