Plan 150

Apply for coverage

To apply for coverage and take advantage of the 10-day risk-free trial complete the application form below. If you have questions regarding Plan 150, 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 Plan 150 Application Form