State Self Insurance Fund (SSIF)

• Report any injury/accident to supervisor.
• Complete an  Injured Employee's Report of Injury form (WC-9) and submit to the SSIF.
• Obtain authorization for medical treatment, if necessary, from SSIF. Remember to use  CompAlliance in Network Providers.
• Communicate with agency/department and SSIF (phone: 785-296-2364).
• Frequently Asked Questions
• A  Mileage Form is available for use in tracking the miles you drive related to either obtaining medical care or purchasing medical related items, such as prescriptions, etc. This form may be submitted periodically - usually monthly.
• A Guideline for the Repair or Replacement of Eyeglasses, WC-00-A PDF, explains the process for obtaining benefits. The  Prescription Eyeglasses Replacement Form, WC-00 PDF, needs to be completed and returned to SSIF, should your prescription eyeglasses be damaged during the course of employment.

• Obtain Prior authorization for medical care, from SSIF.
  Note: If it is a life or a limb threatening emergency, get the employee to the closest medical provider as soon as possible.
• Complete an electronic Employer's Report of Accident via the SSIF web portal and submit it as soon as possible to the SSIF. All other documentation, such as Physician’s notes or return to work slips, may be emailed to wc1101a@ks.gov.
  Note: All email containing Protected Health Information (PHI) such as, physician’s notes, medical reports, etc. must be sent securely. If you do not have a secure email delivery mechanism, you may use DHCF ’s ‘Proofpoint’ secure email delivery server to send encrypted email to DHCF .
• Refer any medical provider to the State Self Insurance Fund at 785-296-2364 if they contact you for authorization of medical care.
• Submission of the electronic Employer’s Report of Accident does not mean that the employee has been approved for Workers Compensation. The SSIF will investigate the claim once they have received the electronic Employer’s Report of Accident and determine compensability.
• Refer the employee to this website for pertinent information about Workers Compensation.
  Note: If they don’t have ready access to the website, please print out the  Frequently Asked Questions and the Information for Employees  PDF version for them. You may also refer them to the SSIF at 785-296-2364.
• Determine if any restrictions given by the medical provider to an injured employee receiving medical care can be accommodated. If an employee is missing work due to a work-related injury and you haven’t received any information from the medical provider, contact the employee and obtain a copy of the work release or restrictions.
• Keep the SSIF informed of any changes in the status of an injured worker. This includes changes in work restrictions, if they begin missing work or return to work.
• When the employee is eligible to receive Workers Compensation disability benefits, they may want to supplement it with vacation or sick leave. Please contact the SSIF if you have questions about the SHARP adjustments.
• IMPORTANT: Employees who receive Workers Compensation are NOT eligible for Shared Leave for the same medical condition. If you have questions about Workers Compensation and how it interacts with the Family Medical and Leave Act, you may contact the SSIF.
• Contact the SSIF whenever you have questions about any aspect of handling a work-related injury. The phone number is 785-296-2364 and the fax is 785-296-6995. If you know who the adjuster is for a particular claim, you may contact them directly.

The program is initiated as soon as the employee reports the injury and wants to go to the doctor for treatment:

• Complete the electronic Employer’s Report of Accident within 24 hours to the SSIF via the SSIF web portal. All other documentation, such as Physician’s notes or return to work slips, may be emailed to wc1101a@ks.gov
  Note: All email containing Protected Health Information (PHI) such as, the Employer’s Report of Injury, physician’s notes, medical reports, etc. must be sent securely. If you do not have a secure email delivery mechanism, you may use DHCF ’s ‘Proofpoint’ secure email delivery server to send encrypted email to DHCF .
• Complete the top portion of the  First Fill Letter with the Injured Worker’s Name, Social Security number and Date of Injury.
• Print off a copy of the completed First Fill Letter and give it to the employee.
• Participating pharmacies are listed on the First Fill Letter (including CVS, Walgreens and Walmart). You can search for a pharmacy at  Work Comp | Elixir
• Instruct the employee to give the  First Fill Letter, along with any prescription the doctor may prescribe to treat the injury, to the participating pharmacy.
  Note: Remember to inform the employee that the First Fill letter is only good for 24 hours after receipt and is only for their FIRST prescription(s) following the injury. The letter can only be used for prescription medications related to this injury.
• Be aware that payment for the prescription may be denied within 5 days if the State Self Insurance Fund does not receive the electronic Employer’s Report of Accident.
• As soon as the electronic Employer’s Report of Accident (SSIF Web Portal Link) is received by the State Self Insurance Fund, compensability will be determined.
• If the claim is accepted, the prescription will be approved and the injured employee will receive a Elixir prescription drug card in 3 to 4 days. The employee should use the Elixir Prescription Drug Card for any medication related to the injury that is prescribed by the treating physician.
• If the claim is not compensable, the employee will receive a letter in the mail indicating that it has been denied and that the employee will need to submit any bills related to the denied claim to their health plan provider.
• The employee’s Elixir Prescription Drug Card will remain valid for up to six months or as soon as the doctor releases the employee from care or the claim is deemed non-compensable. If medical treatment extends beyond a six month period, the employee’s prescriptions may be transferred to a mail order program. State Self Insurance Fund staff will handle this transfer.
• A Elixir Prescription Drug Card will be issued for each new date of injury. Employees with two injury dates requiring medications will be issued two Elixir cards.
• For assistance please contact the State Self Insurance Fund at 785-296-2364 or Elixir toll-free at 1-800-771-4648.