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Get Kaiser Permanente Individual Family Plan Disenrollment Request Form

Rn California Region Each individual disenrolling will need to complete his/her own form. If you have any questions, please call us toll free at 1-800-443-0815 (TTY 1-800-777-1370 for the hearing/speech impaired), seven days a week, 8 a.m. to 8 p.m. If you request disenrollment, you must continue to get all medical care from Kaiser Permanente, until the effective date of disenrollment. Please refer to your Evidence of Coverage for more details. Contact us to verify your disenrollment before you.

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