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
- Enrollment in Medicare Advantage for Douglas, Jackson, Jefferson, Osage, Pottawatomie, Shawnee and Wabaunsee counties
(form 37-001)
- Enrollment in Medicare Advantage for Butler, Cowley, Harvey, Kingman, Reno, Sedgwick and Sumner counties
(form 37-001W)
- Optional Comprehensive Dental Plan Enrollment for Douglas, Jackson, Jefferson, Osage, Pottawatomie, Shawnee, and Wabaunsee counties
(form 37-008)
Low Income Subsidy Premium
- Low Income Subsidy Premium for 2021 Blue Medicare Advantage (PPO) & Blue Medicare Advantage Comprehensive (PPO) for Douglas, Jackson, Jefferson, Osage, Pottawatomie, Shawnee, and Wabaunsee counties
(document 37-030 10/20)
- Low Income Subsidy Premium for 2021 Blue Medicare Advantage (PPO) & Blue Medicare Advantage Comprehensive (PPO) for Butler, Cowley, Harvey, Kingman, Reno, Sedgwick, and Sumner counties
(document 37-031 10/20)
Authorization Forms
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 2021 Blue Medicare Advantage (PPO) & Blue Medicare Advantage Comprehensive (PPO) for Douglas, Jackson, Jefferson, Osage, Pottawatomie, Shawnee, and Wabaunsee counties
(document 37-018 09/20)
- Summary of Benefits for 2021 Blue Medicare Advantage (PPO) & Blue Medicare Advantage Comprehensive (PPO) for Butler, Cowley, Harvey, Kingman, Reno, Sedgwick, and Sumner counties
(document 37-017 09/20)
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 2021 Blue Medicare Advantage (PPO) for Douglas, Jackson, Jefferson, Osage, Pottawatomie, Shawnee, and Wabaunsee counties
(document 37-034 08/20)
- Annual Notice of Changes for 2021 Blue Medicare Advantage (PPO) for Butler, Cowley, Harvey, Kingman, Reno, Sedgwick, and Sumner counties
(document 37-036 08/20)
- Annual Notice of Changes for 2021 Blue Medicare Advantage Comprehensive (PPO) for Douglas, Jackson, Jefferson, Osage, Pottawatomie, Shawnee, and Wabaunsee counties
(document 37-035 08/20)
- Annual Notice of Changes for 2021 Blue Medicare Advantage Comprehensive (PPO) for Butler, Cowley, Harvey, Kingman, Reno, Sedgwick, and Sumner counties
(document 37-037 08/20)
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 2021 Blue Medicare Advantage (PPO) for Douglas, Jackson, Jefferson, Osage, Pottawatomie, Shawnee, and Wabaunsee counties
(document 37-011 10/20)
- Evidence of Coverage for 2021 Blue Medicare Advantage (PPO) for Butler, Cowley, Harvey, Kingman, Reno, Sedgwick, and Sumner counties
(document 37-013 10/20)
- Evidence of Coverage for 2021 Blue Medicare Advantage Comprehensive (PPO) for Douglas, Jackson, Jefferson, Osage, Pottawatomie, Shawnee, and Wabaunsee counties
(document 37-012 10/20)
- Evidence of Coverage for 2021 Blue Medicare Advantage Comprehensive (PPO) for Butler, Cowley, Harvey, Kingman, Reno, Sedgwick, and Sumner counties
(document 37-014 10/20)
Directories
If you're searching for a new doctor, hospital, dentist or other health care provider, this is the place to look.
Formulary
Start here to find out which of your prescription drugs are covered and what the cost will be for you.
