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GENERATIONS STATE OF OKLAHOMA GROUP RETIREES PLAN MEMBER MATERIALS, FORMS, RESOURCES & GUIDELINES

Learn more about your Generations State of Oklahoma Retiree 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.

Member Newsletter

September 2021 Issue (OSR)

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

Document Name
Drug Formulary, Pharmacy Prior Authorization and Step Therapy Information
Current 2022 Versions English  
Summary Of Benefits
Generations State of Oklahoma Group Retirees - Plan year 2022 English  
Benefits Overview
Star Ratings - 2022 English Espanol
Star Ratings - 2021 English Espanol
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  
Member Letter - Important information regarding behavioral health telehealth visits 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  
Provider Directory
Plan Year 2022  English  

 

Important Links
Pharmacy
Medicare Part D Prescription Claim Form English  
2022 Pharmacy Search Tool 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 10/01/2021) English Espanol
Over the Counter Benefit – Place Order English  

 

Additional Documents
Legal Documents
Advance Directive Information English  
Appointment of Representative Form English  
Non-Discrimination Notice English  
Privacy Notice English  
Release of Information Form English  
Your Rights and Responsibilities as a Member of a GlobalHealth Medicare Advantage plan English  
Health Living Tips English  
2022 Creditable Coverage Notice English  
Member Reimbursement
Extra Help to pay your plan premium or prescriptions (LIS) English  
Extra Documents
Assistance During a Disaster English  
Best Available Evidence (BAE) - from CMS English  

 

Click here for member materials prior to 2022.