​2019 Documents and Links

• 2019 All Cost Sheets​
• 2019 Benefits at a Glance
• 2019 Rates
• 2019 Summary Plan Description
• 2019 Metro and Enid - Summary of Benefits and Coverage
• 2019 Regional - Summary of Benefits and Coverage
• 2019 Out of State Dependent - Summary of Benefits and Coverage
• ​2019 INTEGRIS Formulary
• 2019 INTEGRIS PDL
• 2019 INTEGRIS Formulary Drug Exclusions
• 2019 Pharmacy Plan Detail
• 2019 How To Use The ConnectYourCare Employee Portal

​
​​

2019 Forms

• ​2019 Medical Claim Form
• Mail Order Prescription Drug Form
• Life Event Form
• Common Law Marriage Affidavit
• Dependent Disability Affidavit
• Benefits Appeal Form
• HIPAA Privacy Notice
• Dependent Verification Form - Spouse
• Spouse Other Benefits Authorization Form Surcharge
• Dependent Verification Form - Child
• Out of State Dependent Proof of Residency Form
• 2019 How To File A Claim With ConnectYourCare