MHIP Member Information, Links, and Resources

All forms and documents linked from this page will require the Adobe Acrobat Reader.

MHIP Documents

• State Pool Certificate of Coverage
• Federal Pool Certificate of Coverage

Carrier Forms

• MHIP claim Form - This form is to be used when filing for any services received from a non-network provider in the MHIP State Pool. This form should be used for both carriers. There is not a separate form available for Blue Cross and Blue Shield of Kansas City (BCBSKC). To file a claim with BCBSKC, mail the completed form to: Blue Cross and Blue Shield of Kansas City, PO Box 419169, Kansas City, MO, 64179-0147.
• Enrollee Change Form - Anthem BCBS
  Enrollee Change Form - BCBSKC
  - This form is to be used by MHIP members to update contact information, such as a mailing address. It is to also be used when changing your plan choice during the MHIP's annual open enrollment.
• Participating Pharmacies - This is a listing of large pharmacy chains and stores that participate in the Catalyst Rx pharmacy network. If you fill your prescriptions at one of these pharmacies, you maximize the coverage and benefits available under the MHIP's prescription drug program.