KHPA Home - SEHP - 2009 Providers
 2010 Health Plan Carrier Information HERE
***Contact State Employee Health Plan here***
2009 Health Plan Providers and Forms
The Plan A and Plan B Schedule of Benefits listed below
are offered by the State of Kansas through the following carriers:
Blue Cross and Blue Shield,
Coventry Health Care of Kansas, Preferred Health Systems and
UMR a UnitedHealthCare Company and may be modified as necessary.
Schedule of Benefits for All Carriers
Click on the Provider Directory link (listed under each health plan provider) to find the
network physicians, dentists, optometrists, or hospitals for that particular provider.
Health Plan Providers
Active Employees, Non State Group and
Non Medicare Eligible Direct Bill Members
 Website
2009 Benefit Description Plan A - Rev. 02-01-09
2009 Benefit Description Plan B - Rev. 02-01-09
Blue Cross and Blue Shield Provider Directory
TOLL FREE 800-332-0307
Topeka Area 785-291-4185
 Website
2009 Benefit Description Plan A - Rev. 02-01-09
2009 Benefit Description Plan B - Rev. 02-01-09
2009 Benefit Description Plan C QHDHP w/HSA
AVAILABLE TO ACTIVE EMPLOYEES ONLY - Rev. 02-01-09
HSA Enrollment and Change Form
UMB HSA Enrollment Form/Agreement
Coventry Provider Directory
For ALL Plans- Plan A, Plan B AND Plan C - Select State of Kansas Plan A or B PPO.
Kansas City/Topeka Area - 800-969-3343
Wichita/South Central Area - 866-320-0697
 Website
2009 Benefit Description Plan A - Rev. 02-01-09
2009 Benefit Description Plan B - Rev. 02-01-09
2009 Benefit Description Plan C - QHDHP w/HSA
AVAILABLE TO ACTIVE EMPLOYEES ONLY - Rev. 02-01-09
HSA Enrollment and Change Form
Health Equity Contribution Form
PHS Wichita Area Urgent / Immediate Care Map
Preferred Health Systems Provider Directory
TOLL FREE - 866-618-1691
Wichita Area - 316-609-2555
 Website
A United Healthcare Company
2009 Benefit Description Plan A- Rev. 02-01-09
2009 Benefit Description Plan B- Rev. 02-01-09
2009 Benefit Description Plan C - QHDHP w/HSA
AVAILABLE TO ACTIVE EMPLOYEES ONLY - Rev. 02-01-09
HSA Enrollment and Change Form
UMR-American Chartered HSA Application
UMR-American Chartered HSA Elctronic Funding
UMR Provider Directory
TOLL FREE: 866-281-2993
Lab Card Program
AVAILABLE ONLY WITH PLAN B
 Website
QUEST DIAGNOSTICS
LabCard Program - Available ONLY with Plan B coverage
Kansas Collection Sites
TOLL FREE - 800-646-7788
Dental Plan
 Website
2009 Benefit Description
Delta Provider Directory
Identification Cards
TOLL FREE - 800-234-3375
Wichita 316-264-4511
Prescription Drug Plan for
Active Employees, Non State Group and
Non Medicare Eligible Direct Bill Members
 Website
2009 Benefit Description
2009 Preferred Drug List - EFFECTIVE AUGUST 1, 2009
2009 Preferred Drug List Changes - Effective August 1, 2009
2009 Preferred Drug List - Effective May 1, 2009
PDL Changes - Effective January 1, 2009
Lifestyle Mediciations
Generics
Non-Sedating Allergy Medication
Specialty and Biotech Mediciation List - NEW
Self Injectible Drug List
Caremark Claim Form
Caremark Mail Order Form
Special case list effective 3/09
Toll Free Telephone Number - 800-294-6324
Helpful Links
Consumer Reports: Best Buy Drugs
FDA: Generic Drugs: What You Need to Know
Medicare Part D Prescription Drug Coverage
for our Medicare Eligible Members
 Website
Medicare Part D Drug Coverage -
Available with ALL Medicare Plans offered by the State Employee Health Plan
2009 Evidence of Coverage
2009 SilverScript Explanation
2009 Formulary
TOLL FREE 800-837-4092
TDD TOLL FREE 866-236-1069
Vision Plan (Optional)
 Website
2009 Enhanced Plan Certificate of Coverage
*Contact Lens Fitting Benefit
For the Enhanced Plan ONLY
2009 Basic Plan Certificate of Coverage
Superior Vision Provider Directory
TOLL FREE - 800-507-3800
Contact lens by mail
LASIK Surgery
Kansas Refractive Surgeons - February 2008
Lasik Plus
TruVision
Health Plan Providers
for Medicare Eligible Retirees/Direct Bill Only
 Website
Kansas Senior Plan C - 2009 Benefit Description
ALL AREAS 800-332-0307
Topeka Area 785-291-4185
Website
Coventry Advantra Freedom Plans Coverage Map - Updated!
Advantra PPO with Prescription Drug Coverage
Advantra PPO without Prescription Drug Coverage
Advantra PFFS with Prescription Drug Coverage
Advantra PFFS without Prescription Drug Coverage
Coventry Advantra Freedom Plans Formulary
Coventry Advantra Freedom Plans Provider Directory
For the Advantra Freedom plans, select the Advantra PPO option in the Provider Directory
All Areas - 800-727-9712
TDD - 866-347-2459
 Website
Specific Humana Group Medicare Plans
Kansas and Missouri Counties with Humana Coverage - NEW
Humana PPO with Prescription Drug Coverage
Humana PPO without Prescription Drug Coverage
Humana PFFS with Prescription Drug Coverage
Humana PFFS without Prescription Drug Coverage
Humana Group Medicare Plans Formulary 2009
Humana Group Medicare Plans Provider Directory
State Employee Health Plan Home Page
Contact State Employee Health Plan here
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