Disease Management Enrollment Form

This free program is designed to help members, ages 18 and older, who have BCBSKS as their primary carrier.
If Medicare is your primary, we cannot enroll you in this program; please contact Medicare to see if they have similar programs.

* Required

Member Info *

Contact Info *

(Enter at least one phone number)*

(Email address is optional)

Disease Management

Please identify the best time to reach you between 8 a.m. and 4:30 p.m., Central Standard Time.
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 a.m. and 4:30 p.m., Monday through Friday.
**Once you are enrolled in a program, nurses are available to speak with you until 9 p.m.
Disease Management Enrollment Success
Thank you for your interest in our disease management program. An enrollment specialist will contact you at your preferred method of contact within one week.
Your confirmation number is

Disease Management Enrollment Error
Unable to submit the form due to Internal Error. Please, try again later.