OSAGE NATION HEALTH LIMITED BENEFIT INFORMATION AND FORMS  /  Osage Nation Regional Gathering Fund Program Information and Forms  / 



OSAGE NATION
HEALTH LIMITED BENEFIT

INFORMATION AND FORMS
 
 
MUST BE
AN OSAGE TRIBAL MEMBER TO QUALIFY FOR THE OSAGE NATION HEALTH LIMITED BENEFIT (HAVING A C.D.I.B. CARD DOES NOT QUALIFY YOU FOR THE BENEFIT; IF YOU NEED AN APPLICATION FOR MEMBERSHIP CLICK HERE SO YOU CAN BE DIRECTED TO THE OSAGE NATION MEMBERSHIP WEBSITE) 

INITIAL ENROLLMENT FORMS
TO REQUEST A HEALTH BENEFIT INITIAL ENROLLMENT PACKET CALL (918)287-5662 PRESS OPTION 5
 
$500 Maximum Benefit
Per Osage Tribal Member; members may be required to submit a detailed explanation of benefit on purchases $50 or more.  For questions call (918)287-5662 press option 5
 
$1000 Maximum Benefit
Per Osage Tribal Member (65 years and older before of December 31, 2012); members may be required to submit a detailed explanation of benefit on purchases $50 or more.  For questions call (918)287-5662 press option 5
 
NOTE  
DEADLINE to file reimbursements for 2012 was MARCH 28, 2013
  
 
UPDATED-2013 
 

Due to 2011 Federal IRS Changes
OVER THE COUNTER ELIGIBLE PURCHASES WILL ONLY BE PAID FOR BY REIMBURSMENT
 
 
CHANGE OF ADDRESS FORM (NEW) To protect your benefit (you can no longer change your address over the phone);  to change your address through out the year a change of address form must be filled out and signed.  If you are re-enrolling for the new year the change of address form is not required; you will update your address and contact information on the re-enrollment form. 
 
All forms can be excepted via U.S. Mail, Scan and e-mail, or fax (please keep copies of all submitted documents) to:
 
Contact:

Mutual Assurance Administrators

Name:
Katrina Harkey

Mailing:   P.O. Box 42096
                 Oklahoma City, OK 73123
 
Phone:       (405)607-2648
Toll Free:  (800)825-3540 ext. 2648
                                            
Fax:           (405)858-1125