Revised: December 12, 2017

Cancer Plan CP 4000  
 Client Brochure Kansas 2017  Kansas Agent Guide
 Kansas Application 2017
Claims and Service Forms 
Claim Fax Sheet HIPPA Release to Agent 
 Screening Benefit Claim HIPPA Release to Family or Third Party 
Wellness Claim Form HIPPA Release to Provider  
 First Occurrence Claim Form Service Forms  
 Cancer Claim Form Cancellation Form
 EMCNL Policy Cancer Claim Form  EFT Form
 Transportation and Mileage Claim Form  Policy Service Form
  Waiver Claim Form  Address Change Form
OTHER STATES 
Arkansas  Illinois 
 CP 4000 Brochure  CP 4000 Brochure
 Agent Guide  Agent Guide
 Arkansas Application  Illinois Application
Oklahoma  Missouri 
 CP 4000 Brochure  CP 4000 Brochure
 Agent Guide  Agent Guide
 Oklahoma Application  Missouri Application
Lump Sum First Occurrence Policy-Kansas
Kansas Brochure 
 Kansas Agent Guide Kansas Rates 
Kansas Application
Dental-Vision-Hearing to Age 85 -- New 2017
Kansas Big Brochure Kansas Tri-fold Brochure
Kansas Agent Guide and Rates Kansas Application
Dental-Vision-Hearing Claim Form
Worksite Set Up Forms
Payment Agreement New Business Transmital