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Pelican HSA 775

Active Employee

 

Pelican HRA 1000

Active Employee

Medicare Retiree

Non-Medicare Retiree

Magnolia Local

Active Employee/
Non-Medicare Retiree

Medicare Retiree

Medicare Retiree
(prior to March 2015)

Non-Medicare Retiree
(prior to March 2015)

Magnolia Local Plus

Active Employee/
Non-Medicare Retiree

Medicare Retiree

Medicare Retiree
(prior to March 2015)

Non-Medicare Retiree
(prior to March 2015)

Magnolia Open Access

Active Employee/
Non-Medicare Retiree

Medicare Retiree

Medicare Retiree
(prior to March 2015)

Non-Medicare Retiree
(prior to March 2015)

Nurse

Choose your member and plan type above so we can provide you with the appropriate information.

Blue 365's Dental Solutions

OGB members get 20-50% discounts to a network of dentists for just $6 a month. There is no waiting and no red tape to join. You will need to register for Blue365 if you have not already.

Go to Blue365


OGB Customer Forms

Our forms are updated regularly. Please use the most current form to avoid delays in processing. Read each form carefully for special instructions and/or submission information.

2019 OGB Enrollment Guide

Appeals Request Form

Authorized Delegate Form

Balance Billing Notice

Forma De Autorización Delegada

BlueCard International Claim

Catapult Expectant Mother

Catapult Health Primary Care Provider

Continuity of Care Request

Health Insurance Claim (includes OGB Flu Vaccination)

Non-covered Drug Discount

Other Coverage Questionnaire

Request for Continuation of Health Coverage for Incapacitated Child