Employee Forms
	Kaiser Permanente Choice Solution Employee Change Request For employees to update personal information or to add/cancel coverage. Not for plan or provider changes. , 3 Pages (Rev. 4/08)
	Kaiser Permanente Choice Solution Employee Health Questionnaire To be completed by employees in a group with only 2-14 medically enrolled employees., 2 Pages (Rev. 10/06)
	Kaiser Permanente Choice Solution Open Enrollment Change Request For employees to update information and change benefits and/or plan designs during Open Enrollment Only. , 3 Pages (Rev. 10/07)
	Kaiser Permanente Choice Solution Employee Application & Waiver For all members enrolling in (or waiving) coverage. Use for medical, dental, life enrollment., 4 Pages (Rev. 4/08)

EER Forms
	Kaiser Permanente Choice Solution Master Employer Application Required for all new groups applying for coverage., 4 Pages (Rev. 4/08)
	Kaiser Permanente Choice Solution Employer Change Request For the Employer to request Off-Anniversary or Open Enrollment Only changes to the group's policy, 2 Pages (Rev. 4/08)

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For additional information, please contact Claremont at 800.696.4543 or info@claremontcompanies.com