Use the links below to access some of the most popular Advantage Medicare Plan forms. If you can't find the form you're looking for, please contact us for assistance.
- Claim Form
- Oklahoma Advance Directive for Health Care
- Appointment of Representative Form
- Auto Bank Draft Authorization
- Pre-Enrollment Checklist
- Individual Election Form
- Fall Safety Checklist
- Medication Log
- Coverage Determination Request Form - updated 4/18/2019
- Primary Care Physician (PCP) Change Form
- Protected Health Information (PHI) Authorization Form
- Part C Appeal Request Form
- Part D Appeal Request Form
- Request for Disenrollment
- SSA/RRB Withhold Form
- Plan Change Form
- Preventive Services Checklist
- Tulsa Area Social Classes Schedule
Forms will open in a new window and require Acrobat Reader to view.
Everything You Need to Know About CommunityCare Advantage Medicare Plan
Find helpful information regarding our Advantage Medicare Plan in the Advantage Medicare Plan Forms & Resources section. Don't forget to check out Advantage Medicare Plan seminars and social classes. Please call us at 918-594-5202 to register for a seminar or social class.
Although Medicare is a Federal program, Advantage Medicare Plan is available only to individuals who live in our plan service area. To stay a member of our plan, you must keep living in this service area.
The ADVANTAGE Medicare Plan service area includes these counties in Oklahoma: Craig, Creek, McIntosh, Muskogee, Nowata, Osage, Tulsa, Wagoner and Washington
If you plan to move out of the service area, please contact Customer Service at 918-594-5202.