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Member Materials - Medicare Advantage

MEMBER MATERIALS, FORMS, RESOURCES & GUIDELINES

Learn more about your GlobalHealth Medicare Advantage Plan plan and benefits. Download the latest member materials below. All materials shown are available in printed versions. If you need a printed version, please contact Customer Care and a copy will be mailed to you. You may also request a copy to be mailed to you by logging into your Member Portal.

Materials for all Plan Options

Unless otherwise stated, all plans are HMO and require referrals from your Primary Care Physician.

Talk to a friendly, local representative

1-844-280-5555 (TTY: 711)

8:00AM to 8:00PM

7 days a week (Oct 1 - Mar 31)

Monday - Friday (Apr 1 - Sept 30)

Materials for all plan options

2025 Plan Year Documents
Enrollment Forms
All Plans - 2025 Enrollment Request Form English  
C-SNP Plans - Pre-Enrollment Qualification Assessment Tool English  
All Plans - 2025 Pre-Enrollment Checklist English  
For OMES EGID enrollment forms, please contact the employer group    
Benefit Overview & STAR Rating
Benefit Overview Plan Year 2025 English Espanol
Star Ratings - 2025 English Espanol
Summary Of Benefits
Generations Classic Rewards (HMO), Generations Valor (HMO-POS), and Generations Classic Plus (HMO) - Plan Year 2025 English Espanol
Generations Chronic Care (HMO C-SNP), Generations Chronic Care Savings (HMO C-SNP), Generations Dual Support (HMO D-SNP) and Generations Dual Premier (HMO D-SNP) - Plan Year 2025 English Espanol
Generations State of Oklahoma Retirees - Plan year 2025 English Espanol
Evidence Of Coverage (EOC)
Generations Classic Rewards (HMO) - H3706-001 (Updated 05/09/2025) English Espanol
Generations Valor (HMO_POS) - H3706-009 English Espanol
Generations Classic Plus (HMO) - H3706-023 (Updated 05/09/2025) English Espanol
Generations Chronic Care (HMO C-SNP) - H3706-024 (Updated 05/09/2025) English Espanol
Generations Chronic Care Savings (HMO C-SNP) - H3706-025 (Updated 05/09/2025) English Espanol
Generations Dual Support (HMO D-SNP) - H3706-028 (Updated 05/09/2025) English Espanol
Generations Dual Premier (HMO D-SNP) - H3706-029 (Updated 05/09/2025) English Espanol
Generations State of Oklahoma Retirees (Updated 05/09/2025) English Espanol
Annual Notice of Changes (ANOC)
Generations Classic Rewards (HMO) - H3706-001 English Espanol
Generations Valor (HMO-POS) - H3706-009 English Espanol
Generations Classic Plus (HMO) - H3706-023 English Espanol
Generations Chronic Care (HMO C-SNP) - H3706-024 English Espanol
Generations Chronic Care Savings (HMO C-SNP) - H3706-025 English Espanol
Generations Dual Support (HMO D-SNP) - H3706-028 English Espanol
Generations Dual Premier (HMO D-SNP) - H3706-029 English Espanol
Generations State of Oklahoma Retirees (HMO)  English Espanol
Drug Formulary, Pharmacy Prior Authorization and Step Therapy Information
Current 2025 Versions English & Espanol
GlobalHealth Pharmacy Directory
Plan Year 2025  English & Espanol
Provider Directory
Plan Year 2025  - Updated 12/01/2024 English & Espanol
January 2025 - Provider Directory Update - Updated 01/03/2025 English & Espanol
February 2025 - Provider Directory Update - Updated 02/03/2025 English & Espanol
March 2025 - Provider Directory Update - Updated 03/03/2025 English & Espanol
April 2025 - Provider Directory Update - Updated 04/10/2025 English & Espanol
May 2025 - Provider Directory Update - Updated 05/03/2025 English & Espanol
Multi-language Insert
Multi-language Insert  English & Espanol

 

Important Links
Pharmacy
Medicare Part D Prescription Claim Form English  
Prescription Drug Mail Order Form English Espanol
Prescription Drug Transition Policy English  
Medication Therapy Management (MTM) Program Information English  
Utilization Management Program English  
Request for Medicare Prescription Drug Coverage Determination Form English Espanol
Request for Medicare Prescription Drug Appeal (Redetermination) Form English Espanol
Request for Prescription Drug Prior Authorization Exception English Espanol
Request for Prescription Drug Quantity Limits English Espanol
Request for Prescription Drug Step Therapy Exception English Espanol
Request for Prescription Drug Reimbursements English  
Over the Counter Benefit – Place Order English  
Extra Help to pay your plan premium or prescriptions (LIS) English  
Pharmacy FAQ
What is a formulary? English  
What is a late penalty for Part D? English  
All Plans - Additional Documents
Legal Documents
Advance Directive Information English  
Appointment of Representative Form English  
Disenrollment Rights and Responsibilities English  
National Coverage Determinations (NCD) and Local Coverage Determinations (LCD) English  
Non-Discrimination Notice English  
Physician Treatment Request Form (Medical Prior Authorization) English  
Clinical Guidelines English  
Notice of Privacy Practices English  
Referral and Prior Authorization Guide for Members English  
Authorization to Disclose PHI Form English  
Transition of Care Form English  
Your Rights and Responsibilities as a Member of a GlobalHealth Medicare Advantage plan English  
Creditable Coverage Notice English  
Member Reimbursement
Direct Member Reimbursement Form - Online Form - Routine Vision Exam/Eyewear English  
Direct Member Reimbursement Form - Mail In Form - Routine Vision Exam/Eyewear English  
Direct Member Reimbursement Form - Other Medical Services English Espanol
Extra Documents
Best Available Evidence (BAE) - from CMS English  
Quality Improvement Program English  
Remember to Take Your Medication English  
2025 Health Risk Assessment (HRA) English  
Smart Wallet Approved Items English  
Member Health Tools
Blood pressure log English  
Member Newsletters
Member Newsletters
May 2025 Issue English  
February 2025 Issue English  
December 2024 Issue English  
August 2024 Issue English