Health Care Policy / Medical Policy
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Dear
We received the enclosed healthcare coverage application for you.
If you wish to allow
If you do not want
If you wish to apply for yourself, please review the enclosed application submitted by
Please return the reviewed application and either the Medical Representative Authorization Form or the Signature Page in the enclosed envelope. We cannot process your application for healthcare coverage until these forms are received.
Thank you.
Landon State Office Building Phone: 785-296-3981 900 SW Jackson Street, Room 900-N Fax: 785-296-4813 Topeka, KS 66612 www.kdheks.gov/hcf/ Robert Moser, MD, Secretary Sam Brownback, Governor