State of Kansas Employees

Forms

• ID Card Order Form
• Authorization for Release of Protected Health Information (HIPAA form) *
  (Form 29-456)
  • Autorización para divulgar la Información médica protegida *
    (Formulario 29-456)
• State of Kansas Employee Claim Form *
  (Form 34-4)
  • Formulario-de-reclamo *
    (Formulario 34-4es)
• Blue Cross Blue Shield Global Core Claim Form (offsite link)
• Claim Appeal Form *
  (Form 34-730WEB)
  • Sus derechos de apelación de reclamaciones y formulario de apelación *
    (Formulario 34-730WEBes)
• Claim Appeal Representative Authorization Form *
  (Form 29-58)

* These fillable forms were created with Adobe Acrobat. Visit the Adobe website to download the latest version of Acrobat Reader. Version 9.0 or higher is required.