Peoples Health Group Medicare (HMO-POS) and Peoples Health Group Medicare (HMO-POS) OGB | 2023
Peoples Health Group Medicare (HMO-POS) Office of Group Benefits (OGB)
H1961-801-000
*90-Day Supply (from pharmacies with preferred cost-sharing); with coverage through the gap
A Medicare Advantage plan with prescription drug coverage exclusively for Louisiana Office of Group Benefits retirees. This plan features the coordinated, in-network care for which Peoples Health is known. It also offers 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 out-of-network providers are covered.
Plan Benefits for Peoples Health Group Medicare Office of Group Benefits (OGB)
The benefits below are available with this Medicare Advantage plan. For a full list of benefits, please see the Evidence of Coverage for this plan.
| Peoples Health Group Medicare (HMO-POS) Office of Group Benefits (OGB) | In-network | Out-of-network |
| Out-of-Pocket Maximum | $2,500 | Does not apply |
| Doctor Visits & NurseLine | ||
| Primary Care Physician Visit | $0 | 20% coinsurance |
| Specialist Visit | $10 | 20% coinsurance |
| Virtual Medical Visit or 24-Hour NurseLine | $0 | Available through contracted provider |
| Preventive Care+ | ||
| Pap Smears, Pelvic Exams, Mammograms | $0 | 20% coinsurance |
| Prostate & Colorectal Cancer Screenings | $0 | 20% coinsurance |
| Bone Mass Measurement | $0 | 20% coinsurance |
| Vaccinations (COVID-19, flu, pneumonia)++ | $0 | $0 |
| Labs & Tests+ | ||
| Lab Services, Diagnostic Tests, X-rays and Advanced Imaging (MRI, MRA, CT, PET scans etc.) | $0 | 20% coinsurance |
| Outpatient Surgery | ||
| Outpatient Surgery (outpatient hospital or ambulatory surgical center) | $0 | 20% coinsurance |
| Inpatient Hospital Care per admission | ||
| Inpatient Deductible | $0 | Same as Medicare |
| Inpatient Stay (per day) days 1-10 | $50 per day | Same as Medicare |
| Inpatient Stay (per day) days 11 and beyond | $0 | Same as Medicare |
| Worldwide Emergency and Urgent Care ^ | ||
| Emergency Care (worldwide) | $50 | $50 |
| Urgent Care (inside the U.S.) | $5 | $5 |
| Urgent Care (outside the U.S.) | Does not apply | $50 |
| Emergency Transportation (per one-way trip) | ||
| Emergency Ambulance Services (ground or air) | $50 | $50 |
| Home Health & Skilled Nursing Facility Care | ||
| Home Health | $0 | 20% coinsurance |
| Skilled Nursing Facility Care (semi private room and board, days 1-20) | $0 | $0 |
| Skilled Nursing Facility Care (semi private room and board, per each additional day of the benefit period) | $25 per day | $25 per day |
| Outpatient Services & Supplies | ||
| Occupational, Physical or Speech Therapy Visit | $0 | 20% coinsurance |
| Durable Medical Equipment (wheelchairs, oxygen, etc.) | 5% coinsurance | 20% coinsurance |
| Diabetes Monitoring Supplies (test strips, monitor, etc., from a retail pharmacy (select brands) or a DME provider) | $0 | 20% coinsurance |
| Mental Health & Substance Abuse Treatment | ||
| Inpatient Mental Health (days 1-5) | $25 per day | Same as Medicare |
| Inpatient Mental Health (days 6-90) | $0 | Same as Medicare |
| Outpatient Mental Health or Substance Abuse Group or Individual Visit | $0 | 20% coinsurance |
| Virtual Mental Health Visit | $0 | Available through contracted provider |
| +Office visit copay may apply. ^Emergency care copay waived if admitted to inpatient hospital care within 24 hours for the same condition. ++You will pay a $0 copay for all Part D covered vaccines, including Shingrix, from network providers. |
All drugs are COVERED through the Part D coverage gap. 90-day supplies of maintenance medications on tiers 1, 2, 3 and 4 are available at retail pharmacies and by mail order.
You will pay a maximum of $20 for each 1-month supply of Part D select insulin drugs through all coverage stages
You will pay a $0 copay for all Part D covered vaccines, including Shingrix.
| Initial Coverage Period | 30-Day Supply | 90-Day Supply (from pharmacies with preferred cost-sharing) |
| Tier 1 (with coverage through the gap) | $0 | $0 |
| Tier 2 (with coverage through the gap) | $0 | $0 |
| Tier 3 (with coverage through the gap) | $20 | $40 |
| Tier 4 (with coverage through the gap) | $40 | $80 |
| Tier 5 (with coverage through the gap) | 20% coinsurance | 30-day supply only |
| Peoples Health Group Medicare (HMO-POS) Office of Group Benefits (OGB) | Your Cost |
| Meals After Inpatient Hospital Stay | |
| Up to 28 meals over 14 days | $0 |
| Respite Care | |
| Members diagnosed with dementia may be eligible for a maximum of 12 respite care sessions per year from the network respite care provider | $0 |
| Fitness | |
| One Pass™ Fitness Membership (health clubs, online classes, brain health exercises and more) | $0 |
| Vision Services | |
| Routine Eye Exam | $0 |
| Glasses or Contact Lenses | $0 |
| Hearing Services | |
| Hearing Aids | Starting at $175 |
| Routine Hearing Exam | $0 |
| Dental - $2,000 Coverage Maximum | |
| Dental - Preventive (1 set of X-rays and 2 exams and cleanings per year) | $0 |
| Dental - Comprehensive (fillings, dentures, etc.) | $0 |
Notes:
Costs listed are based on use of network providers.
Authorization is required for certain services.
Doctor and Hospital Coverage
| Peoples Health Group Medicare (HMO-POS) Office of Group Benefits (OGB) | In-network | Out-of-network |
| Out-of-Pocket Maximum | $2,500 | Does not apply |
| Doctor Visits & NurseLine | ||
| Primary Care Physician Visit | $0 | 20% coinsurance |
| Specialist Visit | $10 | 20% coinsurance |
| Virtual Medical Visit or 24-Hour NurseLine | $0 | Available through contracted provider |
| Preventive Care+ | ||
| Pap Smears, Pelvic Exams, Mammograms | $0 | 20% coinsurance |
| Prostate & Colorectal Cancer Screenings | $0 | 20% coinsurance |
| Bone Mass Measurement | $0 | 20% coinsurance |
| Vaccinations (COVID-19, flu, pneumonia)++ | $0 | $0 |
| Labs & Tests+ | ||
| Lab Services, Diagnostic Tests, X-rays and Advanced Imaging (MRI, MRA, CT, PET scans etc.) | $0 | 20% coinsurance |
| Outpatient Surgery | ||
| Outpatient Surgery (outpatient hospital or ambulatory surgical center) | $0 | 20% coinsurance |
| Inpatient Hospital Care per admission | ||
| Inpatient Deductible | $0 | Same as Medicare |
| Inpatient Stay (per day) days 1-10 | $50 per day | Same as Medicare |
| Inpatient Stay (per day) days 11 and beyond | $0 | Same as Medicare |
| Worldwide Emergency and Urgent Care ^ | ||
| Emergency Care (worldwide) | $50 | $50 |
| Urgent Care (inside the U.S.) | $5 | $5 |
| Urgent Care (outside the U.S.) | Does not apply | $50 |
| Emergency Transportation (per one-way trip) | ||
| Emergency Ambulance Services (ground or air) | $50 | $50 |
| Home Health & Skilled Nursing Facility Care | ||
| Home Health | $0 | 20% coinsurance |
| Skilled Nursing Facility Care (semi private room and board, days 1-20) | $0 | $0 |
| Skilled Nursing Facility Care (semi private room and board, per each additional day of the benefit period) | $25 per day | $25 per day |
| Outpatient Services & Supplies | ||
| Occupational, Physical or Speech Therapy Visit | $0 | 20% coinsurance |
| Durable Medical Equipment (wheelchairs, oxygen, etc.) | 5% coinsurance | 20% coinsurance |
| Diabetes Monitoring Supplies (test strips, monitor, etc., from a retail pharmacy (select brands) or a DME provider) | $0 | 20% coinsurance |
| Mental Health & Substance Abuse Treatment | ||
| Inpatient Mental Health (days 1-5) | $25 per day | Same as Medicare |
| Inpatient Mental Health (days 6-90) | $0 | Same as Medicare |
| Outpatient Mental Health or Substance Abuse Group or Individual Visit | $0 | 20% coinsurance |
| Virtual Mental Health Visit | $0 | Available through contracted provider |
| +Office visit copay may apply. ^Emergency care copay waived if admitted to inpatient hospital care within 24 hours for the same condition. ++You will pay a $0 copay for all Part D covered vaccines, including Shingrix, from network providers. |
Part D Prescription Drug Coverage
| Initial Coverage Period | 30-Day Supply | 90-Day Supply (from pharmacies with preferred cost-sharing) |
| Tier 1 (with coverage through the gap) | $0 | $0 |
| Tier 2 (with coverage through the gap) | $0 | $0 |
| Tier 3 (with coverage through the gap) | $20 | $40 |
| Tier 4 (with coverage through the gap) | $40 | $80 |
| Tier 5 (with coverage through the gap) | 20% coinsurance | 30-day supply only |
Additional Benefits
| Peoples Health Group Medicare (HMO-POS) Office of Group Benefits (OGB) | Your Cost |
| Meals After Inpatient Hospital Stay | |
| Up to 28 meals over 14 days | $0 |
| Respite Care | |
| Members diagnosed with dementia may be eligible for a maximum of 12 respite care sessions per year from the network respite care provider | $0 |
| Fitness | |
| One Pass™ Fitness Membership (health clubs, online classes, brain health exercises and more) | $0 |
| Vision Services | |
| Routine Eye Exam | $0 |
| Glasses or Contact Lenses | $0 |
| Hearing Services | |
| Hearing Aids | Starting at $175 |
| Routine Hearing Exam | $0 |
| Dental - $2,000 Coverage Maximum | |
| Dental - Preventive (1 set of X-rays and 2 exams and cleanings per year) | $0 |
| Dental - Comprehensive (fillings, dentures, etc.) | $0 |
Notes:
Costs listed are based on use of network providers.
Authorization is required for certain services.
Peoples Health Group Medicare (HMO-POS)
H1961-801-000
*90-Day Supply (from pharmacies with preferred cost-sharing); with coverage through the gap
A Medicare Advantage plan with prescription drug coverage and a point-of-service (POS) option, which lets you see providers who are not in the plan’s provider network for certain services. This plan features the coordinated, in-network care for which Peoples Health is known. Not all services received from out-of-network providers are covered.
Plan Benefits for Peoples Health Group Medicare
The benefits below are available with this Medicare Advantage plan. For a full list of benefits, please see the Evidence of Coverage for this plan.
| Peoples Health Group Medicare (HMO-POS) | In-network | Out-of-network |
| Out-of-Pocket Maximum | $2,500 | Does not apply |
| Doctor Visits & NurseLine | ||
| Primary Care Physician Visit | $5 | 20% coinsurance |
| Specialist Visit | $10 | 20% coinsurance |
| Virtual Medical Visit or 24-Hour NurseLine | $0 | Available through contracted provider |
| Preventive Care+ | ||
| Pap Smears, Pelvic Exams, Mammograms | $0 | 20% coinsurance |
| Prostate and Colorectal Cancer Screenings | $0 | 20% coinsurance |
| Bone Mass Measurement | $0 | 20% coinsurance |
| Vaccinations (COVID-19, flu, pneumonia)++ | $0 | $0 |
| Labs & Tests+ | ||
| Lab Services, Diagnostic Tests, X-rays and Advanced Imaging (MRI, MRA, CT, CTA, PET scans, etc.) | $0 | 20% coinsurance |
| Outpatient Surgery | ||
| Outpatient Surgery (outpatient hospital or ambulatory surgical center) | $0 | 20% coinsurance |
| Inpatient Hospital Care per admission | ||
| Inpatient Deductible | $0 | Same as Medicare |
| Inpatient Stay per day, for days 1-10 | $50 | Same as Medicare |
| Inpatient Stay for days 11 and beyond | $0 | Same as Medicare |
| Worldwide Emergency and Urgent Care^ | ||
| Emergency Care (worldwide) | $50 | $50 |
| Urgent Care (inside the U.S.) | $10 | $10 |
| Urgent Care (outside the U.S.) | Does not apply | $50 |
| Emergency Transportation (per one-way trip) | ||
| Emergency Ambulance Services (ground or air) | $50 | $50 |
| Home Health & Skilled Nursing Facility Care | ||
| Home Health | $0 | 20% coinsurance |
| Skilled Nursing Facility Care (semi private room and board, days 1-20) | $0 | $0 |
| Skilled Nursing Facility Care (semi private room and board, per each additional day of the benefit period) | $25 per day | $25 per day |
| Outpatient Services & Supplies | ||
| Occupational, Physical or Speech Therapy Visit | $0 | 20% coinsurance |
| Durable Medical Equipment (wheelchairs, oxygen, etc.) | 5% coinsurance | 20% coinsurance |
| Diabetes Monitoring Supplies (test strips, monitor, etc., from a retail pharmacy (select brands) or a DME provider) | $0 | 20% coinsurance |
| Mental Health & Substance Abuse Treatment | ||
| Inpatient Mental Health (days 1-10) | $50 per day | Same as Medicare |
| Inpatient Mental Health (days 11-90) | $0 | Same as Medicare |
| Outpatient Mental Health or Substance Abuse Group or Individual Visit | $10 | 20% coinsurance |
| Virtual Mental Health Visit | $0 | Available through contracted provider |
| +Office visit copay may apply. ^Emergency care copay waived if admitted to inpatient hospital care within 24 hours for the same condition. ++You will pay a $0 copay for all Part D covered vaccines, including Shingrix, from network providers. |
All drugs are COVERED through the Part D coverage gap. 90-day supplies of maintenance medications on tiers 1, 2, 3 and 4 are available at retail pharmacies and by mail order.
You will pay a maximum of $25 for each 1-month supply of Part D select insulin drugs through all coverage stages
You will pay a $0 copay for all Part D covered vaccines, including Shingrix.
| Initial Coverage Period | 30-Day Supply | 90-Day Supply (from pharmacies with preferred cost-sharing) |
| Tier 1 (with coverage through the gap) | $3 | $0 |
| Tier 2 (with coverage through the gap) | $10 | $0 |
| Tier 3 (with coverage through the gap) | $25 | $50 |
| Tier 4 (with coverage through the gap) | $50 | $100 |
| Tier 5 (with coverage through the gap) | 20% coinsurance | 30-day supply only |
| Peoples Health Group Medicare (HMO-POS) | Your Cost |
| Over-the-Counter Items | |
| $40 allowance per quarter | $0 |
| Meals After Inpatient Hospital Stay | |
| Up to 28 meals over 14 days | $0 |
| Respite Care | |
| Members diagnosed with dementia may be eligible for a maximum of 12 respite care sessions per year from the network respite care provider | $0 |
| Fitness | |
| One Pass™ Fitness Membership (health clubs, online classes, brain health exercises and more) | $0 |
| Vision Services | |
| Routine Eye Exam | $0 |
| Glasses or Contact Lenses | $0 |
| Hearing Services | |
| Hearing Aids | Starting at $175 |
| Routine Hearing Exam | $0 |
| Dental - $2,500 Coverage Maximum | |
| Dental - Preventive (1 set of X-rays and 2 exams and cleanings per year) | $0 |
| Dental - Comprehensive (fillings, dentures, etc.) | $0 |
Notes:
Costs listed are based on use of network providers.
Authorization is required for certain services.
Doctor and Hospital Coverage
| Peoples Health Group Medicare (HMO-POS) | In-network | Out-of-network |
| Out-of-Pocket Maximum | $2,500 | Does not apply |
| Doctor Visits & NurseLine | ||
| Primary Care Physician Visit | $5 | 20% coinsurance |
| Specialist Visit | $10 | 20% coinsurance |
| Virtual Medical Visit or 24-Hour NurseLine | $0 | Available through contracted provider |
| Preventive Care+ | ||
| Pap Smears, Pelvic Exams, Mammograms | $0 | 20% coinsurance |
| Prostate and Colorectal Cancer Screenings | $0 | 20% coinsurance |
| Bone Mass Measurement | $0 | 20% coinsurance |
| Vaccinations (COVID-19, flu, pneumonia)++ | $0 | $0 |
| Labs & Tests+ | ||
| Lab Services, Diagnostic Tests, X-rays and Advanced Imaging (MRI, MRA, CT, CTA, PET scans, etc.) | $0 | 20% coinsurance |
| Outpatient Surgery | ||
| Outpatient Surgery (outpatient hospital or ambulatory surgical center) | $0 | 20% coinsurance |
| Inpatient Hospital Care per admission | ||
| Inpatient Deductible | $0 | Same as Medicare |
| Inpatient Stay per day, for days 1-10 | $50 | Same as Medicare |
| Inpatient Stay for days 11 and beyond | $0 | Same as Medicare |
| Worldwide Emergency and Urgent Care^ | ||
| Emergency Care (worldwide) | $50 | $50 |
| Urgent Care (inside the U.S.) | $10 | $10 |
| Urgent Care (outside the U.S.) | Does not apply | $50 |
| Emergency Transportation (per one-way trip) | ||
| Emergency Ambulance Services (ground or air) | $50 | $50 |
| Home Health & Skilled Nursing Facility Care | ||
| Home Health | $0 | 20% coinsurance |
| Skilled Nursing Facility Care (semi private room and board, days 1-20) | $0 | $0 |
| Skilled Nursing Facility Care (semi private room and board, per each additional day of the benefit period) | $25 per day | $25 per day |
| Outpatient Services & Supplies | ||
| Occupational, Physical or Speech Therapy Visit | $0 | 20% coinsurance |
| Durable Medical Equipment (wheelchairs, oxygen, etc.) | 5% coinsurance | 20% coinsurance |
| Diabetes Monitoring Supplies (test strips, monitor, etc., from a retail pharmacy (select brands) or a DME provider) | $0 | 20% coinsurance |
| Mental Health & Substance Abuse Treatment | ||
| Inpatient Mental Health (days 1-10) | $50 per day | Same as Medicare |
| Inpatient Mental Health (days 11-90) | $0 | Same as Medicare |
| Outpatient Mental Health or Substance Abuse Group or Individual Visit | $10 | 20% coinsurance |
| Virtual Mental Health Visit | $0 | Available through contracted provider |
| +Office visit copay may apply. ^Emergency care copay waived if admitted to inpatient hospital care within 24 hours for the same condition. ++You will pay a $0 copay for all Part D covered vaccines, including Shingrix, from network providers. |
Part D Prescription Drug Coverage
| Initial Coverage Period | 30-Day Supply | 90-Day Supply (from pharmacies with preferred cost-sharing) |
| Tier 1 (with coverage through the gap) | $3 | $0 |
| Tier 2 (with coverage through the gap) | $10 | $0 |
| Tier 3 (with coverage through the gap) | $25 | $50 |
| Tier 4 (with coverage through the gap) | $50 | $100 |
| Tier 5 (with coverage through the gap) | 20% coinsurance | 30-day supply only |
Additional Benefits
| Peoples Health Group Medicare (HMO-POS) | Your Cost |
| Over-the-Counter Items | |
| $40 allowance per quarter | $0 |
| Meals After Inpatient Hospital Stay | |
| Up to 28 meals over 14 days | $0 |
| Respite Care | |
| Members diagnosed with dementia may be eligible for a maximum of 12 respite care sessions per year from the network respite care provider | $0 |
| Fitness | |
| One Pass™ Fitness Membership (health clubs, online classes, brain health exercises and more) | $0 |
| Vision Services | |
| Routine Eye Exam | $0 |
| Glasses or Contact Lenses | $0 |
| Hearing Services | |
| Hearing Aids | Starting at $175 |
| Routine Hearing Exam | $0 |
| Dental - $2,500 Coverage Maximum | |
| Dental - Preventive (1 set of X-rays and 2 exams and cleanings per year) | $0 |
| Dental - Comprehensive (fillings, dentures, etc.) | $0 |
Notes:
Costs listed are based on use of network providers.
Authorization is required for certain services.
Find Doctors, Medications & More
Find Doctors, Medications & More
Important Documents
Group Medicare OGB Documents
Plan Overview for Peoples Health Group Medicare (HMO-POS) Office of Group Benefits (OGB) – An overview of plan benefits
Annual Notice of Changes for Peoples Health Group Medicare (HMO-POS) Office of Group Benefits (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 (HMO-POS) Office of Group Benefits (OGB) – Information about plan benefits, membership, covered and noncovered services, member rights and responsibilities, and other important plan details
Vendor Information – A listing of providers offering benefit-related services
Group Medicare Documents
Plan Overview for Peoples Health Group Medicare – An overview of plan benefits
Annual Notice of Changes for Peoples Health Group Medicare – A summary of plan benefit changes compared to the previous year and other important plan details
Evidence of Coverage for Peoples Health Group Medicare – Information about plan benefits, membership, covered and noncovered services, member rights and responsibilities, and other important plan details
Vendor Information – A listing of providers offering benefit-related services
How to Enroll
By Appointment
A representative can schedule an appointment for you with a licensed sales representative.
By Mail
Write to us and request an enrollment packet.
Indicate your group plan – either:
Peoples Health Group Medicare OR Peoples Health Group Medicare for Office of Group Benefits Enrollment Packet Request
Three Lakeway Center
3838 N. Causeway Blvd.
Suite 2500
Metairie, LA 70002
