Written by a parent, not a doctor. Nothing here is medical advice.

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Wichita Cancer Foundation

Health Insurance Premium Assistance

What you get

Help paying primary private, employer, or COBRA insurance premiums for up to six months, paid to the insurer. The dollar limit isn't published. Ask. Open now.

Who starts it
You
How it’s sent
By post
Your time
An hour or so
Last checked
Aug 27, 2026

Before you start, check you fit

  • Adjusted gross income must be at or below 500% of the federal poverty level.
  • Assistance is not guaranteed and depends on available funds.
  • Cancer care must be initiated or received in Kansas.

  1. What their form asksA preview, so you can gather things first. Fill it in on their site.

    Open their application ↗ Checked Aug 27, 2026

    Send it by post to the address on the form.

    What the form asks for

    Eligibility Criteria
    Are you a US Citizen or permanent residentHave you been diagnosed with cancerWas your cancer care or treatment initiated or received in KansasDo you have, or are you in the process of securing, private health insurance, an employer-sponsored health plan or COBRA insuranceHave you applied to receive government assistance through Medicare or MedicaidWhat was the outcome to receive government assistance through Medicare or Medicaid
    Demographic Information
    Which of the following best describes youAre you of Hispanic, Latino, or Spanish originWhat is the highest level of education you have completedWhich of the following best describes your living statusOther
    Show the rest of the form (5 more sections)
    Financial Criteria
    What is your household sizeWhat do you expect your household income to be for the current calendar yearWhat was your annual household income based on last years federal income tax return
    Patient and Medical Information
    Patient’s NameLegal Representative / Guardian NameDate of BirthLast Four Digits of Social Security NumberEmailPhone NumberGenderAddressHas your income changed in the last yearHave you lost your job since your diagnosisCancer DiagnosisDate of DiagnosisAre you currently receiving care related to your cancer diagnosisCare you are currently receiving, or planned care if knownHave you received care related to your diagnosis from or at a Via Christi HospitalHave you received care related to your diagnosis from or at Tammy Walker Cancer CenterName all known physicians involved in your careBrief description of your current medical expensesDescription of your current other expensesHow did you hear about usPlease tell us more about yourself and what brought you to apply
    Employment & Insurance Information
    Are you currently employedEmployerHave you applied for disabilityHave you been declared disabled by the Social Security Administration (SSA)What is the date you were declared disabled by the Social Security Administration (SSA)Are you currently receiving or applying for any other financial assistance related to your cancer diagnosisWith what organizationWhat kind of financial assistanceOtherSelect which type of insurance you have or are in the process of securingWhat is your insurance statusSelect the option that best describes your insurance policyOtherWhere do you send your Cobra paymentsAddress of where you send Cobra paymentsPhone number of where you send Cobra paymentsInsurance Company NameInsurance Company AddressInsurance Company Phone NumberMember ID NumberGroup NumberAmount of Monthly Insurance PremiumPremium Due DateThe Care Committee will need proof of insurance and evidence of cost (invoice). I willAttach proof of insurance and evidence of cost (invoice) here
    Help Others Like You
    Are you willing/able to share your story so that we may gain more donations and sponsorships in order to assist others
    Application Terms and Conditions Agreement
    TermsElectronic Signature of Patient or Legal Representative or Guardian if applicable

    Have ready

    • Proof of insurance.
    • Evidence of premium cost, such as an invoice.
    • Most recent payroll stub when coverage is employer-sponsored.

After you send

Monitor email for the decision and verification requests. If approved, verify monthly carrier payments and immediately forward insurance-carrier notices to WCF. If you have not heard back in two weeks, write and ask whether it arrived.

Full record, as published