To download (or print) a PDF of a document shown on this page, click on the link under the item. NOTE: If you are having difficulty accessing a PDF, you may need to upgrade to the most recent version of Adobe Reader; it's free.
Enrollment/Change/Cancellation Forms
To initiate an enrollment, change, or cancellation of your dental/vision plan, fill out the appropriate form below.
To help you complete your healthcare forms accurately, we have created detailed, step-by-step instructions and samples to use as a reference while filling out your forms. Please click on the appropriate sample below.
Medical Plan Enrollment, Change, Cancellation Form
Medical Instructions and Sample Forms
Dental and Vision Plan Enrollment, Change, Cancellation Form
Dental and Vision Instructions and Sample Forms
Medicare Advantage Prescription Drug Plan Enrollment Form
Medicare Advantage Prescription Drug Instructions and Sample Form
Kaiser Permanente Hawaii Arbitration Agreement
Brochures & Rate Tables
New Retiree Healthcare Packet
Annual Retiree Healthcare Packet
To order healthcare forms and packets, call Retiree Healthcare Division at 800-786-6464.
To order other retirement information, visit the Forms and Publications page.