Employee Resources
Instructions for KSU1-11b.pdf

KSU1-11b,
Notice of Intent to Participate in the State of Kansas Health Care Program for Non-State Groups


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As stated in the general instructions, this form can be filled in and printed. Use tab key or mouse to navigate this form.

Procedure for Entering the Plan

For boards/governing bodies who are ready to participate here are the steps:

Submit the attached "Notice of Intent to Participate" to the HCC in Topeka at least 90 days before the insurance is to begin.

Following receipt of the notice, the HCC will mail a contract to the Extension Council or District Governing Body for signature.

Once the contract has been signed, the HCC staff will send enrollment information to employees.

The HCC will also send participating groups a State of Kansas Health Plan Non State Groups Administrative Manual which give additional details on employee eligibility, dependent eligibility, cost of coverage, open enrollment, mid-year enrollment changes, termination of coverage, billing and coverage, etc.

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Please send your questions, comments, and suggestions about this form to Cheryl Christian, cchristi@ksu.edu. Thanks.