Member Handbooks and Forms

Handbooks

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

• Integrated Life Plan (PDF)
• Provider Directory - Contact customer service at 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.
  • Johnson, Leavenworth, Wyandotte counties (PDF)
  • Northeast & Western Kansas counties (PDF)
  • Southwest Kansas counties (PDF)
  • Sedgwick County Area (PDF)

Forms

• Notification of Pregnancy Form - English (PDF)
• Notification of Pregnancy Form - Spanish (PDF)

• PCP Change Form - English (PDF)
• PCP Change Form - Spanish (PDF)

• Appeal & Grievance Authorized Representative Form (PDF)
• Appeal Form (PDF)
• Authorization to Disclose Personal Health Information (PHI) Form (PDF)
• Revocation of Authorization to Disclose Personal Health Information (PHI) Form (PDF)
• Office Visit Checklist - English (PDF) | Office Visit Checklist - Spanish (PDF) - 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.
• Prescription Claim Reimbursement Form (PDF)