BLUE CROSS AND BLUE SHIELD OF KANSAS CLAIM FORM

It's easy to submit a paper claim form for reimbursement. Simply follow these steps:

1. Click on the Claim Form link below.
2. Type in the requested information on the first page of the claim form.
3. Print the entire two-page form.
4. Tape your receipts to the appropriate sections.
5. Mail the form to the address listed at the bottom of the second page.

This claim form is designed for members covered under the Blue Cross and Blue Shield of Kansas plan. If you have coverage under another health plan, please contact the health plan's customer service center to request a claim form.

Blue Cross and Blue Shield of Kansas Claim Form

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