Once you’ve chosen the PowerPlan that best meets your needs, then you are ready to enroll.

STEP 1:

 If you are an individual enrolling, complete the individual form listed below. If you are a company enrolling, complete the company enrollment form listed below.

Individual Enrollment Form

Company Enrollment Form

STEP 2:

Complete the enrollment form and return to Kaiser Permanente by mail, fax or email:

Mail to: 
Kaiser Permanente
Summit High School
15551 Summit Ave
Fontana CA 92336
Fax to:
909-357-5961
Email to: company.9@virtualenterprise.org

STEP 3:

Once you submit an individual enrollment form, then a Kaiser representative will contact you within 48 hours to complete your enrollment. You may also add any additional family members to your plan at that time.
If you completed a company enrollment form, then a representive will contact you within 48 hours to complete the company enrollment.