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Plans and Forms: Health

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Blue Cross Blue Shield of Kansas

More than 625,000 Kansans have chosen Blue Cross and Blue Shield of Kansas for their health insurance needs. That number represents nearly one-third of the population in the 103 Kansas counties served by BCBSKS. BCBSKS offers Greenbush health members a choice of three fully insured health coverage options.

 

Blue Cross Blue Shield of Kansas Forms

2011-2012 Benefits Summary (Grandfathered)

2011-2012 Benefits Summary (Non-Grandfathered)

Member Claim Form

Triple Option Change Form

Waiver of Enrollment Form

Enrollment Form

Change Form

Advance Life Insurance Forms

Advance Enrollment Form

Advance Beneficiary Form

Advance Death Claim Benefit Form

 

Important Information about Comprehensive Major Medical

Coverage is limited to those charges that are medically necessary, as described in your plan document. Exclusions are: duplicate benefits provided under federal, state or local laws, regulations or programs, except Medicaid; services involving cosmetic surgery limited by certificate. Charges for personal items; convalescent or custodial care or rest cures, all keratotomy procedures, services related to temporomandibular join dysfunction syndrome, blood or payments to donors of blood; any service or supply related to the medical management of obesity; dental implants; services or supplies related to sex transformations; services related to the reversal of sterilization procedures; any medical aided insemination procedure; charges for services by immediate relatives or by members of the household; acupuncture and admissions for acupuncture; medically unnecessary services and admissions; services covered and payable by any medical expense payment provision of any automobile insurance policy; treatment of nervous or mental conditions over the amount specified in the certificate; services supplies or treatments not specifically listed as covered in the insureds certificate.

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