Peoples Health Group Medicare (HMO-POS) for the Office of Group Benefits | 2020
Designed for members of the Louisiana Office of Group Benefits (OGB), Peoples Health Group Medicare for OGB is a Medicare Advantage HMO plan with a point of service (POS) option, which lets you see providers who are not in the plan’s provider network for certain services. Not all services received from an out-of-network provider are covered.
Get these benefits +MORE!
PRIMARY CARE
PHYSICIAN VISITS
SPECIALIST
VISITS
DENTAL EXAMS
& CLEANINGS
TIER 1 AND TIER 2
GENERIC DRUGS*
*90-day supply costs at network pharmacies with preferred pricing
FITNESS CLUB
MEMBERSHIP
EYEGLASSES OR
CONTACTS
Virtual
Visits
The Doctor Will “See” You Now
Virtual Visits: $0
When you need care — anytime, day or night — virtual visits can be a great option. From treating colds and fevers to caring for migraines and allergies, you can connect with a doctor using your computer or mobile device.
Explore Plan Benefits
Doctor and Hospital Coverage
| Peoples Health Group Medicare for OGB | In Network | Out Of Network |
|---|---|---|
| Out-of-Pocket Maximum | $2,500 | Does not apply out of network |
| Doctor Visits | ||
| Primary Care Physician Visit | $5 | 20% coinsurance |
| Virtual Visit | $0 | Not covered |
| Specialist Visit | $10 | 20% coinsurance |
| Preventive Care+ | ||
| Pap Smears, Pelvic Exams and Mammograms | $0 | 20% coinsurance |
| Prostate and Colorectal Cancer Screenings | $0 | 20% coinsurance |
| Bone Mass Measurement | $0 | 20% 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.) | $0 | 20% coinsurance |
| Outpatient Surgery | ||
| Outpatient Hospital Facility or Ambulatory Surgical Center | $0 | 20% coinsurance |
| Inpatient Hospital Care per admission | ||
| Inpatient Deductible | $0 | Same as Medicare |
| Hospital Stay per day for days 1-10 | $50 | Same as Medicare |
| Hospital Stay per day for days 11 and beyond | $0 | Same as Medicare |
| Worldwide Emergency and Urgent Care♦ | ||
| Emergency Care – Copay waived if admitted. | $50 | $50 |
| Urgently Needed Care | $10 in the U.S. and its territories | $10 in the U.S. and its territories; $50 outside the U.S. and its territories |
| Emergency Transportation per one-way trip | ||
| Emergency Ambulance Services (ground or air) | $50 | $50 |
| Home Health | ||
| Home Health Care | $0 | 20% 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) | $0 | 20% coinsurance |
| Durable Medical Equipment (DME) (wheelchairs, oxygen, etc.) | 5% coinsurance | 20% coinsurance |
| Diabetes Monitoring Supplies (test strips, monitor, etc., from a DME provider) | $0 | 20% coinsurance |
| Mental Health and Substance Abuse Treatment | ||
| Inpatient Mental Health Care per day for days 1-5 | $25 | Same as Medicare |
| Inpatient Mental Health Care per day for days 6-90 | $0 | Same as Medicare |
| Outpatient Mental Health or Substance Abuse Treatment Visit | $0 | 20% coinsurance |
| Hearing Services | ||
| Medicare-Covered Diagnostic Exam | $10 | 20% coinsurance |
Notes:
Costs listed are based on use of network providers.
Authorization is required for certain services.
*See the Provider Directory for network lab and diagnostic providers.
+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 drug tiers COVERED through the Part D coverage gap. Costs listed are at network pharmacies. 90-day supply costs listed are at network pharmacies with preferred pricing.
| TIER | 30-DAY SUPPLY AT A NETWORK PHARMACY | 90-DAY SUPPLY AT A NETWORK PHARMACY |
|---|---|---|
| Tier 1 | $0 | $0 |
| Tier 2 | $0 | $0 |
| Tier 3 | $20 | $40 |
| Tier 4 | $40 | $80 |
| Tier 5 | 20% coinsurance | 20% coinsurance |
Additional Benefits – Not Covered by Original Medicare
| PEOPLES HEALTH GROUP MEDICARE FOR 0GB | IN NETWORK | OUT OF NETWORK |
|---|---|---|
| Fitness | ||
| Fitness Center Membership | $0 | Not covered |
| Routine Vision Services | ||
| Routine Vision Exam | $15 | Not covered |
| Eyeglasses or Contact Lenses (one pair per year) | $0 | Not covered |
| Dental – up to $2,000 in coverage | ||
| Oral Exams and Cleanings (one every six months) | $0 | Out-of-pocket costs are higher. Member is responsible for any charges over and above the agreed amount the plan would normally pay as its share of the cost to a network provider. |
| X-rays (one set per year) | $0 | Out-of-pocket costs are higher. Member is responsible for any charges over and above the agreed amount the plan would normally pay as its share of the cost to a network provider. |
| Comprehensive Dental Services (such as fillings and dentures; $50 deductible applies) | Copays vary | Out-of-pocket costs are higher. Member is responsible for any charges over and above the agreed amount the plan would normally pay as its share of the cost to a network provider. |
Notes:
Costs listed are based on use of network providers.
Authorization is required for certain services.
Explore Plan Benefits
Doctor and Hospital Coverage
| Peoples Health Group Medicare for OGB | In Network | Out Of Network |
|---|---|---|
| Out-of-Pocket Maximum | $2,500 | Does not apply out of network |
| Doctor Visits | ||
| Primary Care Physician Visit | $5 | 20% coinsurance |
| Virtual Visit | $0 | Not covered |
| Specialist Visit | $10 | 20% coinsurance |
| Preventive Care+ | ||
| Pap Smears, Pelvic Exams and Mammograms | $0 | 20% coinsurance |
| Prostate and Colorectal Cancer Screenings | $0 | 20% coinsurance |
| Bone Mass Measurement | $0 | 20% 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.) | $0 | 20% coinsurance |
| Outpatient Surgery | ||
| Outpatient Hospital Facility or Ambulatory Surgical Center | $0 | 20% coinsurance |
| Inpatient Hospital Care per admission | ||
| Inpatient Deductible | $0 | Same as Medicare |
| Hospital Stay per day for days 1-10 | $50 | Same as Medicare |
| Hospital Stay per day for days 11 and beyond | $0 | Same as Medicare |
| Worldwide Emergency and Urgent Care♦ | ||
| Emergency Care – Copay waived if admitted. | $50 | $50 |
| Urgently Needed Care | $10 in the U.S. and its territories | $10 in the U.S. and its territories; $50 outside the U.S. and its territories |
| Emergency Transportation per one-way trip | ||
| Emergency Ambulance Services (ground or air) | $50 | $50 |
| Home Health | ||
| Home Health Care | $0 | 20% 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) | $0 | 20% coinsurance |
| Durable Medical Equipment (DME) (wheelchairs, oxygen, etc.) | 5% coinsurance | 20% coinsurance |
| Diabetes Monitoring Supplies (test strips, monitor, etc., from a DME provider) | $0 | 20% coinsurance |
| Mental Health and Substance Abuse Treatment | ||
| Inpatient Mental Health Care per day for days 1-5 | $25 | Same as Medicare |
| Inpatient Mental Health Care per day for days 6-90 | $0 | Same as Medicare |
| Outpatient Mental Health or Substance Abuse Treatment Visit | $0 | 20% coinsurance |
| Hearing Services | ||
| Medicare-Covered Diagnostic Exam | $10 | 20% coinsurance |
Notes:
Costs listed are based on use of network providers.
Authorization is required for certain services.
*See the Provider Directory for network lab and diagnostic providers. Lab services, diagnostic tests and X-rays at a doctor’s office or outpatient hospital may have higher out-of-pocket costs.
+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 drug tiers COVERED through the Part D coverage gap. Costs listed are at network pharmacies. 90-day supply costs listed are at network pharmacies with preferred pricing.
| TIER | 30-DAY SUPPLY AT A NETWORK PHARMACY | 90-DAY SUPPLY AT A NETWORK PHARMACY |
|---|---|---|
| Tier 1 | $0 | $0 |
| Tier 2 | $0 | $0 |
| Tier 3 | $20 | $40 |
| Tier 4 | $40 | $80 |
| Tier 5 | 20% coinsurance | 20% coinsurance |
Additional Benefits
| PEOPLES HEALTH GROUP MEDICARE FOR 0GB | IN NETWORK | OUT OF NETWORK |
|---|---|---|
| Fitness | ||
| Fitness Center Membership | $0 | Not covered |
| Routine Vision Services | ||
| Routine Vision Exam | $15 | Not covered |
| Eyeglasses or Contact Lenses (one pair per year) | $0 | Not covered |
| Dental – up to $2,000 in coverage | ||
| Oral Exams and Cleanings (one every six months) | $0 | Out-of-pocket costs are higher. Member is responsible for any charges over and above the agreed amount the plan would normally pay as its share of the cost to a network provider. |
| X-rays (one set per year) | $0 | Out-of-pocket costs are higher. Member is responsible for any charges over and above the agreed amount the plan would normally pay as its share of the cost to a network provider. |
| Comprehensive Dental Services (such as fillings and dentures; $50 deductible applies) | Copays vary | Out-of-pocket costs are higher. Member is responsible for any charges over and above the agreed amount the plan would normally pay as its share of the cost to a network provider. |
Costs listed are based on use of network providers. Authorization is required for certain services.
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 at 1-866-687-7335 (TTY: 711).
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 at 1-866-687-7335 (TTY: 711).
Eligibility Guidelines
Determining if you’re eligible to enroll in Peoples Health Group Medicare for OGB is easy. If you meet the following Medicare enrollment requirements, you’re eligible to become a member of this plan:
OGB RETIREE
Be a retiree with OGB and meet any additional requirements determined by the employer or retiree group
END-STAGE RENAL DISEASE
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
Medicare PARTS A & B
Be enrolled in Medicare Part A and Medicare Part B
PLAN’S SERVICE AREA
Live in the plan’s service area determined by the OGB
How to Enroll
ENROLL BY APPOINTMENT
Call us toll-free at 1-866-912-8304, seven days a week, from 8 a.m. to 8 p.m.
TTY users may call 711.
A sales representative will schedule an appointment with you.
ENROLL BY MAIL
Write to 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
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 health care.
COMPREHENSIVE WELLNESS ASSESSMENT
We schedule a health evaluation at no cost through the Peoples Health Comprehensive Wellness Assessment Program. This assessment helps us understand your health needs and allows us to better work together to coordinate your care.
Important Documents
Why Medicare Advantage?
Peoples Health Group Medicare for OGB is designed for members of the Louisiana Office of Group Benefits. This Medicare Advantage HMO plan has a POS option, which lets you see providers who are not in our provider network. Not all services received from out-of-network providers are covered.
As good as Medicare is, it doesn’t cover everything. To protect yourself from high health care costs, consider a Medicare Advantage plan, like the ones offered by Peoples Health.
Also known as Medicare Part C, Medicare Advantage combines your Part A (hospital insurance) and Part B (medical coverage), such as doctor’s visits and outpatient services, into one plan. Medicare Advantage plans usually include prescription drug coverage (Part D). Additionally, Medicare Advantage plans may include extra benefits, like worldwide urgent and emergency care, routine dental and vision coverage, and gym memberships. A Medicare Advantage plan from Peoples Health is an all-inclusive package, making your health insurance easy and convenient. Our rich health care benefits make Peoples Health one of the most popular Medicare Advantage plans in Louisiana. It’s no wonder Peoples Health has been covering people with Medicare in Louisiana for over 20 years.
During select parts of the year, like Medicare’s Annual Enrollment Period, you have the option to compare Medicare health insurance plans and decide what fit is best for you. Let us help make that decision easy. Peoples Health’s 2020 Medicare Advantage plans offer more benefits than ever before.
Unlike supplemental insurance, which typically costs more for fewer services, a Medicare Advantage plan from Peoples Health offers you more benefits and saves you money. The Peoples Health Group Medicare for OGB plan includes Part D drug coverage.
If you’re a member of a participating employer or retiree group and live in the plan’s service area determined individually by each group, you may be eligible to enroll in Peoples Health Group Medicare for OGB. Not part of an employer or retiree group? Shop our other Medicare Advantage plans. If you have Medicare and Medicaid, also known as state assistance, ask about a Peoples Health special needs plan. You may be entitled to more coverage and bigger savings.