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Applications

• KHIA Plan Application and Description

Premiums

KHIA Premium Rates Plan (Eff. Jan. 1, 2008)

• Single Rates (Non Tobacco User)
• Single Rates (Tobacco User)
• Two Party Rates (Non Tobacco User)
• Two Party Rates (Tobacco User)
• Family Rates (Non Tobacco User)
• Family Rates (Tobacco User)

Policies

• KHIA Policy (Eff. Jan. 1, 2008)
• KHIA Policy (Eff. Jan. 1, 2007)

Forms

• Automatic Bank Withdrawal Authorization
• Member Change Form
• Personal Representative Form - used to provide permission to the health plan to release information on an ongoing basis to an individual acting as the member's "personal representative"
• Medical Claim Form

Outline of Coverage

• Outline of Coverage

Survey for Kansas Health Insurance Association.

• Frequently Asked Questions

Misc.

• KHIA Privacy Notice