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Disease and Wellness Management Enrollment Form



This free program is designed to help members, ages 18 and older, who have BCBSKS as their primary carrier.

Employees with Spirit AeroSystems, Stormont-Vail, State of Kansas, and Watco aren't eligible for this program. Please contact your respective human resources department for information about similar programs available to you. If Medicare is your primary, we cannot enroll you in this program; please contact Medicare to see if they have similar programs.

Member Info

Contact Info

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Disease and Wellness Management


We will call to schedule your first appointment with your nurse. The best way and time to reach me is:
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We will call you within one week after you submit this form.
This information is confidential. Only authorized Blue Cross and Blue Shield of Kansas employees will have access to this information. For more information call 1-800-520-3137 between 8 AM and 4:30 PM, Monday through Thursday, and between 7 AM and 3:30 PM Friday.
** Once you are enrolled in a program, nurses are available to speak with you until 9 PM by appointment.
Disease and Wellness Management Enrollment Success

Form Submission Success

Thank you for your interest in our disease and wellness management program. An enrollment specialist will contact you at your preferred method of contact within one week.

Your confirmation number is:

Disease and Wellness Management Enrollment State Group
State of Kansas employees aren't eligible for this program. Please contact your human resources department for information about similar programs available to you.

Disease and Wellness Management Enrollment State Group
Members who have our Medicare supplemental plans aren't eligible for this program. Please contact your primary health care insurer for similar programs available to you.

Disease and Wellness Management Enrollment Error

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