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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

May 2021 Issue

January 2021 Issue

Document Name Language Action
Drug Formulary, Pharmacy Prior Authorization and Step Therapy Information
Current 2022 Versions English View
Current 2021 Versions English View
Summary Of Benefits
Generations State of Oklahoma Group Retirees - Plan year 2022 English View
Generations State of Oklahoma Group Retirees - Plan year 2022 Espanol View
Generations State of Oklahoma Group Retirees - Plan year 2021 English View
Evidence Of Coverage (EOC)
Generations State of Oklahoma Group Retirees - Plan Year 2022 English View
Generations State of Oklahoma Group Retirees - Plan Year 2022 Espanol View
Generations State of Oklahoma Group Retirees - Plan Year 2021 English View
Member Letter - Important information regarding behavioral health telehealth visits  English View
Annual Notice of Changes (ANOC)
Generations State of Oklahoma Group Retirees - 2022 English View
Generations State of Oklahoma Group Retirees - 2022 Espanol View
Generations State of Oklahoma Group Retirees - 2021 English View
Enrollment Forms
2022 OMES EGID Application for Medicare Advantage Prescription Drug (MA-PD) Plan English View
OMES EGID Application for Retiree/Vested/Non-Vested/Defer Insurance Coverage Form English View
2021 OMES EGID Application for Medicare Advantage Prescription Drug (MA-PD) Plan English View
OMES EGID Application for Retiree/Vested/Non-Vested/Defer Insurance Coverage Form English View
Provider Directory
Plan Year 2022  English View
Plan Year 2021  English View

 

Important Links Language Action
Pharmacy
Medicare Part D Prescription Claim Form English View
2022 Pharmacy Search Tool English View
2021 Pharmacy Search Tool English View
Prescription Drug Mail Order Form English View
Prescription Drug Mail Order Form Espanol View
Prescription Drug Transition Policy English View
Medication Therapy Management (MTM) Program Information English View
Utilization Management Program English View
Request for Medicare Prescription Drug Coverage Determination Form English View
Request for Medicare Prescription Drug Appeal (Redetermination) Form English View
Request for Prescription Drug Prior Authorization Exception English View
Request for Prescription Drug Quantity Limits English View
Request for Prescription Drug Step Therapy Exception English View
Request for Prescription Drug Reimbursements English View
Over the Counter Benefit – Place Order English View
2021 Over the Counter Benefit FAQs English View
2022 Over the Counter Benefit Catalog (Updated 10/01/2021) English View
2021 Over the Counter Benefit Catalog (Updated 10/01/2020) English View

 

Additional Documents Language Action
Advance Directive Information English View
Appointment of Representative Form English View
Assistance During a Disaster English View
CMS Website's Best Available Evidence (BAE) Page English View
Get information about Extra Help to pay your plan premium or prescriptions (LIS) English View
Non-Discrimination Notice English View
Plan Year 2022 Medicare Star Ratings English View
Plan Year 2022 Medicare Star Ratings Espanol View
Plan Year 2021 Medicare Star Ratings English View
Plan Year 2021 Medicare Star Ratings Espanol View
Privacy Notice English View
Release of Information Form English View
Your Rights and Responsibilities as a Member of a GlobalHealth Medicare Advantage plan English View
Health Living Tips English View
2022 Creditable Coverage Notice English View
2021 Creditable Coverage Notice English View
2020 Creditable Coverage Notice English View

 

Click here for member materials prior to 2021.