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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.
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.
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.
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.
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.