Forms and Documents

Use the links below to access some of the important Senior Health Plan forms. If you can't find the form you're looking for, please contact us for assistance.

Enrollment

Pre-Enrollment Checklist
Individual Election Formupdated 06/12/2025
Plan Change Formupdated 01/24/2025
Request for Disenrollment

Manage Plan

Auto Bank Draft Authorization
SSA/RRB Withhold Form
Protected Health Information (PHI) Authorization Form
Member Request to Access Protected Health Information
Primary Care Physician (PCP) Change Form
Appointment of Representative Form
Oklahoma Advance Directive for Health Care
Alternate Contact
Continuity of Care Program

Claims, Authorizations and Appeals

Claim Form
Part C Authorization Request Form
Coverage Determination Request Form
Part C Appeal Request Formupdated 05/14/2026

Health and Wellness

Annual Care Checklistupdated 11/22/2024
Medication Log
Fall Safety Checklist
Blood Pressure Log
Blood Pressure Brochure
Text Campaign

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Everything You Need to Know About CommunityCare Senior Health Plan

Find helpful information in Important Resources .
Find out about Upcoming Seminars.
Find upcoming events at our Senior Center.

2025 Senior Health Plan

Plan Details and Enrollment

Seminars

Additional Benefits

Important Resources

Grievances, Coverage Decisions, Appeals

Disclaimers

Fraud Awareness

For Members

State of Oklahoma Retirees

Information for Employers

Information for Brokers

Information for Providers

Contact us for help