You can enroll for Kaiser Permanente health coverage, by downloading and completing the form below:

Hawaii Pacific University enrollment form^♦

Submit your completed form and: 

1. Make your check or money order payable to:
    Kaiser Foundation Health Plan, Inc.
    Do not send cash.    

2. Payment can be made:
      a. In person at any Kaiser Permanente clinic.
      b. By mail to:
          Kaiser Foundation Health Plan, Inc.
          Membership Administration
          P.O. Box 30820
          Honolulu, HI 96820-0820

3. Keep the Member Copy/Temporary Identification
    Card (second copy of the enrollment form)

Why should I choose the Kaiser Permanente HPU Student Medical Plan?

• You can choose your own Kaiser Permanente doctor.
• There are no financial surprises.
• Most clinics provide one-stop convenience.

How do I enroll in the Kaiser Permanente HPU Student Medical Plan?

• Enrollment is limited to one semester at a time.
• Proof of registration or approval of HPU is required.
• Student must be enrolled at least half-time as defined by HPU.
• An HPU enrollment form must be completed and returned with a check or money order made payable to Kaiser Foundation Health Plan.

To enroll for Kaiser Permanente health coverage, contact your benefits advisor/coordinator.

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