I Want To...
Find a Provider
Find a Pharmacy
Change My PCP
Contact GlobalHealth
Sign Up for Emails
Have an Agent Contact Me

A salesperson will call.

2018 State of Oklahoma Retiree Medicare Advantage Plan

Benefits at a Glance

The following is intended to be only a summary of benefits for the Generations State of Oklahoma Retiree Plan. For a complete list, including any limitations, exclusions, and plan restrictions, please review the GlobalHealth Summary of Benefits for the Generations State of Oklahoma Retiree Plan.

Coverage effective Jan 1, 2018 to Dec 31, 2018

Benefit You Pay
Premium $192
Deductible $0
MOOP $3,400
Primary Care Physician $0 copay
Specialist $20 copay
Preventative Care* You pay nothing
Inpatient Hospital Care $250
Outpatient Surgery and Hospital Services

$150 copay for observation services
$200 copay for surgery

Diagnostic Tests, X-rays, Lab Services and Radiology You pay $150 copay per visit for diagnostic radiology service
You pay nothing for lab services
You pay $100 for sleep studies in an outpatient facility; all other
diagnostic tests and procedures, you pay nothing
• You pay $40 copay per visit for therapeutic radiology 
• You pay nothing for outpatient x-rays
MRI, PET, CT Scans $150
Ambulance Services $50
Emergency Room $75
Urgent Care $20 copay 

Prescription Drug Coverage

Generations State of Oklahoma Retiree Plan Deductible: $0

Drug Type 30-Day Supply at Preferred Retail Pharmacy 90-Day Supply from Mail Order Pharmacy† 30-Day Supply from Standard Retail Pharmacy
Tier 1 - Preferred Generics† $5 $10 $10
Tier 2 - Generics† $15 $30 $20
Tier 3 - Preferred Brand Name‡ $42 $84 $47
Tier 4 - Non-Preferred 40% 30% 50%
Tier 5 - Specialty 33% N/A 33%
Coverage Gap Stage After your prescription costs reach $3,750 Your costs will be no more than 44% of the cost for generic drugs. You pay 35% of the cost of brand name drugs.
Catastrophic Coverage Stage After you have paid $5,000 out-of-pocket You pay the greater of 5% of the cost of the drug or $3.35 for generics/ $8.35 for brand names.

* Our plan covers many preventive services, including:

  • Abdominal aortic aneurysm screening
  • Alcohol misuse counseling
  • Bone mass measurement
  • Breast cancer screening (mammogram)
  • Cardiovascular disease (behavioral therapy)
  • Cardiovascular screenings
  • Cervical and vaginal cancer screening
  • Colonoscopy
  • Colorectal cancer screenings
  • Depression screening
  • Diabetes screenings
  • Fecal occult blood test
  • Flexible sigmoidoscopy
  • HIV screening
  • Medical nutrition therapy services
  • Obesity screening and counseling
  • Prostate cancer screenings (PSA)
  • Sexually transmitted infections screening and counseling
  • Tobacco use cessation counseling (counseling for people with no sign of tobacco-related disease)
  • Vaccines, including Flu shots, Hepatitis B shots, Pneumococcal shots
  • "Welcome to Medicare" preventive visit (one-time)
  • Yearly "Wellness" visit

Any additional preventive services approved by Medicare during the contract year will be covered.

† You pay the same amount in the Coverage Gap Phase as you do in the Initial Coverage Phase for Tier 1 & 2.

‡ You pay the same amount in the Coverage Gap Phase as you do in the Initial Coverage Phase for Tier 3, for insulin only.