Permission to Contact Form - KS - American Health Plans

Fill out the form below to get more information about our Medicare Advantage plan offered in Kansas.

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Authorized Representative Name

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I understand an agent may contact me. Kansas Health Advantage Choice, offered by Kansas Superior Select, Inc, is a Health Maintenance Organization (HMO) with a Medicare Contract. Enrollment in Kansas Health Advantage Choice depends on contract renewal. This plan is available to Medicare recipients who reside in a contracted nursing home or live at home and Kansas has certified that you need the type of care that is usually provided in a nursing home.

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I understand an agent may contact me. Kansas Health Advantage, offered by Kansas Superior Select, Inc, is a Health Maintenance Organization (HMO) with a Medicare Contract. Enrollment in Kansas Health Advantage depends on contract renewal. This plan is available to Medicare recipients who reside in a contracted nursing home or live at home and Kansas has certified that you need the type of care that is usually provided in a nursing home.

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