State of Oklahoma Group Retirees Member Materials
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
2021 Plan
Drug Formulary, Pharmacy Prior Authorization and Step Therapy Information
Summary of Benefits
Evidence of Coverage (EOC)
Member Letter - Important information regarding behavioral health telehealth visits
Annual Notice of Changes (ANOC)
Enrollment Forms
- 2021 OMES EGID Application for Medicare Advantage Prescription Drug (MA-PD) Plan
- OMES EGID Application for Retiree/Vested/Non-Vested/Defer Insurance Coverage Form
Provider Directory
- Plan Year 2021 Provider Directory (for a current listing, click here.)
Pharmacy Documents, Links and Resources
- Medicare Part D Prescription Claim Form
- 2021 Pharmacy Search Tool
- Prescription Drug Mail Order Form
- For more information, please visit https://www.caremark.com/manage-prescriptions/rx-delivery-by-mail.html.
- Prescription Drug Transition Policy
- Medicare Therapy Management (MTM) Program Information
- Utilization Management Program
- Request for Medicare Prescription Drug Appeal (Redetermination) Form
- Request for Medicare Prescription Drug Coverage Determination Form
- Use the above Coverage Determination Form for Exceptions, Prescription Drug Prior Authorization, Quantity Limits, Step Therapy, and Reimbursements.
- Over the Counter Benefit
Please note when ordering OTC items online, you should not enter the “01” located at the end of your GlobalHealth member ID number. If the “01” is entered, the member ID number will not be recognized.
Additional Documents, Links and Resources
- Plan Year 2021 Medicare Star Ratings (English) (Spanish)
- Non-Discrimination Notice
- Get information about Extra Help to pay your plan premium or prescriptions (LIS)
- Your Rights and Responsibilities as a Member of Generations Medicare Advantage plan, offered by GlobalHealth
- Assistance During a Disaster
- Advance Directive Information
- CMS Website's Best Available Evidence (BAE) Page
- Appointment of Representative Form
- Healthy Living Tips
- Release of Information Form
- Privacy Notice
- 2020 Creditable Coverage Notice
Click here for member materials prior to 2021.