To be eligible for the Kaiser Permanente Bridge Program, you must be a Georgia State Undergraduate or Graduate student, currently enrolled in one of the following programs:

• Health Informatics (accepted into the program, not pre-health informatics)
• Nursing (accepted into the nursing program, not exploratory students)
• Nutrition (accepted into the program, not pre-nutrition students)
• Occupational Therapy (accepted into the OTM program)
• Respiratory Therapy (accepted into the program, not exploratory students)
• Social Work (accepted into the School of Social Work, not pre-social work students)
• Physical Therapy (accepted into the DPT program)

Requirements for eligibility include:

• The primary applicant must be a GSU student currently enrolled in one of the above programs
• The primary applicant and all applying dependents must live in Kaiser Permanente’s metro Atlanta 20-county service area*
• The annual aggregate household income of the Applicant and all dependents must be less than the current income guidelines of 100% of the Federal Poverty Level guidelines (see chart below)
• The primary applicant and all applying dependents cannot be eligible for other public or private health coverage such as, but not limited to, Medicaid, Peach Care for Kids, Medicare, an affordable job-based health plan, or financial help through the health benefit exchange.
• The applicant must be 64 or younger, and all child dependents must be younger than 26
• The primary applicant and applying dependents are limited to a maximum of 24 consecutive months of subsidy through the Georgia Bridge Program.
• Completion of an application and submission of required supporting documents
• Signed Community Partner Verification Form with University designee’s signature (Contact Felisha Norrington at 404-413-1000 or fnorrington@gsu.edu to schedule an appointment)

*Bartow, Butts, Cherokee, Clayton, Cobb, Coweta, DeKalb, Douglas, Fayette, Forsyth, Fulton, Gwinnett, Henry, Lamar, Newton, Paulding, Pike, Rockdale, Spalding, and Walton counties.

Please follow these steps to learn more and/or to apply for the program:

1. Review the Kaiser Permanente Bridge Program flyer and Bridge Program brochure.
2. Review the Bridge Program Overview PowerPoint which includes instructions for completing the application.
3. Complete the Application for Health Coverage: Kaiser Permanente for Individuals & Families (KPIF) Application AND the Community Health Subsidy Eligibility Form.
4. Print Community Partner Verification Letter and have the authorized Georgia State University staff member sign your Community Partner Verification Letter (see ‘Requirements for eligibility’ above).
5. Include all supporting documentation requested on the document check list with your applications. Be sure to sign and submit the document check list.
6. Submit the completed Application for Health Coverage, Community Health Subsidy Eligibility Form and all supporting documentation to:

Email: CHC-Applications@kp.org (this is the preferred method)

FAX: 1-855-355-5334

Mail:

California Service Center
Attn: CHC
PO Box 939095
San Diego, CA 92193-9095

Please be patient and allow 30 business days for your application to be processed.  If you have application status questions, contact the Member Services Contact Center at 1-888-865-5813. Be sure to provide the representative your name, date of birth, and the date you applied.

Please click on the link and review the following documents:

1. Kaiser Permanente Bridge Program Flyer
2. Kaiser Permanente Bridge Program Brochure
3. Kaiser Permanente Bridge Program Overview PowerPoint
4. Application for Health Coverage: KPIF Application
5. Community Health Subsidy Eligibility Form
6. Document Checklist
7. Community Partner Verification Letter
8. Declaration of Zero Income
9. Profit & Loss Statement
10. What to Expect After Applying
11. KP GA Gold 500/20 Summary of Benefits
12. KP GA Signature Gold 500/20 Summary of Benefits