Resources for your Medicare Advantage plan
Everything you need in one place, including links to directories for doctors and pharmacies, your Evidence of Coverage documents, medicare list details and more!
Enrollment Forms
- 2024 Enrollment in Blue Medicare Advantage Freedom (PPO), Blue Medicare Advantage Choice (PPO), and Blue Medicare Advantage Comprehensive (PPO) for Butler, Chase, Coffey, Cowley, Dickinson, Douglas, Franklin, Geary, Harvey, Jackson, Jefferson, Kingman, Leavenworth, Linn, Lyon, Marion, McPherson, Miami, Morris, Osage, Pottawatomie, Reno, Riley, Sedgwick, Shawnee, Sumner and Wabaunsee counties
(form 37-001 09/23) - 2024 Enrollment in Blue Medicare Advantage (PPO) for Chase, Coffey, Douglas, Franklin, Geary, Jackson, Jefferson, Leavenworth, Linn, Lyon, Miami, Morris, Osage, Pottawatomie, Riley, Shawnee and Wabaunsee counties
(form 37-001N 09/23) - 2024 Enrollment in Blue Medicare Advantage (PPO) for Butler, Cowley, Dickinson, Harvey, Kingman, Marion, McPherson, Reno, Sedgwick and Sumner counties
(form 37-001W 09/23)
Low Income Subsidy Premium
Authorization Forms
- Authorization for Release of Protected Health Information
(form 37-004) - Revocation of Authorization for the Release of Protected Health Information
(form 37-009) - Prior Authorization: Rehabilitation Assessment Form
(form 37-024) - Prior Authorization: LTACH Assessment Form
(form 37-025) - Prior Authorization: Inpatient Hospital Assessment Form
(form 37-026) - Authorization Agreement for Automatic Payment Withdrawal
(form MC964) - Waiver of Liability Statement
(form 37-038)
Social Security Deduction Application
- Social Security Deduction Application
(form MC965)
Claim Forms
- International Claims Form
(form 18-059-N35) - Member Claim Form
(form 34-4) - Member Reimbursement Form
(form H7063_IGPAYSUBR_C)
Summary of Benefits
These documents are intended to help you better understand your coverage, and summarizes key features, such as what is covered, how much you might owe for certain services and details about services and procedures that may not be covered.
- Summary of Benefits for 2024 Blue Medicare Advantage (PPO) for Chase, Coffey, Douglas, Franklin, Geary, Jackson, Jefferson, Leavenworth, Linn, Lyon, Miami, Morris, Osage, Pottawatomie, Riley, Shawnee and Wabaunsee
(document 37-018 10/23) - Summary of Benefits for 2024 Blue Medicare Advantage (PPO) for Butler, Cowley, Dickinson, Harvey, Kingman, McPherson, Marion, Reno, Sedgwick and Sumner counties
(document 37-017 10/23) - Summary of Benefits for 2024 Blue Medicare Advantage Choice (PPO) for Butler, Chase, Coffey, Cowley, Dickinson, Douglas, Franklin, Geary, Harvey, Jackson, Jefferson, Kingman, Leavenworth, Linn, Lyon, Marion, McPherson, Miami, Morris, Osage, Pottawatomie, Reno, Riley, Sedgwick, Shawnee, Sumner and Wabaunsee counties
(document 37-044 10/23) - Summary of Benefits for 2024 Blue Medicare Advantage Comprehensive (PPO) for Butler, Chase, Coffey, Cowley, Dickinson, Douglas, Franklin, Geary, Harvey, Jackson, Jefferson, Kingman, Leavenworth, Linn, Lyon, Marion, McPherson, Miami, Morris, Osage, Pottawatomie, Reno, Riley, Sedgwick, Shawnee, Sumner and Wabaunsee counties
(document 37-062 10/23) - Summary of Benefits for 2024 Blue Medicare Advantage Freedom (PPO) for Butler, Chase, Coffey, Cowley, Dickinson, Douglas, Franklin, Geary, Harvey, Jackson, Jefferson, Kingman, Leavenworth, Linn, Lyon, Marion, McPherson, Miami, Morris, Osage, Pottawatomie, Reno, Riley, Sedgwick, Shawnee, Sumner and Wabaunsee counties
(document 37-063 10/23)
Annual Notice of Changes
These important documents help prepare you for Medicare's Annual Open Enrollment (AEP) by providing details about new and changed benefits.
- Annual Notice of Changes for 2024 Blue Medicare Advantage (PPO) for Chase, Coffey, Douglas, Franklin, Geary, Jackson, Jefferson, Leavenworth, Linn, Lyon, Miami, Morris, Osage, Pottawatomie, Riley, Shawnee and Wabaunsee counties
(document 37-034 03/23) - Annual Notice of Changes for 2024 Blue Medicare Advantage (PPO) for Butler, Cowley, Dickinson, Harvey, Kingman, Marion, McPherson, Reno, Sedgwick and Sumner counties
(document 37-036 03/23) - Annual Notice of Changes for 2024 Blue Medicare Advantage Comprehensive (PPO) for Butler, Chase, Coffey, Cowley, Dickinson, Douglas, Franklin, Geary, Harvey, Jackson, Jefferson, Kingman, Leavenworth, Linn, Lyon, Marion, McPherson, Miami, Morris, Osage, Pottawatomie, Reno, Riley, Sedgwick, Shawnee, Sumner and Wabaunsee counties
(document 37-035 03/23) - Annual Notice of Changes for 2024 Blue Medicare Advantage Comprehensive (PPO) for Butler, Chase, Coffey, Cowley, Dickinson, Douglas, Franklin, Geary, Harvey, Jackson, Jefferson, Kingman, Leavenworth, Linn, Lyon, Marion, McPherson, Miami, Morris, Osage, Pottawatomie, Reno, Riley, Sedgwick, Shawnee, Sumner and Wabaunsee counties
(document 37-037 06/23) - Annual Notice of Changes for 2024 Blue Medicare Advantage Choice (PPO) for Butler, Chase, Coffey, Cowley, Dickinson, Douglas, Franklin, Geary, Harvey, Jackson, Jefferson, Kingman, Leavenworth, Linn, Lyon, Marion, McPherson, Miami, Morris, Osage, Pottawatomie, Reno, Riley, Sedgwick, Shawnee, Sumner and Wabaunsee counties
(document 37-051 03/23)
Evidence of Coverage
Find all the details about your plan. Consider this your owner's manual for your BCBSKS Medicare Advantage plan.
- Evidence of Coverage for 2024 Blue Medicare Advantage (PPO) for Chase, Coffey, Douglas, Franklin, Geary, Jackson, Jefferson, Leavenworth, Linn, Lyon, Miami, Morris, Osage, Pottawatomie, Riley, Shawnee and Wabaunsee counties
(document 37-011 03/23) - Evidence of Coverage for 2024 Blue Medicare Advantage (PPO) for Butler, Cowley, Dickinson, Harvey, Kingman, Marion, McPherson, Reno, Sedgwick and Sumner counties
(document 37-013 03/23) - Evidence of Coverage for 2024 Blue Medicare Advantage Comprehensive (PPO) for Butler, Chase, Coffey, Cowley, Dickinson, Douglas, Franklin, Geary, Harvey, Jackson, Jefferson, Kingman, Leavenworth, Linn, Lyon, Marion, McPherson, Miami, Morris, Osage, Pottawatomie, Reno, Riley, Sedgwick, Shawnee, Sumner and Wabaunsee counties
(document 37-014 06/23) - Evidence of Coverage for 2024 Blue Medicare Advantage Choice (PPO) for Butler, Chase, Coffey, Cowley, Dickinson, Douglas, Franklin, Geary, Harvey, Jackson, Jefferson, Kingman, Leavenworth, Linn, Lyon, Marion, McPherson, Miami, Morris, Osage, Pottawatomie, Reno, Riley, Sedgwick, Shawnee, Sumner and Wabaunsee counties
(document 37-052 03/23) - Evidence of Coverage for 2024 Blue Medicare Advantage Freedom (PPO) for Butler, Chase, Coffey, Cowley, Dickinson, Douglas, Franklin, Geary, Harvey, Jackson, Jefferson, Kingman, Leavenworth, Linn, Lyon, Marion, McPherson, Miami, Morris, Osage, Pottawatomie, Reno, Riley, Sedgwick, Shawnee, Sumner and Wabaunsee counties
(document 37-061 07/23)
Directories
If you're searching for a new doctor, hospital, dentist or other health care provider, this is the place to look.
- Pharmacies (offsite link)
- Doctors and hospitals (offsite link)
- Dentists (offsite link)
Disenrollment Forms
Formulary
Start here to find out which of your prescription drugs are covered and what the cost will be for you.
- Formulary for 2024 Blue Medicare Advantage (PPO), Blue Medicare Advantage Comprehensive (PPO) and Blue Medicare Advantage Choice (PPO)
(document 37-029A)
Star Rating
Strive+ Activity Coupon
Utilization Management Medical Policy Access (offsite link)
Lucet medical policies (offsite link)
Medicare resources
H7063_Medicareforms_M