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Group Plan/State Employee/Federal Employee FAQs

Please review the Q&A below for answers to frequently asked questions regarding Pharmacy, Choice of Doctor and Coverage.

Click here for Medicare Advantage member FAQs.

Members

  • As a GlobalHealth member, you must use providers contracted with our plan to receive your covered services. This starts with choosing a Primary Care Physician from the list of physicians in the Provider Directory or the Provider Search tool.
  • Each family member may choose a different PCP, including a pediatrician for children.
  • You may change your PCP selection at any time throughout the year through our MyGlobal Member Portal or by contacting our Customer Care team. Your PCP change will be effective the same day.
  • If you do not choose a PCP, one will automatically be assigned to you.
  • See or call your Primary Care Physician (PCP) first for all your medical care. Your Primary Care Physician will see that you get the care you need, whether in his/her office or from another doctor.
  • If you or a covered member of your family needs same-day urgent care, call your Primary Care Physician's office for medical direction. After hours, you may self-refer to an in-network Urgent Care Center.
  • If you need emergency care, go immediately to the nearest medical facility. Call your Primary Care Physician within 48 hours of receiving the care. Emergency care is covered when it is for a medical emergency. An emergency is based on your presenting symptoms arising from any injury, illness or condition manifesting itself by acute symptoms of sufficient severity (including severe pain) such that a reasonable and prudent layperson could expect the absence of medical attention to result in serious jeopardy to the patient's health (or in the case of a pregnant woman, serious jeopardy to the health of the fetus); serious impairment to bodily function; or serious dysfunction of any bodily organ or part.
  • Follow-up care after an emergency or urgent care visit is also covered when provided or arranged by your Primary Care Physician.

In-Area

  1. If you need urgent medical care, call your PCP’s office and inform them that you are a GlobalHealth member.
  2. Inform your PCP or office personnel that you have an urgent medical problem and need assistance, and describe your condition or symptoms.
  3. During office hours, your call will be given to your PCP or a medical staff person who will give you instructions.
  4. After office hours, you have two options:
    • Call the number on your member ID card for your PCP. Your PCP’s answering service will take your name and phone number. Your PCP or an on-call physician will call you back. You will be given medical direction at that time, which may include directing you to an urgent care facility.
    • After your PCP’s office hours or on the weekend, you may self-refer to an in-network urgent care facility. For a list of in-network urgent care facilities nearest you, please refer to the GlobalHealth Physician & Health Providers Directory, or utilize the Provider Search tool.

Out-of-Area

If you are traveling and require urgent care that cannot be delayed until you return to the GlobalHealth service area, contact your PCP for medical advice and direction, and/or self-refer to an urgent care facility.

Please note:

An urgent care facility is not to be used in place of accessing your PCP for routine services and continuity of care. Use of urgent care services are only for an unforeseen illness, injury, or condition that requires immediate, medically necessary care. All follow-up care must be provided by your PCP, or arranged by your PCP, and prior authorized by GlobalHealth.

  • You may change your PCP selection at any time throughout the year through our MyGlobal Member Portal or by contacting our Customer Care team. Your PCP change will be effective the same day.
  • Members may access mental health and substance abuse services directly by calling or emailing Customer Care.
  • Behavioral health staff will manage and arrange all inpatient and outpatient mental health and substance abuse services to assure that you and/or your family members receive timely and appropriate care.
  • You do not need to go through your Primary Care Physician, behavioral health services are self-referral.
  • Always contact GlobalHealth prior to services to ensure that the provider is an in-network provider so that you will not be balance billed.
  • If you have a complaint or are dissatisfied with a denial of coverage for claims under your plan, you have the right to appeal or file a grievance.
  • GlobalHealth will reconsider the claim or service denial.
  • Send your written request to GlobalHealth's Customer Care within six months of the day of the denial.
  • For your convenience, you may access an Appeals and Grievance Request Form by clicking on Find a Form.
  • If you have any questions, call Customer Care.
  • For Group, State, and Federal members, a referral and prior authorization from GlobalHealth are required. Generally, authorization will only be for network providers.
  • See your PCP first. When appropriate, your PCP will process a referral on your behalf for specialty care.
  • When your referral is approved, you will receive a letter of authorization in the mail. Authorization is typically for 90 days. At this point, you may make your appointment with the specialist as directed in the letter.
  • The specialist may process referrals for procedures and follow-up care after initial visit. You should go back to your PCP for other care. Also, in most cases, you will need to go back to your PCP after 90 days for follow-up.
  • If you have any questions or concerns regarding a referral, please contact our Customer Care team for assistance.

You may self-refer for the following services. Some services may be subject to plan limitations.

  • In-network chiropractic care
  • Emergency care
  • In-network eye exams
  • Eyewear
  • In-network routine mammograms
  • In-network mental health/substance misuse services - call Beacon Health Options directly at the number on the back of your member ID card
  • In-network OB/GYN services
  • In-network physical therapy evaluations
  • Urgent care

Providers

  • Commercial:
    • As a general rule, GlobalHealth authorizes referrals to in-network specialists only. However, if we are not able to provide for specific services within our network, we will authorize a referral to a non-network specialist. In that case, a recommendation by the referring physician will be considered.
  • Medicare Advantage:
    • Referrals and prior authorizations are not required for specialist office visits.
    • In addition, Generations Classic Choice (HMO-POS) allows some out-of-network coverage for specialist office visits. The specialist must be Medicare-contracted.
  • Time is dependent on type of request, see chart below. However, most requests are typically processed within 24 hours. Please refer to the GlobalHealth Provider Manual for more information.

    Non-Urgent Pre-Service Decisions

    Within 14 days of receipt of completed request

    Urgent Decisions - Concurrent

    Within 24 hours of receipt of completed request

    Urgent Decisions - Pre-Service 

    Within 72 hours of receipt of completed request

  • The final determination for medical necessity is made by a GlobalHealth Medical Director.
  • You may nominate physicians by completing the nomination form online for contract consideration. If additional professional staff are being added to an existing contracted practice, please email ghcredentialing@globalhealth.com to obtain a credentialing packet.
  • You may call Customer Care for laboratories. Hospitals, Urgent Care facilities and Pharmacies are available in our Provider Search tool.
  • Corrected claims can be submitted electronically when they are clearly marked as being corrected.
  • GlobalLink™ accounts that have not been used in 90 days are permanently closed. A new GlobalLink™ access request form will need to be completed.
  • Current GlobalLink users that are experiencing access issues can send an email to globallink.access@globalhealth.com for resolution. Your user name, Tax ID number, and group NPI should be included in the email.

Employers/Agents/Brokers

  • Commissions are paid based on the Medicare effective date. Commissions are paid on the last business day of the month in which your member was effective. (Example – Commission will be paid on 1/31/2021 for a member effective 1/1/2021)

  • Once you have enrolled a client in a plan, you receive the initial payment the first year. For each year after, if your client stays in that plan, you will receive a renewal commission, pro-rated out monthly.

  • The website provider search can be found here.
  • On the mobile app, click Find a Provider, scroll down to narrow your search.
  • The member can call Customer Care and the representative will coordinate with a Case Manager, based on the member’s needs. Click here for the Customer Care contact information.

  • Click here to see the GlobalHealth coverage area.

  • You may schedule events on the broker portal here. Please provide at least seven (7) days advance notice.

  • You may contact the Broker Support Line at (855) 455-7060.

  • You can find your commissions statement here.
  • You cannot access the statement without the proper credentials. Your login is your agent number.

Pharmacy

  • If you are a member or potential member and have questions concerning coverage of your prescription medications, please review the drug formulary to view covered drugs on your plan. If you still have questions, you may contact GlobalHealth Customer Care.
  • Prior authorization is required on certain drugs before coverage is available. If your formulary states that prior authorization or step therapy is required, your doctor should submit a prior authorization request to GlobalHealth for approval. If the request is not approved, you still have the option to pay for the drug at your expense.

A formulary is a list of covered drugs selected by our plan in consultation with a team of healthcare providers, which represents the prescription therapies believed to be a necessary part of a quality treatment program.

Our plan will generally cover the drugs listed in our formulary as long as the drug is medically necessary, the prescription is filled at a plan network pharmacy, and other plan rules are followed. For more information on how to fill your prescriptions, please review your plan materials.

Click here to view the drug formulary for your plan.

Visit the Mail Order Prescription Drugs page to learn about mail order.

Visit the Find a Pharmacy page to locate a local in-network pharmacy.

Please refer to your Prescription Drug Formulary to determine if a drug requires prior authorization.

Click here to view the drug formulary for your plan.

Specialty medications are identified in your drug formulary. For State and Commercial members, these medications are on tier 4. For Federal members, these medications are on tiers 4 and 5. Specialty medications can be filled at any network pharmacy.

A recall is when a product is removed from the market or a correction is made to the product because it is either defective or potentially harmful. Sometimes a company discovers a problem and recalls a product on its own. Other times, a company recalls a product after FDA raises concerns. If you have a medicine or device that has been recalled, talk to your healthcare professional about the best course of action. For other products, such as foods, dietary supplements and cosmetics, take them back to the place of purchase and ask for a refund. Stores generally have a return and refund policy when a company has announced a recall of its products. Please click here to be routed to the FDA website to see the most recent drug recalls.

You may request an exception to a drug that is not covered in the formulary or to a prior authorization or step therapy rule by:

  • Sending a request through MyGlobal™.
  • Mailing a request to GlobalHealth.
  • Calling Customer Care for assistance.

Advance Directives

  • An Advance Directive for Health Care is a written legal document which allows you to instruct your attending physician whether or not you wish to be given life-sustaining treatments and artificially administered nutrition (food) and hydration (water) and to give other medical directions that impact the end of life. Its purpose is to recognize your right to control some aspects of your medical care and treatment primarily including the right to decline medical treatment or direct that it be withdrawn even if death ensues. An Advance Directive for Health Care may include a living will, the appointment of a health care proxy (a person you authorize to make medical treatment decisions for you in the event you are unable to make such decisions).
  • Any person of sound mind who is 18 or older.
  • An Advance Directive must be signed before two witnesses who are 18 or older. The witnesses cannot be beneficiaries under your will nor may they be persons who would inherit your property if you died without a will. An Advance Directive is not required to be notarized.
  • If you have completed an Advance Directive and been diagnosed as terminally ill or persistently unconscious by two physicians as defined in the Advance Directive and your attending physician does not want to comply with your wishes, that physician must act promptly to arrange for your care by another physician or healthcare provider.
  • After you complete an Advance Directive, you may revoke it in whole or in part at any time and in any manner, without regard to your mental or physical condition. A revocation is effective upon your communication to your attending physician or other care provider or a witness to the revocation.
  • Thinking about end-of-life decisions is not something we like to talk about. But, it is important to plan ahead and let your loved ones know your wishes should the unexpected happen.
  • Be sure and make copies of your Advance Directive for your personal records, your family, your physician, your attorney, your Health Care Proxy and alternate Health Care Proxy.
  • If you signed a Directive to Physicians or other Advance Directive for Health Care under Oklahoma law prior to 2006, it is recommended that you complete a new Advance Directive because of additional options under existing law.
  • Oklahoma's Advance Directive for Health Care law allows you, if you are 18 years of age or older, to inform physicians and others of your wishes to provide, decline or withdraw life-sustaining medical care and to donate specified organs when you have been diagnosed by your attending physician and another physician to be in a terminal condition, a persistently unconscious state, or an end-stage condition.