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.

* Required

Member Info *

Contact Info *

(Enter at least one phone number)*

(Email address is optional)

Wellness Management

Tobacco Cessation
Weight Management
Stress Management
We will call to schedule your first appointment with your nurse. Please specify the best time to reach you for that initial scheduling call.
**

We will call you within three business days 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 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.
Wellness Management Enrollment Success
Thank you for your interest in our wellness management program. An enrollment specialist will contact you at your preferred method of contact within one week.
Your confirmation number is

Disease 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.


Wellness Management Enrollment Error
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