to main content

Pay My Bill

We offer three convenient methods to pay your monthly premium. Simply download the form that best suits your needs, then send the completed form to us by mail, email, or fax.

Appeals & Grievances

An appeal is a special kind of complaint you can make if KelseyCare Advantage refuses to cover something you think should be covered.
New for 2021! Organizational Determination & Payment Request (Medical Part C)
An organization determination is a decision your health plan makes regarding a request by you, your authorized representative or a physician for the Plan to cover health services, a payment request of a claims for services you have already received or increased coverage for services you are already receiving.
New for 2021! Coverage Determination & Payment Request (Prescription Part D)
A drug coverage determination is a decision our plan makes about the coverage of a Part D drug or the amount our plan will pay for your Part D prescription drugs. This includes asking our plan to make an exception to the way a drug is covered.
2020 Organization Determination & Payment Request (Medical Part C)
An organization determination is a decision your health plan makes regarding a request by you, your authorized representative or a physician for the Plan to cover health services, a payment request of a claims for services you have already received or increased coverage for services you are already receiving.

2020 Coverage Determination & Payment Request (Prescriptions Part D)

A drug coverage determination is a decision our plan makes about the coverage of a Part D drug or the amount our plan will pay for your Part D prescription drugs. This includes asking our plan to make an exception to the way a drug is covered.
Disenrollment Rights  & Responsibilities
You may end your membership during certain times of the year, known as enrollment periods. All members have the opportunity to request to leave the plan during the Annual Enrollment Period and during the annual Medicare Advantage Open Enrollment Period.

Member Rights & Responsibilities

As a member of KelseyCare Advantage, you have certain rights and responsibilities. These are discussed in detail in the link below.

Member Newsletters

We always want to keep our KelseyCare Advantage members up to date on important insurance plan, wellness, and prevention information. Many times, questions you may have as a member are answered in our newsletter archives.

Quality Assurance

KelseyCare Advantage’s Quality Assurance Processes are designed to help ensure the safety and effectiveness of care related to prescription drugs.

Search Tools

Find a provider, pharmacy or prescription drug.
X
Cookies help us improve your website experience.
By using our website, you agree to our use of cookies.
Confirm