Submit applications for MHIP coverage to the Administering Carrier in the county of residence of the applicant. You must submit your application to the correct Administering Carrier for timely processing. Use the link below to identify the correct Administering Carrier in your county.

Find the administering carrier for your county.

Click here to print an application on a printer attached to your computer. You will also need to print the Application Checklist since this form, along with the Application, must all be received by the administering carrier to enable processing of your MHIP application. The mailing address at the bottom of the form only applies to applicants that live in the Anthem Blue Cross Blue Shield service area. If you live in the Blue Cross and Blue Shield of Kansas City (BCBSKC) service area, you must mail the forms to: P.O. Box 419169, Kansas City, MO, 64179-0147.

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Call the Administering Carrier to request an application.

After you have completed the Application and signed it, send it to the correct administering carrier. Pay special attention to the Application Checklist to make sure you have included all required documentation. Incomplete documentation will result in a delay in the processing of your Application as missing information will be required and requested by the administering carrier.

The MHIP no longer requires that you submit a copy of a letter of declination from two individual health insurance carriers. If you are afflicted by a medical condition that would normally result in Anthem BCBS or BCBSKC rejecting you for one of their individual policy products, you automatically qualify for the MHIP coverage.

Once your Application and accompanying documentation is reviewed by the marketing/underwriting department of the administering carrier, you will receive written notification that you have been accepted under the MHIP program. You will also be notified if the MHIP plan's pre-existing condition exclusion applies or if you qualify for the waiver. Your effective date will be either the first day of the month following your approval date or, if you want your MHIP coverage to be effective sooner to prevent a gap in coverage, we will make it effective the date immediately following the termination of your previous health coverage.