Peoples Health Group Medicare (HMO-POS) for Office of Group Benefits | 2018

Questions?

Call us.
1-800-978-9765 (TTY: 711)

Monday through Friday, from 8 a.m. to 8 p.m.

 

Peoples Health Group Medicare for the Office of Group Benefits (OGB) is designed for members of the Louisiana Office of Group Benefits. Peoples Health Group Medicare for OGB is a Medicare Advantage HMO POS plan with a long list of benefits. You get more benefits than Original Medicare, plus additional benefits like Part D prescription drug coverage with coverage through the gap, routine vision and dental benefits, a $0 fitness center membership, worldwide urgent and emergency care, and much more. This plan has a robust network of providers, but you also have an out-of-network option.

Plan Highlights

$0

Tier 1 and Tier 2
Generic Drugs

$0

Dental Exams
and Cleanings

$5

Primary Care
Physician Visit

$0

Eyeglasses
or Contacts

$0

Fitness Club
Membership

Helpful Tools

Find Doctors, Search Medications and More...

Use our search tools to find out if your doctors and favorite pharmacy are in our network or if we cover your prescription drug.

If you need help, call us
1-800-978-9765 (TTY: 711)

Explore Plan Benefits

Doctor and Hospital Coverage

Peoples Health Group Medicare FOR OGBIn NetworkOut Of Network
Out-of-Pocket Maximum$2,500Does not apply out of network
Doctor Visits
Primary Care Physician Visit$520% coinsurance
Specialist Visit$1020% coinsurance
Preventive Care+
Pap Smears, Pelvic Exams, Mammograms$020% coinsurance
Prostate and Colorectal Cancer Screenings$020% coinsurance
Bone Mass Measurement$020% coinsurance
Vaccinations (flu, pneumonia)$0$0
Labs and Tests+
Lab Services, Diagnostic Tests, X-rays and Advanced Imaging
(MRI, MRA, CT, CTA, PET scans, etc.)
$020% coinsurance
Outpatient Surgery
Outpatient Hospital Facility or Ambulatory Surgical Center$020% coinsurance
Inpatient Hospital Care per Benefit Period
Inpatient Deductible$0Same as Medicare
Hospital Stay per day for days 1-10$50Same as Medicare
Hospital Stay for days 11 and beyond $0Same as Medicare
Worldwide Emergency and Urgent Care♦
Emergency Care – Copay waived if admitted.$50$50
Urgently Needed Care$10 in the U.S.$10 in the U.S.; $50 outside the U.S.
Emergency Transportation (per one-way trip)
Emergency Ambulance Services$50$50
Home Health
Home Health Care$020% coinsurance
Skilled Nursing Facility Care
Semiprivate Room and Board (per day for days 1-20)$0$0
Semiprivate Room and Board (per day for each additional day of the benefit period)$25$25
Outpatient Services and Supplies
Occupational, Physical or Speech Therapy Visit (Medicare limits apply)$020% coinsurance
Durable Medical Equipment (DME) (wheelchairs, oxygen, etc.)5% coinsurance20% coinsurance
Diabetes Monitoring Supplies (test strips, monitor, etc., from a DME provider)$020% coinsurance
Mental Health and Substance Abuse Treatment
Inpatient Mental Health Care (per day for days 1-5)$25Same as Medicare
Inpatient Mental Health Care (per day for days 6 - 90)$0Same as Medicare
Outpatient Mental Health or Substance Abuse Treatment Visit$020% coinsurance
Hearing Services
Medicare-Covered Diagnostic Exam$1020% coinsurance

Notes:

Authorization is required for certain services.

+Office visit copay may apply.

♦Emergency care copay waived if admitted to inpatient hospital care within 24 hours for the same condition. Up to $5,000 of coverage for emergency and urgently needed care (combined) outside the U.S. and its territories.

Part D Prescription Drug Coverage

All drugs tiers are COVERED through the Part D coverage gap.
Ninety-day supplies of maintenance medications are available at retail pharmacies and by mail order.

 Up to a 30-Day Supply Up to a 90-Day Supply*
Tier 1 $0$0
Tier 2$0$0
Tier 3$20$40
Tier 4$40$80
Tier 520% coinsurance20% coinsurance

*90-day supply costs listed are at network pharmacies with preferred cost-sharing

Additional Benefits –  Not Covered by Original Medicare

Peoples Health Group Medicare FOR OGBYour Cost
Fitness
Fitness Center Membership$0
Routine Vision Services
Eye Exam$15
Eyeglasses or Contact Lenses (one pair per year)$0
Dental – up to $2,000 in coverage
Oral Exams and Cleanings (every six months)$0
X-rays (one set per year)$0
Comprehensive Dental (such as fillings. $50 deductible applies)Copays vary

Notes:

Costs listed are based on use of network providers.

Authorization is required for certain services.

For a detailed list of all plan benefits, click here to download the 2018 Peoples Health Group Medicare for OGB Evidence of Coverage.

Eligibility Guidelines
Determining if you’re eligible to enroll in Peoples Health Group Medicare for OGB is easy. If you satisfy the following enrollment requirements, you’re eligible to become a member of this plan:

  • Be a retiree with the OGB and meet any additional requirements determined by the employer or retiree group
  • Be enrolled in Medicare Part A and Medicare Part B
  • Not have end-stage renal disease (ESRD), with limited exceptions, such as if you develop ESRD when you are already a member of a plan that we offer, or you were a member of a different plan that is no longer available
  • Reside within the plan’s service area determined by the OGB.

How to Enroll

Enroll by Appointment

Call us toll-free at 1-800-978-9765, Monday through Friday, from 8 a.m. to 8 p.m. TTY users may call 711.

A sales representative will schedule an appointment with you at your home or meet you at one of our offices.

Peoples Health – Baton Rouge
7434 Perkins Rd., Suite 200
Baton Rouge, LA 70808
View Map: Peoples Health – Baton Rouge

Peoples Health – Metairie
Three Lakeway Center
3838 N. Causeway Blvd., Suite 2200
Metairie, LA 70002
View Map: Peoples Health – Metairie

Enroll by Mail

Write us and request an enrollment packet. The address is:

Peoples Health Group Medicare for OGB Enrollment Packet Request
Three Lakeway Center
3838 N. Causeway Blvd., Suite 2200
Metairie, LA 70002

What to Expect Next

Confirmation of Enrollment Letter

We will send you written confirmation of your enrollment in the mail.

New Member Packet

We will mail a packet to you with important information about your coverage through your Peoples Health plan. Be sure to read everything in the packet and call us with any questions.  We will also send you a member ID card.

Transition Call

As a new member, you will receive a call from a Peoples Health representative to coordinate continuation of any special services you may need. This helps us make sure there are no interruptions in your healthcare.

Important Documents
Plan Overview for Peoples Health Group Medicare for OGB – An overview of plan benefits

Annual Notice of Changes for Peoples Health Group Medicare for OGB – A summary of plan benefit changes compared to the previous year and other important plan details

Evidence of Coverage for Peoples Health Group Medicare for OGB – Information about plan benefits, membership, covered and noncovered services, member rights and responsibilities, and other important plan details

Prior Authorization Criteria– Detailed criteria for select covered drugs

Step Therapy Criteria – Detailed criteria for select covered drugs

Peoples Health Group Medicare (HMO-POS) for Office of Group Benefits | 2018

Questions? Call us.

1-800-978-9765 (TTY: 711)

Monday through Friday, from 8 a.m. to 8 p.m.

Plan Highlights

$5 Primary Care Physician Visit
$0
Eyeglasses or Contacts
$0
Tier 1 Generic Drugs
$0
Fitness Club Membership
$0
Dental Exams and Cleanings

Helpful Tools

Need Help Choosing a Plan?
Search Doctors, Medications and More...
  Search doctors

  Search medications

  Search pharmacies

  Search hospitals

Use our search tools to find out if your doctors and favorite pharmacy are in our network or if we cover your prescription drug. If you need help, call us 1-800-978-9765 (TTY: 711)

Explore Plan Benefits
Doctor and Hospital Coverage
Peoples Health Group Medicare FOR OGBIn NetworkOut Of Network
Out-of-Pocket Maximum$2,500Does not apply out of network
Doctor Visits
Primary Care Physician Visit$520% coinsurance
Specialist Visit$1020% coinsurance
Preventive Care+
Pap Smears, Pelvic Exams, Mammograms$020% coinsurance
Prostate and Colorectal Cancer Screenings$020% coinsurance
Bone Mass Measurement$020% coinsurance
Vaccinations (flu, pneumonia)$0$0
Labs and Tests+
Lab Services, Diagnostic Tests, X-rays and Advanced Imaging
(MRI, MRA, CT, CTA, PET scans, etc.)
$020% coinsurance
Outpatient Surgery
Outpatient Hospital Facility or Ambulatory Surgical Center$020% coinsurance
Inpatient Hospital Care per Benefit Period
Inpatient Deductible$0Same as Medicare
Hospital Stay per day for days 1-10$50Same as Medicare
Hospital Stay for days 11 and beyond $0Same as Medicare
Worldwide Emergency and Urgent Care♦
Emergency Care – Copay waived if admitted.$50$50
Urgently Needed Care$10 in the U.S.$10 in the U.S.; $50 outside the U.S.
Emergency Transportation (per one-way trip)
Emergency Ambulance Services$50$50
Home Health
Home Health Care$020% coinsurance
Skilled Nursing Facility Care
Semiprivate Room and Board (per day for days 1-20)$0$0
Semiprivate Room and Board (per day for each additional day of the benefit period)$25$25
Outpatient Services and Supplies
Occupational, Physical or Speech Therapy Visit (Medicare limits apply)$020% coinsurance
Durable Medical Equipment (DME) (wheelchairs, oxygen, etc.)5% coinsurance20% coinsurance
Diabetes Monitoring Supplies (test strips, monitor, etc., from a DME provider)$020% coinsurance
Mental Health and Substance Abuse Treatment
Inpatient Mental Health Care (per day for days 1-5)$25Same as Medicare
Inpatient Mental Health Care (per day for days 6 - 90)$0Same as Medicare
Outpatient Mental Health or Substance Abuse Treatment Visit$020% coinsurance
Hearing Services
Medicare-Covered Diagnostic Exam$1020% coinsurance
Notes:

Authorization is required for certain services.

+Office visit copay may apply.

♦Emergency care copay waived if admitted to inpatient hospital care within 24 hours for the same condition. Up to $5,000 of coverage for emergency and urgently needed care (combined) outside the U.S. and its territories.

Part D Prescription Drug Coverage
All drugs tiers are COVERED through the Part D coverage gap.
Ninety-day supplies of maintenance medications are available at retail pharmacies and by mail order.

 Up to a 30-Day Supply Up to a 90-Day Supply*
Tier 1 $0$0
Tier 2$0$0
Tier 3$20$40
Tier 4$40$80
Tier 520% coinsurance20% coinsurance
*90-day supply costs listed are at network pharmacies with preferred cost-sharing

Additional Benefits
Peoples Health Group Medicare FOR OGBYour Cost
Fitness
Fitness Center Membership$0
Routine Vision Services
Eye Exam$15
Eyeglasses or Contact Lenses (one pair per year)$0
Dental – up to $2,000 in coverage
Oral Exams and Cleanings (every six months)$0
X-rays (one set per year)$0
Comprehensive Dental (such as fillings. $50 deductible applies)Copays vary
Notes:

Costs listed are based on use of network providers.

Authorization is required for certain services.

For a detailed list of all plan benefits, click here to download the 2018 Peoples Health Group Medicare for OGB Evidence of Coverage.

Eligibility Guidelines
What are the Eligibility Guidelines?
Determining if you’re eligible to enroll in Peoples Health Group Medicare for OGB is easy. If you satisfy the following enrollment requirements, you’re eligible to become a member of this plan:

  • Be a retiree with the OGB and meet any additional requirements determined by the employer or retiree group
  • Be enrolled in Medicare Part A and Medicare Part B
  • Not have end-stage renal disease (ESRD), with limited exceptions, such as if you develop ESRD when you are already a member of a plan that we offer, or you were a member of a different plan that is no longer available
  • Reside within the plan’s service area determined by the OGB

How to Enroll

Enroll by Mail

Write us and request an enrollment packet. The address is:

Peoples Health Group Medicare for OGB Enrollment Packet Request
Three Lakeway Center
3838 N. Causeway Blvd., Suite 2200
Metairie, LA 70002

Enroll by Appointment

Call us toll-free at 1-800-978-9765, Monday through Friday, from 8 a.m. to 8 p.m. TTY users may call 711.

A sales representative will schedule an appointment with you at your home or meet you at one of our offices.

Peoples Health – Baton Rouge
7434 Perkins Rd., Suite 200
Baton Rouge, LA 70808
View Map: Peoples Health – Baton Rouge

Peoples Health – Metairie
Three Lakeway Center
3838 N. Causeway Blvd., Suite 2200
Metairie, LA 70002
View Map: Peoples Health – Metairie

What to Expect Next

Enroll

We will send you written confirmation of your enrollment in the mail.

New Member Packet

We will mail a packet to you with important information about your coverage through your Peoples Health plan. Be sure to read everything in the packet and call us with any questions.  We will also send you a member ID card.

Transition Call

As a new member, you will receive a call from a Peoples Health representative to coordinate continuation of any special services you may need. This helps us make sure there are no interruptions in your healthcare.

Important Documents
Important Plan Documents
Plan Overview for Peoples Health Group Medicare for OGB – An overview of plan benefits

Annual Notice of Changes for Peoples Health Group Medicare for OGB – A summary of plan benefit changes compared to the previous year and other important plan details

Evidence of Coverage for Peoples Health Group Medicare for OGB – Information about plan benefits, membership, covered and noncovered services, member rights and responsibilities, and other important plan details

Prior Authorization Criteria– Detailed criteria for select covered drugs

Step Therapy Criteria – Detailed criteria for select covered drugs