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Plan 65

Required Statements and Disclosures

This outline shows benefits and premiums of policies sold for effective dates on or after June 1, 2010. Policies sold for effective dates prior to June 1, 2010 have different benefits and premiums. Plans E, H, I and J are no longer for sale.

Read Your Policy Very Carefully

This Outline of Medicare Supplement Coverage describes your policy's most important features for comparison. The policy you receive after you enroll is your insurance contract. Please read the policy to understand the rights and duties for you and for Blue Cross and Blue Shield of Kansas (BCBSKS).

Know Your Right to Return Your Policy

If you are not satisfied with your policy, you may return it to:

BCBSKS
1133 S.W. Topeka Blvd.
Topeka, Kansas 66629-0001

Note: If you return your policy within 30 days after you receive it, BCBSKS will treat the policy as if it had never been issued and return any applicable payments.

Replacing Your Current Policy

If you are replacing another health insurance policy, do NOT cancel it until you are in possession of your new policy and are sure you want to keep it.

Complete Your Enrollment Form Carefully

You will need to complete an enrollment form for your new policy. If you are applying for Plan 65 or Plan 65-Select coverage more than six months after the effective date of your Medicare Part B coverage, you may need to answer questions on the enrollment form about your medical and health history. BCBSKS may cancel your policy and refuse to pay claims if you leave out or falsify important medical information.

Review the enrollment form carefully and make sure all information has been properly recorded before you sign.

Easy Renewal

You may renew this Plan 65 policy as long as you live by paying the premium on time. We cannot cancel or refuse to renew your policy, or place any restrictions on it, other than for non-payment or for fraudulent misstatements made by you in your applications for the policy.

Simple Cancellation Terms

You may cancel this policy at any time by written notice delivered or mailed to BCBSKS, effective upon receipt of such notice or on such late date as may be specified in such notice. In the event of cancellation or death of the insured, BCBSKS will promptly return the unearned portion of any premium paid. The earned premium shall be computed on a pro-rata basis last filed with the state official having supervision of insurance in the state where the insured resided when the policy was issued pro-rata. Cancellation shall be without prejudice to any claim originating prior to the effective date of cancellation.

Premium Information

Any premium rate increase must be implemented on a class basis in Kansas. No rate adjustment may be made on an individual basis.

Plan 65 Policy Numbers:

Benefit Plan A # 95-1052
Benefit Plan C # 95-1053
Select Benefit Plan C # 95-1054
Benefit Plan F # 95-1055
Select Benefit Plan F # 95-1056
Benefit Plan K # 95-1057
Select Benefit Plan K # 95-1058
Benefit Plan N # 95-1060

Important Notices:

Vice President Sales and Marketing
Blue Cross and Blue Shield of Kansas
1133 S.W. Topeka Blvd.
Topeka, Kansas 66629-0001

Exclusions…

Here is a list of key services not covered by Plan 65 Benefit Plans.

Questions?

Contact us about Plan 65 or Plan 65-Select Benefit Plans at 1-800-752-6650 outside Topeka or 785-291-4301 in Topeka.