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
- 2025 Enrollment in Blue Medicare Advantage Freedom (PPO), Blue Medicare Advantage Choice (PPO), and Blue Medicare Advantage Comprehensive (PPO) for Allen, Anderson, Bourbon, Butler, Chase, Chautauqua, Cherokee, Coffey, Cowley, Crawford, Dickinson, Douglas, Elk, Franklin, Geary, Greenwood, Harper, Harvey, Jackson, Jefferson, Kingman, Labette, Leavenworth, Linn, Lyon, Marion, McPherson, Miami, Montgomery, Morris, Neosho, Osage, Pottawatomie, Reno, Riley, Sedgwick, Shawnee, Sumner, Wabaunsee, Wilson and Woodson counties
(form 37-001 03/25) - 2025 Enrollment in Blue Medicare Advantage (PPO) for Chase, Coffey, Douglas, Franklin, Geary, Jackson, Jefferson, Leavenworth, Linn, Lyon, Miami, Morris, Osage, Pottawatomie, Riley, Shawnee and Wabaunsee counties
(form 37-001N 03/25) - 2025 Enrollment in Blue Medicare Advantage (PPO) for Butler, Cowley, Dickinson, Harvey, Kingman, Marion, McPherson, Reno, Sedgwick and Sumner counties
(form 37-001W 03/25)
Multi-Language Interpreter Services
Nondiscrimination and Accessibility Statement and Notice
Low Income Subsidy Premium
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) - Authorization Agreement for Automatic Payment Withdrawal
(form MC964) - Waiver of Liability Statement
(form 37-038)
Social Security Deduction Application
- Social Security Deduction Application
(form MC965)
Claim Forms
- International Claims Form
(form 18-059-N35) - Member Claim Form
(form 34-4) - Member Reimbursement Form
(form H7063_IGPAYSUBR_C)
Transition Policy
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.
- 2025 Summary of Benefits for Blue Medicare Advantage (PPO) for Chase, Coffey, Douglas, Franklin, Geary, Jackson, Jefferson, Leavenworth, Linn, Lyon, Miami, Morris, Osage, Pottawatomie, Riley, Shawnee and Wabaunsee
(document 37-018 09/24) - 2025 Summary of Benefits for Blue Medicare Advantage (PPO) for Butler, Cowley, Dickinson, Harvey, Kingman, McPherson, Marion, Reno, Sedgwick and Sumner counties
(document 37-017 09/24) - 2025 Summary of Benefits for Blue Medicare Advantage Choice (PPO) for Allen, Anderson, Bourbon, Butler, Chase, Chautauqua, Cherokee, Coffey, Cowley, Crawford, Dickinson, Douglas, Elk, Franklin, Geary, Greenwood, Harper, Harvey, Jackson, Jefferson, Kingman, Labette, Leavenworth, Linn, Lyon, Marion, McPherson, Miami, Montgomery, Morris, Neosho, Osage, Pottawatomie, Reno, Riley, Sedgwick, Shawnee, Sumner, Wabaunsee, Wilson and Woodson counties
(document 37-044 09/24) - 2025 Summary of Benefits for Blue Medicare Advantage Comprehensive (PPO) for Allen, Anderson, Bourbon, Butler, Chase, Chautauqua, Cherokee, Coffey, Cowley, Crawford, Dickinson, Douglas, Elk, Franklin, Geary, Greenwood, Harper, Harvey, Jackson, Jefferson, Kingman, Labette, Leavenworth, Linn, Lyon, Marion, McPherson, Miami, Montgomery, Morris, Neosho, Osage, Pottawatomie, Reno, Riley, Sedgwick, Shawnee, Sumner, Wabaunsee, Wilson and Woodson counties
(document 37-062 09/24) - 2025 Summary of Benefits for Blue Medicare Advantage Freedom (PPO) for Allen, Anderson, Bourbon, Butler, Chase, Chautauqua, Cherokee, Coffey, Cowley, Crawford, Dickinson, Douglas, Elk, Franklin, Geary, Greenwood, Harper, Harvey, Jackson, Jefferson, Kingman, Labette, Leavenworth, Linn, Lyon, Marion, McPherson, Miami, Montgomery, Morris, Neosho, Osage, Pottawatomie, Reno, Riley, Sedgwick, Shawnee, Sumner, Wabaunsee, Wilson and Woodson counties
(document 37-063 09/24)
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.
- 2025 Annual Notice of Changes for Blue Medicare Advantage (PPO) for Chase, Coffey, Douglas, Franklin, Geary, Jackson, Jefferson, Leavenworth, Linn, Lyon, Miami, Morris, Osage, Pottawatomie, Riley, Shawnee and Wabaunsee counties
(document 37-034 06/24) - 2025 Annual Notice of Changes for Blue Medicare Advantage (PPO) for Butler, Cowley, Dickinson, Harvey, Kingman, Marion, McPherson, Reno, Sedgwick and Sumner counties
(document 37-036 06/24) - 2025 Annual Notice of Changes for Blue Medicare Advantage Choice (PPO) for Allen, Anderson, Bourbon, Butler, Chase, Chautauqua, Cherokee, Coffey, Cowley, Crawford, Dickinson, Douglas, Elk, Franklin, Geary, Greenwood, Harper, Harvey, Jackson, Jefferson, Kingman, Labette, Leavenworth, Linn, Lyon, Marion, McPherson, Miami, Montgomery, Morris, Neosho, Osage, Pottawatomie, Reno, Riley, Sedgwick, Shawnee, Sumner, Wabaunsee, Wilson and Woodson counties
(document 37-035 06/24) - 2025 Annual Notice of Changes for Blue Medicare Advantage Comprehensive (PPO) for Allen, Anderson, Bourbon, Butler, Chase, Chautauqua, Cherokee, Coffey, Cowley, Crawford, Dickinson, Douglas, Elk, Franklin, Geary, Greenwood, Harper, Harvey, Jackson, Jefferson, Kingman, Labette, Leavenworth, Linn, Lyon, Marion, McPherson, Miami, Montgomery, Morris, Neosho, Osage, Pottawatomie, Reno, Riley, Sedgwick, Shawnee, Sumner, Wabaunsee, Wilson and Woodson counties
(document 37-037 06/24) - 2025 Annual Notice of Changes for Blue Medicare Advantage Freedom (PPO) for Allen, Anderson, Bourbon, Butler, Chase, Chautauqua, Cherokee, Coffey, Cowley, Crawford, Dickinson, Douglas, Elk, Franklin, Geary, Greenwood, Harper, Harvey, Jackson, Jefferson, Kingman, Labette, Leavenworth, Linn, Lyon, Marion, McPherson, Miami, Montgomery, Morris, Neosho, Osage, Pottawatomie, Reno, Riley, Sedgwick, Shawnee, Sumner, Wabaunsee, Wilson and Woodson counties
(document 37-066 03/23)
Evidence of Coverage
Find all the details about your plan. Consider this your owner's manual for your BCBSKS Medicare Advantage plan.
- 2025 Evidence of Coverage for Blue Medicare Advantage (PPO) for Chase, Coffey, Douglas, Franklin, Geary, Jackson, Jefferson, Leavenworth, Linn, Lyon, Miami, Morris, Osage, Pottawatomie, Riley, Shawnee and Wabaunsee counties
(document 37-011 06/24) - 2025 Evidence of Coverage for Blue Medicare Advantage (PPO) for Butler, Cowley, Dickinson, Harvey, Kingman, Marion, McPherson, Reno, Sedgwick and Sumner counties
(document 37-013 06/24) - 2025 Evidence of Coverage for Blue Medicare Advantage Comprehensive (PPO) for Butler, Chase, Coffey, Cowley, Dickinson, Douglas, Franklin, Geary, Harvey, Jackson, Jefferson, Kingman, Leavenworth, Linn, Lyon, Marion, McPherson, Miami, Morris, Osage, Pottawatomie, Reno, Riley, Sedgwick, Shawnee, Sumner and Wabaunsee counties
(document 37-014 06/24) - 2025 Evidence of Coverage for Blue Medicare Advantage Choice (PPO) for Butler, Chase, Coffey, Cowley, Dickinson, Douglas, Franklin, Geary, Harvey, Jackson, Jefferson, Kingman, Leavenworth, Linn, Lyon, Marion, McPherson, Miami, Morris, Osage, Pottawatomie, Reno, Riley, Sedgwick, Shawnee, Sumner and Wabaunsee counties
(document 37-012 06/24) - 2025 Evidence of Coverage for Blue Medicare Advantage Freedom (PPO) for Butler, Chase, Coffey, Cowley, Dickinson, Douglas, Franklin, Geary, Harvey, Jackson, Jefferson, Kingman, Leavenworth, Linn, Lyon, Marion, McPherson, Miami, Morris, Osage, Pottawatomie, Reno, Riley, Sedgwick, Shawnee, Sumner and Wabaunsee counties
(document 37-061 06/24)
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)
Disenrollment Forms
Formulary
Start here to find out which of your prescription drugs are covered and what the cost will be for you.
- 2025 Formulary for Blue Medicare Advantage (PPO), Blue Medicare Advantage Comprehensive (PPO) and Blue Medicare Advantage Choice (PPO)
(document 37-029A)
Star Rating
Strive+ Activity Coupon
Utilization Management Medical Policy Access (offsite link)
Lucet medical policies (offsite link)
Medicare resources
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