Plan Year 2012 Information


PLAN YEAR 2012 MATERIALS

BOOKLETS AND CHARTS

ACTIVE STATE EMPLOYEES

PY 2012 Active State/NSEGroup Booklet

PY 2012 Active State Comparison Chart


NON STATE EMPLOYER GROUPS

PY 2012 Active State/NSEGroup Booklet

PY 2012 NSE Group Comparison Chart


RETIREE/DIRECT BILL MEMBERS

PY 2012 Retiree/Direct Bill Booklet

PY 2012 Retiree/Direct Bill NON Medicare Plans - Chart 1

PY 2012 Retiree/Direct Bill MEDICARE Plans - Chart 2


COBRA

PY 2012 COBRA Booklet

PY 2012 Active State COBRA Rates

PY 2012 NSE Group COBRA Rates

FORMS

ACTIVE STATE EMPLOYEES

PY 2012 Active State Enrollment Form

PY 2012 Active State Change Form

PY 2012 FSA Enrollment/Change Form

PY 2012 ASI (Vendor) - FSA Claim Form

PY 2012 HSA (With Plan C) - Enrollment and Change Form


NON STATE EMPLOYER GROUPS

PY 2012 NSEGroup Enrollment Form

PY 2012 NSEGroup Change Form

PY 2012 HSA With Plan C Enrollment and Change Form


RETIREEE/DIRECT BILL MEMBERS

PY 2012 Retiree/Direct Bill Enrollment/Change Form

PY 2012 Retiree/Direct Bill ACH Enrollment Form

PLAN YEAR 2012 VENDOR BENEFIT DESCRIPTIONS

Active State, Non State Employer Group and
NON- MEDICARE ELIGIBLE Retiree/Direct Bill

Blue Cross Blue Shield of Kansas |

2012 Plan A

2012 Plan B

2012 Plan C



Coventry |

2012 Plan A

2012 Plan B

2012 Plan C


UHC |

2012 Plan A |

2012 Plan B |

2012 Plan C


CVS Caremark |

2012 With Plans A & B

2012 With Plan C


Delta Dental |

2012 Delta Dental


Superior Vision |

2012 Basic

2012 Enhanced


MEDICARE ELIGIBLE
Retiree/Direct Bill

Blue Cross Blue Shield - Sr. Plan C |

2012 Senior Plan C



Coventry Health Care - Advantra |

2012 Coventry Advantra With Rx

2012 Coventry Advantra Without Rx


Humana Group Medicare |

2012 Humana Group Medicare Regional PPO |

2012 Humana Group Medicare PPO


SilverScript |

2012 SilverScript