If you require assistance, please contact us.
Forms & Handouts
Forms
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Self Pay Claim Form (Reimbursement Form)
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HIPAA / PHI Release Form
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Notice of Qualifying Event / Continuation of Coverage Under COBRA
Handouts
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Member Portal Flyer
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KPPFree Member Flyer Booklet
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What is KPPFree?
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KPPFree Know Before You Go
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KPPFree Cash Price Agreements
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KPPFree Educacion en Espanol
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Provider Introduction Letter - PPO Plans
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Provider Introduction Letter - No Network Plans
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RBP Know Before You Go - Out of Network
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RBP Know Before You Go Flyer- No PPO
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Reference Based Pricing Patient Guide - PPO Plans Out-of-Network
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Reference Based Pricing Patient Guide - No Network Plans
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Reference Based Pricing Pre-Service Advocacy Form
