By completing the form below, you are submitting a request to enroll in a Peoples Health plan. This plan is a dual-eligible special needs plan. Your ability to enroll will be based on verification that you are entitled to both Medicare and medical assistance from a state plan under Louisiana Medicaid.
Note: The form may take a few moments to download completely.
If you have any questions about your eligibility to enroll in this plan or about the plan itself, please call to speak with one of our representatives at 1-800-978-9765. TTY users may call 711.