Kansas Plan Materials and Forms


This booklet gives you a summary of costs and coverage in your plan. 

Please select the document for your plan and county:

Plan Name CMS#  County Summary of Benefits
[PRODUCT_NAME_HMO_001] H5398-001 Butler, Harvey and Sedgwick counties
[PRODUCT_NAME_HMO_002] H5398-002 Butler, Harvey and Sedgwick counties

This booklet gives you a complete list of services, limitations and exclusions for your plan coverage.

Please select the document for your plan and county:
 

Plan Name CMS# County Evidence of Coverage (EOC)
[PRODUCT_NAME_HMO_001] H5398-001 Butler, Harvey and Sedgwick counties
[PRODUCT_NAME_HMO_002] H5398-002 Butler, Harvey and Sedgwick counties

This booklet will tell you about changes to your plan’s costs and benefits for the coming year. Please select the document for your plan and county:

Plan Name CMS# County Annual Notice of Changes (ANOC)
[PRODUCT_NAME_HMO_001] H5398-001 Butler, Harvey and Sedgwick counties
  • Annual Notice of Changes, H5398-001 (PDF)
[PRODUCT_NAME_HMO_002] H5398-002 Butler, Harvey and Sedgwick counties
  • Annual Notice of Changes, H5398-002 (PDF)

Your current plan may have an over-the-counter benefit that allows you to purchase over-the-counter (OTC) health and wellness products. This catalog includes a list of over-the-counter items that you can order to be directly mailed to your home. Check the catalog for item limits.

Ordering is easy! Just follow the steps listed on your plan's catalog.

If you have questions please, contact Member Services.