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 applicant must be a GSU student currently enrolled in one of the above programs
• The 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 guidelines (see chart below)
• The applicant and all applying dependents cannot be eligible for financial assistance through the Georgia Health Insurance Exchange; cannot be eligible for public programs such as Medicaid, Peach Care for Kids, or Medicare; and cannot have access to an affordable job-based health plan (plans exceeding 9.86% of the employee’s household income are considered not affordable)
• The applicant must be 64 or younger, and all child dependents must be younger than 26
• No Applicant and/or applying dependent(s) cannot have been previously enrolled in the Kaiser Permanente 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
2. Review the Bridge Program Overview PowerPoint which includes instructions for completing the application.
3. Complete the Kaiser Permanente for Individuals & Families (KPIF) Application AND the Community Health Subsidy Eligibility Form.
4. 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).
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. Mail the completed KPIF Application, Community Health Subsidy Eligibility Form and all supporting documentation to:

California Service Center

Attn: CHC
PO Box 939095
San Diego, CA 92193-9095
FAX-1-855-355-5334

Email: CHC-Applications@kp.org

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:

1. Kaiser Permanente Bridge Program Flyer
2. Kaiser Permanente Bridge Program Brochure
3. Kaiser Permanente Bridge Program Overview PowerPoint
4. KPIF Application: KP GA Gold 500/20 plan/KP GA Signature Gold 500/20 plan
5. Community Health Subsidy Eligibility Form
6. Document Checklist
7. Community Partner Verification Form
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