Kaiser Permanente Bridge Program
(404) 364-3811 or firstname.lastname@example.org.
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*.
- Live in a household with an income no more than 100% of the federal poverty level. Household includes self, spouse/domestic partner, and dependents (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 primary applicant and applying spouse/domestic partner must be age 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 applications and submission of required supporting documents.
- Signed Community Partner Verification Form with University designee’s signature (Contact Felisha Norrington at 404-413-1000or email@example.com 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.
|Monthly Gross Income||Annual Gross Income|
For families with more than 8 people, add $4,540 for each additional person per year.
Please follow these steps to learn more and/or to apply for the program:
- Review the Kaiser Permanente Bridge Program flyer and brochure.
- Review the Bridge Program Overview PowerPoint which includes instructions for completing the applications.
- Complete the Kaiser Permanente for Individuals & Families (KPIF) Application AND the Community Health Subsidy Eligibility Form.
- Print Community Partner Verification Form and have the authorized Georgia State University staff member sign your Community Partner Verification Form (see ‘Requirements for eligibility’ above).
- Include all supporting documentation requested on the document check list with your applications. Be sure to sign and submit the document check list.
- Email, fax, or mail the completed KPIF Application, Community Health Subsidy Eligibility Form and all supporting documentation to:
Mail: California Service Center
PO Box 939095
San Diego, CA 92193-9095
Please be patient and allow 30 days for your application to be processed. If you have questions/issues, 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:
- Kaiser Permanente Bridge Program Flyer
- Kaiser Permanente Bridge Program Brochure
- Kaiser Permanente Bridge Program Overview PowerPoint
- KPIF Application: KP GA Gold 500/20 plan/KP GA Signature Gold 500/20 plan
- Community Health Subsidy Eligibility Form
- Document Checklist
- Community Partner Verification Form
- Profit & Loss Statement
- What to Expect After Applying
- KP GA Gold 500/20 Summary of Benefits
- KP GA Signature Gold 500/20 Summary of Benefits