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
- 2023 Enrollment in Medicare Advantage for Chase, Coffey, Douglas, Franklin, Geary, Jackson, Jefferson, Linn, Lyon, Miami, Morris, Osage, Pottawatomie, Riley, Shawnee and Wabaunsee counties
(form 37-001 08/22) - 2023 Enrollment in Medicare Advantage for Butler, Cowley, Dickinson, Harvey, Kingman, Marion, McPherson, Reno, Sedgwick and Sumner counties
(form 37-001W 08/22)
Low Income Subsidy Premium
- Low Income Subsidy Premium for 2023 Blue Medicare Advantage (PPO), Blue Medicare Advantage Comprehensive (PPO) & Blue Medicare Choice (PPO) for Chase, Coffey, Douglas, Franklin, Geary, Jackson, Jefferson, Linn, Lyon, Miami, Morris, Osage, Pottawatomie, Riley, Shawnee, Wabaunsee counties
(document 37-030 10/22) - Low Income Subsidy Premium for 2023 Blue Medicare Advantage (PPO), Blue Medicare Advantage Comprehensive (PPO) & Blue Medicare Choice (PPO) for Butler, Cowley, Dickinson, Harvey, Kingman, McPherson, Marion, Reno, Sedgwick and Sumner counties
(document 37-031 10/22)
Authorization Forms
- Authorization for Release of Protected Health Information
(form 37-004) - Revocation of Authorization for the Release of Protected Health Information
(form 37-009) - Prior Authorization: Rehabilitation Assessment Form
(form 37-024) - Prior Authorization: LTACH Assessment Form
(form 37-025) - Prior Authorization: Inpatient Hospital Assessment Form
(form 37-026) - Automatic Payment Withdrawal (ACH) Authorization Form
(form H7063_20ACHForm_C) - Waiver of Liability Statement
(form 37-038)
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 2023 Blue Medicare Advantage (PPO) & Blue Medicare Advantage Comprehensive (PPO) for Chase, Coffey, Douglas, Franklin, Geary, Jackson, Jefferson, Linn, Lyon, Miami, Morris, Osage, Pottawatomie, Riley, Shawnee and Wabaunsee counties
(document 37-018 10/22) - Summary of Benefits for 2023 Blue Medicare Advantage (PPO) & Blue Medicare Advantage Comprehensive (PPO) for Butler, Cowley, Dickinson, Harvey, Kingman, McPherson, Marion, Reno, Sedgwick and Sumner counties
(document 37-017 10/22) - Summary of Benefits for 2023 Blue Medicare Advantage Choice (PPO) for Butler, Chase, Coffey, Cowley, Dickinson, Douglas, Franklin, Geary, Harvey, Jackson, Jefferson, Kingman, Linn, Lyon, Marion, McPherson, Miami, Morris, Osage, Pottawatomie, Reno, Riley, Sedgwick, Shawnee, Sumner and Wabaunsee counties
(document 37-044 10/22)
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 2023 Blue Medicare Advantage (PPO) for Chase, Coffey, Douglas, Franklin, Geary, Jackson, Jefferson, Linn, Lyon, Miami, Morris, Osage, Pottawatomie, Riley, Shawnee and Wabaunsee counties
(document 37-034 07/22) - Annual Notice of Changes for 2023 Blue Medicare Advantage (PPO) for Butler, Cowley, Dickinson, Harvey, Kingman, Marion, McPherson, Reno, Sedgwick and Sumner counties
(document 37-036 07/22) - Annual Notice of Changes for 2023 Blue Medicare Advantage Comprehensive (PPO) for Chase, Coffey, Douglas, Franklin, Geary, Jackson, Jefferson, Linn, Lyon, Miami, Morris, Osage, Pottawatomie, Riley, Shawnee and Wabaunsee counties
(document 37-035 07/22) - Annual Notice of Changes for 2023 Blue Medicare Advantage Comprehensive (PPO) for Butler, Cowley, Dickinson, Harvey, Kingman, Marion, McPherson, Reno, Sedgwick and Sumner counties
(document 37-037 07/22) - Annual Notice of Changes for 2023 Blue Medicare Advantage Choice (PPO) for Butler, Chase, Coffey, Cowley, Dickinson, Douglas, Franklin, Geary, Harvey, Jackson, Jefferson, Kingman, Linn, Lyon, Marion, McPherson, Miami, Morris, Osage, Pottawatomie, Reno, Riley, Sedgwick, Shawnee, Sumner and Wabaunsee counties
(document 37-051 07/22)
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 2023 Blue Medicare Advantage (PPO) for Chase, Coffey, Douglas, Franklin, Geary, Jackson, Jefferson, Linn, Lyon, Miami, Morris, Osage, Pottawatomie, Riley, Shawnee and Wabaunsee counties
(document 37-011 08/22) - Evidence of Coverage for 2023 Blue Medicare Advantage (PPO) for Butler, Cowley, Dickinson, Harvey, Kingman, Marion, McPherson, Reno, Sedgwick and Sumner counties
(document 37-013 08/22) - Evidence of Coverage for 2023 Blue Medicare Advantage Comprehensive (PPO) for Chase, Coffey, Douglas, Franklin, Geary, Jackson, Jefferson, Linn, Lyon, Miami, Morris, Osage, Pottawatomie, Riley, Shawnee and Wabaunsee counties
(document 37-012 08/22) - Evidence of Coverage for 2023 Blue Medicare Advantage Comprehensive (PPO) for Butler, Cowley, Dickinson, Harvey, Kingman, Marion, McPherson, Reno, Sedgwick and Sumner counties
(document 37-014 08/22) - Evidence of Coverage for 2023 Blue Medicare Advantage Choice (PPO) for Butler, Chase, Coffey, Cowley, Dickinson, Douglas, Franklin, Geary, Harvey, Jackson, Jefferson, Kingman, Linn, Lyon, Marion, McPherson, Miami, Morris, Osage, Pottawatomie, Reno, Riley, Sedgwick, Shawnee, Sumner and Wabaunsee counties
(document 37-052 08/22)
Directories
If you're searching for a new doctor, hospital, dentist or other health care provider, this is the place to look.
- Pharmacies (offsite link)
- Doctors and hospitals (offsite link)
- Dentists (offsite link)
Formulary
Start here to find out which of your prescription drugs are covered and what the cost will be for you.
- Formulary for 2023 Blue Medicare Advantage (PPO), Blue Medicare Advantage Comprehensive (PPO) and Blue Medicare Advantage Choice (PPO)
(document 37-029A)