Member Handbooks and Forms

Handbooks

• Sunflower Health Plan Member Handbook - English (PDF)
• Sunflower Health Plan Member Handbook - Español (PDF)

• Provider Directory - Contact customer service at toll free 1-877-644-4623 for a copy of this directory. Please note: our online Find a Provider tool is the most current source of network provider information.
  • Region 1 (PDF) - KANSAS COUNTIES: Johnson, Leavenworth, Wyandotte MISSOURI COUNTIES: Platte, Clay, Jackson, Cass
  • Region 2 (PDF) - KANSAS COUNTIES: Atchison, Barber, Barton, Brown, Cheyenne, Clark, Clay, Cloud, Comanche, Decatur, Dickinson, Doniphan, Douglas, Edwards, Ellis, Ellsworth, Finney, Ford, Franklin, Geary, Gove, Graham, Grant, Gray, Greeley, Hamilton, Haskell, Hodgeman, Jackson, Jefferson, Jewell, Kearny, Kiowa, Lane, Lincoln, Logan, Marshall, Meade, Miami, Mitchell, Morton, Nemaha, Ness, Norton, Osborne, Ottawa, Pawnee, Phillips, Pottawatomie, Pratt, Rawlins, Republic, Riley, Rooks, Rush, Russell, Saline, Scott, Seward, Shawnee, Sheridan, Sherman, Smith, Stafford, Stanton, Stevens, Thomas, Trego, Wabaunsee, Wallace, Washington, Wichita COLORADO COUNTIES: Yuma, Kit Carson, Cheyenne, Kiowa, Prowers, Baca MISSOURI COUNTIES: Platte, Buchanan, Andrew, Holt NEBRASKA COUNTIES: Richardson, Pawnee, Gage, Jefferson, Thayer, Nuckolls, Webster, Franklin, Harlan, Fumas, Red Willow, Hitchcock, Dundy OKLAHOMA COUNTIES: Cimarron, Texas, Beaver, Harper, Woods, Alfalfa
  • Region 3 (PDF) - KANSAS COUNTIES: Allen, Anderson, Bourbon, Butler, Chase, Chautauqua, Cherokee, Coffey, Cowley, Crawford, Elk, Greenwood, Harper, Harvey, Kingman, Labette, Linn, Lyon, Marion, McPherson, Montgomery, Morris, Neosho, Osage, Reno, Rice, Sumner, Wilson, Woodson MISSOURI COUNTIES: Newton, Jasper, Barton, Vernon, Bates, Cass OKLAHOMA COUNTIES: Alfalfa, Grant, Kay, Osage, Washington, Nowata, Craig, Ottawa
  • Region 4 (PDF) - KANSAS COUNTIES: Sedgwick

Forms

• Notification of Pregnancy Form
  • Notification of Pregnancy Form - English (PDF)
  • Notification of Pregnancy Form - Español (PDF)
• PCP Change Form
  • PCP Change Form - English (PDF)
  • PCP Change Form - Español (PDF)
• Appeal & Grievance Authorized Representative Form
  • Appeal & Grievance Authorized Representative Form - English (PDF)
  • Appeal & Grievance Authorized Representative Form - Español (PDF)
• Appeal Form (PDF)
  • Appeal Form - English (PDF)
  • Appeal Form - Español (PDF)
• Authorization to Disclose Personal Health Information (PHI) Form
  • Authorization to Disclose Personal Health Information (PHI) Form - English (PDF)
  • Authorization to Disclose Personal Health Information (PHI) Form - Español (PDF)
• Revocation of Authorization to Disclose Personal Health Information (PHI) Form
  • Revocation of Authorization to Disclose Personal Health Information (PHI) Form - English (PDF)
  • Revocation of Authorization to Disclose Personal Health Information (PHI) Form - Español (PDF)
• Office Visit Checklist - Use this worksheet to help you prepare for your appointment and for writing notes during your visit. Take charge of your health by asking questions and sharing information, so your PCP can help you receive the best possible care.
  • Office Visit Checklist - English (PDF)
  • Office Visit Checklist - Español (PDF)
• Prescription Claim Reimbursement Form
  • Prescription Claim Reimbursement Form - English (PDF)
  • Prescription Claim Reimbursement Form - Español (PDF)
• Mileage Reimbursement Form (PDF) - Transportation log, mileage log, gas reimbursement. Modivcare form.
• Integrated Life Plan (PDF)