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GENERATIONS STATE OF OKLAHOMA RETIREES ARCHIVES

Document Name
Summary Of Benefits
Generations State of Oklahoma Group Retirees - Plan year 2022 English  
Evidence Of Coverage (EOC)
Generations State of Oklahoma Group Retirees - Plan Year 2022 (updated 11/15/2021) English Espanol
Generations State of Oklahoma Group Retirees erratum (updated 11/15/2021) English  
Annual Notice of Changes (ANOC)
Generations State of Oklahoma Group Retirees - 2022 English Espanol
Enrollment Forms
2022 OMES EGID Application for Medicare Advantage Prescription Drug (MA-PD) Plan English  
OMES EGID Application for Retiree/Vested/Non-Vested/Defer Insurance Coverage Form English  

 

Important Links
Pharmacy Documents, Links and Resources
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  
Request for Medicare Prescription Drug Appeal (Redetermination) Form English  
Request for Prescription Drug Prior Authorization Exception English  
Request for Prescription Drug Quantity Limits English  
Request for Prescription Drug Step Therapy Exception English  
Request for Prescription Drug Reimbursements English  
Over the Counter Benefit Catalog (Updated 05/01/2022) English Espanol
Over the Counter Benefit – Place Order English  
All Plans - Additional Documents
ADDITIONAL DOCUMENTS, LINKS AND RESOURCES
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  
Privacy Notice English  
Referral and Prior Authorization Guide for Members English  
Release of Information Form English  
Transition of Care Form English  
Your Rights and Responsibilities as a Member of a GlobalHealth Medicare Advantage plan English  
2022 Creditable Coverage Notice English  
Member Newsletters
Member Newsletters
October 2022 Issue English  
August 2022 Issue English  
June 2022 Issue English  
March 2022 Issue English