How to Apply for Community Health Care Program – Important Deadlines
Open Enrollment 2025
You may apply for the Community Health Care Program during the open enrollment period, which runs from November 1, 2024 through January 31, 2025.
We encourage you to submit your application as early as possible!
| To start coverage on: | Send your completed paperwork by: |
|---|---|
| January 1, 2025 | December 31, 2024 |
| February 1, 2025 | January 31, 2025 |
1. Fill out this application for health coverage
Kaiser Permanente for Individual and Families Application
Note: Social Security numbers or tax identification numbers are NOT required to apply for the Community Health Care Program, but if you have one please include it on the application.
Need more help filling out the application?
2. Fill out this form for the Kaiser Permanente Community Health Care Program subsidy. (Be sure to include proof of income when you mail in your application.)
Kaiser Permanente Application for Subsidy form
Here are the best ways to show proof of your income:
If you get a paycheck or direct deposit, we need:
- your last 2 paycheck stubs, or
- your most recent W-2, or
- your most recent wage or tax statement
If you work for yourself, we need:
- a Schedule C and page 1 of your last federal tax return (showing your adjusted gross income), or
- a completed Profit and Loss Statement form
If you get paid in cash, we need:
- a signed letter of income from your employer on company letterhead or the Reporting Form for Other Income
If you have income from other sources (e.g. social security, unemployment benefits):
- include documentation showing proof (e.g. a benefit statement)
Need help completing the Subsidy Eligibility form? Find a local organization near you that can help
3. Send your completed forms and proof of income to one of the following options:
By email: (preferred)
CHC-Applications@kp.org
By Mail:
Kaiser Foundation Health Plan, Inc.
California Service Center
P.O. Box 939095
San Diego, CA 92193-9095
By fax:
1-855-355-5334
Note: Sending your forms to us does not guarantee that you will be approved for the Community Health Care Program. We may ask you for more information to determine your eligibility.
When you’ll hear from us: We’ll let you know if we can include you in the Community Health Care Program after we receive and review your completed forms and proof of income.
*Continued eligibility for the Community Health Care Program is not guaranteed. We reserve the right to close enrollment or change the CHCP eligibility rules at any time. If you are approved for CHCP, the subsidy period is limited, and we will contact you in the future to confirm that you still qualify.