Claim Forms

If you are a active employee or a retired member of the SCSO Benefit Fund and you need to submit a claim to the Benefit Fund, please follow these steps;

• print off and fill out the Claim Form  

• All receipts and/or statement should show date of service, doctor’s or clinic name, type of service provided and charge for the claimed services. 

• Prescription claims should show the name of the drug, date received, prescription number, prescribing doctors name and cost.

• All claims are for members only, not for family or dependents. Claims must be incurred while you are an active or retired Benefit Fund member.  Medical claims must be for required services, not elective.  If this is a Chiropractic claim, be sure to include documentation to prove authorization from primary care physician.
  • Mail all claims to 
    • Sedgwick County Sheriff's Office Benefit Fund
    • P.O. BOX 2315
    • Wichita Ks 67201