Senior Health Plan (HMO)
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  • Medical & Pharmacy Plans
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      • Wallet Benefits
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    • 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
    • Pharmacy and Prescription Info
      • Online Formulary/Prescription Drug Search
      • Online Pharmacy Search
      • Mail Order Prescription Drug Program
        • CVS 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
    • Disclaimers
    • Fraud Awareness
      • How You Can Help
      • How to Report Fraud
    • For Members
    • State of Oklahoma Retirees
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    • Contact us for help
  • Medical Only Plans
    • Plan Details and Enrollment
      • Silver
      • Silver Savings
      • Enroll Now
    • Seminars
    • Additional Benefits
      • Wallet Benefits
      • Vision Benefits
      • Dental Benefits
      • Hearing Aid Benefits
      • Non-Emergency Transportation
      • Over-the-Counter Benefits
      • Nurse Line
      • Behavioral Health
    • 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
      • Senior Center
      • Newsletters
      • 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
    • 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
    • Disclaimers
    • Fraud Awareness
      • How You Can Help
      • How to Report Fraud
    • For Members
    • State of Oklahoma Retirees
    • Information for Employers
    • Information for Brokers
    • Information for Providers
    • Contact us for help
  • Oklahoma Dual Complete
    • Plan Details and Enrollment
      • Dual Eligibility
      • Enroll Now
    • Seminars
    • Additional Benefits
      • Vision Benefits
      • Dental Benefits
      • Hearing Aid Benefits
      • Non-Emergency Transportation
      • Over-the-Counter Benefits
      • Nurse Line
      • Behavioral Health
    • 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
      • Senior Center
      • Newsletters
      • 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
    • 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
    • Pharmacy and Prescription Info
      • Online Formulary/Prescription Drug Search
      • Online Pharmacy Search
      • Mail Order Prescription Drug Program
        • CVS 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
    • Disclaimers
    • Fraud Awareness
      • How You Can Help
      • How to Report Fraud
    • For Members
    • State of Oklahoma Retirees
    • Information for Employers
    • Information for Brokers
    • Information for Providers
    • Contact us for help
  • Medical & Pharmacy Plans
    • Plan Details and Enrollment
      • Silver Plus
      • Platinum
      • Platinum Plus
      • Enroll Now
    • Seminars
    • Additional Benefits
      • Wallet Benefits
      • Vision Benefits
      • Dental Benefits
      • Hearing Aid Benefits
      • Non-Emergency Transportation
      • Over-the-Counter Benefits
      • Nurse Line
      • Behavioral Health
    • 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
      • Senior Center
      • Newsletters
      • 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
    • 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
    • Pharmacy and Prescription Info
      • Online Formulary/Prescription Drug Search
      • Online Pharmacy Search
      • Mail Order Prescription Drug Program
        • CVS 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
    • Disclaimers
    • Fraud Awareness
      • How You Can Help
      • How to Report Fraud
    • For Members
    • State of Oklahoma Retirees
    • Information for Employers
    • Information for Brokers
    • Information for Providers
    • Contact us for help
  • 2025
  • 2026

2025 Medical & Prescription Plans

Plan Details and Enrollment

Seminars

Additional Benefits

Important Resources

Physician or Hospital Search

Request Directories

Forms and Documents

Cancer Care

Senior Health Plan Star Rating

Notice of Availability (Language and Auxiliary Aids and Services)

Service Area

Senior Center

Newsletters

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

Grievances, Coverage Decisions, Appeals

Pharmacy and Prescription Info

Disclaimers

Fraud Awareness

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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Member Login

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 Form
  • Part D Appeal Request Formupdated 02/06/2025

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: 03/20/2025
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