NEW! To apply online: please click here.

Did you started an application for health insurance with Kaiser Permanente that you have not yet completed? Please click this link to sign in and complete your application.

To make sure all steps are completed we recommend that you Print this page.

You can download and print the application and medical questionnaire. You will need the free Adobe Acrobat Reader to read this file.

1. Using a black or blue ink pen, complete the Enrollment Application and Change Form/Medical Questionnaire for yourself and each dependent applying for coverage. A subscriber's spouse and/or unmarried children (age 19 and under) of the subscriber or the subscriber's spouse are eligible for enrollment.
    
   • Be sure to answer all questions carefully and accurately.
   • Questionnaire must be completed and signed by applicant or parent/guardian only.
      
2. Do not send money with your application. If you are approved Kaiser will send you an invoice.
    
3. Please return the completed forms to:
   
   GORDON PAUL
   Kaiser Permanente Personal Advantage Plan
   1368 W. Herndon Avenue, Suite 101
   Fresno, CA 93711
   Fax forms to: 559-431-0009
   
   
4. We will review your application upon receipt of the Enrollment Application and Change Form/Medical Questionnaire. To avoid processing delays, your application information must be completed in full. Be sure to sign and date the Application and Change Form/Medical Questionnaire. If there are no further questions arising from this review, you can expect a written decision of your membership status within two weeks.
    
5. Do not cancel your current coverage. Kaiser Permanente will notify you by mail upon acceptance.

All applications are subject to medical screening. Each applicant will be accepted or rejected based on health habits and history.