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Brochures & Forms

View or download plan information and commonly used forms here.

View 2023 Plan Documents

2023 Enrollment Guide

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2023 Benefits & Rates

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2023 FEHB Brochure (73-003)

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2023 Summary of Benefits and Coverage High Option

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2023 Summary of Benefits and Coverage Standard Option

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2023 Summary of Benefits and Coverage Prosper

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2023 CA Dental Programs for KP FEHB Members

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View 2023 Medicare Plan Documents

2023 FEHB Guide to Medicare

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2023 Senior Advantage Enrollment Kit

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2023 Senior Advantage 2 Enrollment Application

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Senior Advantage 2 Program Description

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2023 Senior Advantage 2 Reimbursement Instruction Flyer

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2023 Senior Advantage 2 Annual Documentation Submission Form

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Silver&Fit Exercise and Health Aging Program flyer

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2023 Northern California FEHB Senior Advantage EOC

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Enrollment Change Form

Use this form to add or remove an eligible dependent if you currently have Kaiser Permanente Self and Family coverage and adding or removing a dependent will not change your FEHB plan, plan option or enrollment type.

Enrollment Change Form

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Other forms and publications

Getting Care While Traveling for Federal Members

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Visiting Member Services

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FEHB Claims Appeal Form

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Glossary of Health Coverage and Medical Terms

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