Once you select a plan, everything you need to enroll is only a click away. Simply print, complete and mail the following forms to:
KPS Health Plans
PO Box 339
Bremerton, WA 98337-0039
You must include your payment for the first month's premium with your application. We must receive your application by the 20th of the month to be considered for coverage effective the first day of the following month.
Required:
Application for Individual Coverage
Standard Health Questionnaire
(Effective April 1, 2008)
Additional Forms:
Sure Pay Automatic Premium Payment Form