How to Join
- 1. Employer’s Request for Participation Agreement & Employer’s Statement
- 2. Employee Enrollment Application Form
- 3. COBRA-Cal-COBRA Status Questionnaire
- 4. Enrollment Declination Form
All forms must be returned to your Association/Exchange contact or to the NBBE Benefits Desk email firstname.lastname@example.org within 60 days after your exchange approval date.
Medical - Kaiser Permanente
Policy Number: 231224 & 603780