Hospital Indemnity Plan (HIP)

Apply for coverage

To apply for coverage please use the form listed below to begin the process. If you have questions regarding HIP, email us at or call 1-800-641-1019, or 291-4306, in Topeka.

Mail your application to:
Blue Cross and Blue Shield of Kansas
Individual Sales Dept.
PO Box 239
Topeka, KS 66601-9834

Or Fax to: 785-290-0770

This form can be completed and printed using your Web browser and the Adobe Acrobat Reader program.

Information about PDF Files HIP Enrollment Form