Senior Health Plan (HMO)
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      • Online Formulary/Prescription Drug Search
      • Online Pharmacy Search
      • Mail Order Prescription Drug Program
        • Costco Mail Order
        • Walgreens Mail Service
      • Prescription Drug Discount Program
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      • Comprehensive Formulary & Utilization Management
      • CMS Best Available Evidence Policy
      • Prescription Drug Transition Policy
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      • Drug Management Programs
      • Monthly plan premiums for people who get extra help from Medicare
      • Improving Drug Utilization Review Controls
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      • Fraud Awareness
    • Grievances, Coverage Decisions, Appeals
      • Medicare Part D Coverage Decisions and Appeals
      • Summary of Medicare Part C and Part D grievances, coverage decisions and appeals
      • National Coverage Determination (NCD) Notification
      • Medicare Complaint Form
      • Get help with complaints, grievances, and information requests
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  • Medical Only Plans
    • Plan Details
      • Silver
      • Silver Savings
    • Additional Benefits
      • Fitness Plus Benefit
      • Vision Benefits
      • Dental Benefits
      • Hearing Aid Benefits
      • Non-Emergency Transportation
      • Over-the-Counter Benefits
      • Nurse Line
      • Behavioral Health
    • Seminars
    • Senior Center
    • Newsletters
    • Important Resources
      • Physician or Hospital Search
      • Dentist Search
      • Request Directories
      • Forms and Documents
      • Cancer Care
      • Senior Health Plan Star Rating
      • Notice of Availability (Language and Auxiliary Aids and Services)
      • Service Area
      • Health and Wellness
      • Annual Wellness Visit
      • FAQs
      • Medicare & You
      • Disenrollment Information
      • Disaster Planning Policy
      • Quality Improvement Program
      • Quality Improvement Organization
      • Privacy and Compliance
      • Clinical Criteria
      • Disclaimers
      • Fraud Awareness
    • Grievances, Coverage Decisions, Appeals
      • Summary of Medicare Part C grievances, coverage decisions and appeals
      • National Coverage Determination (NCD) Notification
      • Medicare Complaint Form
      • Get help with complaints, grievances, and information requests
    • For Members
    • State of Oklahoma Retirees
    • Information for Employers
    • Information for Brokers
    • Information for Providers
    • Contact us for help
  • Oklahoma Dual Complete
    • Plan Details
      • Dual Eligibility
    • Additional Benefits
      • Vision Benefits
      • Dental Benefits
      • Hearing Aid Benefits
      • Non-Emergency Transportation
      • Over-the-Counter Benefits
      • Nurse Line
      • Behavioral Health
    • Pharmacy and Prescription Info
      • Online Formulary/Prescription Drug Search
      • Online Pharmacy Search
      • Mail Order Prescription Drug Program
        • Costco Mail Order
        • Walgreens Mail Service
      • Prescription Drug Discount Program
      • Medicare Prescription Payment Plan
      • Comprehensive Formulary & Utilization Management
      • CMS Best Available Evidence Policy
      • Prescription Drug Transition Policy
      • Medication Therapy Management (MTM) Program
      • Drug Management Programs
      • Monthly plan premiums for people who get extra help from Medicare
      • Improving Drug Utilization Review Controls
    • Seminars
    • Senior Center
    • Newsletters
    • Important Resources
      • Physician or Hospital Search
      • Dentist Search
      • Request Directories
      • Forms and Documents
      • Cancer Care
      • Senior Health Plan Star Rating
      • Notice of Availability (Language and Auxiliary Aids and Services)
      • Service Area
      • Health and Wellness
      • Annual Wellness Visit
      • FAQs
      • Medicare & You
      • Disenrollment Information
      • Disaster Planning Policy
      • Quality Improvement Program
      • Quality Improvement Organization
      • Privacy and Compliance
      • Clinical Criteria
      • Disclaimers
      • Fraud Awareness
    • Grievances, Coverage Decisions, Appeals
      • Medicare Part D Coverage Decisions & Appeals
      • Summary of Medicare Part C and Part D grievances, coverage decisions and appeals
      • National Coverage Determination (NCD) Notification
      • Medicare Complaint Form
      • Get help with complaints, grievances, and information requests
    • For Members
    • State of Oklahoma Retirees
    • Information for Employers
    • Information for Brokers
    • Information for Providers
    • Contact us for help
  • Medical & Pharmacy Plans
    • Plan Details
      • Silver Plus
      • Platinum
      • Platinum Plus
    • Additional Benefits
      • Fitness Plus Benefit
      • Vision Benefits
      • Dental Benefits
      • Hearing Aid Benefits
      • Non-Emergency Transportation
      • Over-the-Counter Benefits
      • Nurse Line
      • Behavioral Health
    • Pharmacy and Prescription Info
      • Online Formulary/Prescription Drug Search
      • Online Pharmacy Search
      • Mail Order Prescription Drug Program
        • Costco Mail Order
        • Walgreens Mail Service
      • Prescription Drug Discount Program
      • Medicare Prescription Payment Plan
      • Comprehensive Formulary & Utilization Management
      • CMS Best Available Evidence Policy
      • Prescription Drug Transition Policy
      • Medication Therapy Management (MTM) Program
      • Drug Management Programs
      • Monthly plan premiums for people who get extra help from Medicare
      • Improving Drug Utilization Review Controls
    • Seminars
    • Senior Center
    • Newsletters
    • Important Resources
      • Physician or Hospital Search
      • Dentist Search
      • Request Directories
      • Forms and Documents
      • Cancer Care
      • Senior Health Plan Star Rating
      • Notice of Availability (Language and Auxiliary Aids and Services)
      • Service Area
      • Health and Wellness
      • Annual Wellness Visit
      • FAQs
      • Medicare & You
      • Disenrollment Information
      • Disaster Planning Policy
      • Quality Improvement Program
      • Quality Improvement Organization
      • Privacy and Compliance
      • Clinical Criteria
      • Disclaimers
      • Fraud Awareness
    • Grievances, Coverage Decisions, Appeals
      • Medicare Part D Coverage Decisions and Appeals
      • Summary of Medicare Part C and Part D grievances, coverage decisions and appeals
      • National Coverage Determination (NCD) Notification
      • Medicare Complaint Form
      • Get help with complaints, grievances, and information requests
    • For Members
    • State of Oklahoma Retirees
    • Information for Employers
    • Information for Brokers
    • Information for Providers
    • Contact us for help
  • 2025
  • 2026

2026 Medical & Prescription Plans

Plan Details

Additional Benefits

Pharmacy and Prescription Info

Seminars

Senior Center

Newsletters

Important Resources

Physician or Hospital Search

Dentist Search

Request Directories

Forms and Documents

Cancer Care

Senior Health Plan Star Rating

Notice of Availability (Language and Auxiliary Aids and Services)

Service Area

Health and Wellness

Annual Wellness Visit

FAQs

Medicare & You

Disenrollment Information

Disaster Planning Policy

Quality Improvement Program

Quality Improvement Organization

Privacy and Compliance

Clinical Criteria

Disclaimers

Fraud Awareness

Grievances, Coverage Decisions, Appeals

For Members

State of Oklahoma Retirees

Information for Employers

Information for Brokers

Information for Providers

Contact us for help

Member Portal
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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 Form
  • Plan Change Form
  • 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 Form
  • Part D Appeal Request Form

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 Medical & Prescription Plans

  • Find helpful information in Important Resources .
  • Find out about Upcoming Seminars.
  • Find upcoming events at our Senior Center.
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Senior Health Plan is an HMO plan and a D-SNP plan with a Medicare & Medicaid contract. Enrollment in Senior Health Plan depends on contract renewal.

We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact www.medicare.gov or 1-800-MEDICARE (1-800-633-4227) to get information on all of your options. Medicare customer service representatives are available 24 hours a day, 7 days a week. TTY/TDD users should call 1-877-486-2048.

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  • Updated: 10/01/2025
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