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Provider Plan Documents and Forms | 2024

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Looking for 2023 plan documents and forms? Click here.

Looking for 2024 plan provider forms? Click here.

2024 Plan Coverage Documents

Peoples Health Choices 65 (HMO-POS) Greater New Orleans and Baton Rouge Area | 2024

Plan Overview for Peoples Health Choices 65 Greater New Orleans and Baton Rouge Area – An overview of plan benefits

Annual Notice of Changes for Peoples Health Choices 65 Greater New Orleans and Baton Rouge Area – A summary of plan benefit changes compared to the previous year and other important plan details

Evidence of Coverage for Peoples Health Choices 65 Greater New Orleans and Baton Rouge Area – Information about plan benefits, membership, covered and noncovered services, member rights and responsibilities, and other important plan details

Summary of Benefits for Peoples Health Choices 65 Greater New Orleans and Baton Rouge Area – A general summary of plan benefits

Vendor Information – A listing of providers offering benefit-related services

Medicare Star Ratings Summary

Peoples Health Choices 65 (HMO-POS) Northshore | 2024

Plan Overview for Peoples Health Choices 65 Northshore – An overview of plan benefits

Annual Notice of Changes for Peoples Health Choices 65 Northshore – A summary of plan benefit changes compared to the previous year and other important plan details

Evidence of Coverage for Peoples Health Choices 65 Northshore – Information about plan benefits, membership, covered and noncovered services, member rights and responsibilities, and other important plan details

Summary of Benefits for Peoples Health Choices 65 Northshore – A general summary of plan benefits

Vendor Information – A listing of providers offering benefit-related services

Medicare Star Ratings Summary

Peoples Health Choices 65 (HMO-POS) Southland | 2024

Plan Overview for Peoples Health Choices 65 Southland – An overview of plan benefits

Annual Notice of Changes for Peoples Health Choices 65 Southland – A summary of plan benefit changes compared to the previous year and other important plan details

Evidence of Coverage for Peoples Health Choices 65 Southland – Information about plan benefits, membership, covered and noncovered services, member rights and responsibilities, and other important plan details

Summary of Benefits for Peoples Health Choices 65 Southland – A general summary of plan benefits

Provider Directory – A list of the plan’s network providers (Updated 01/29/2024)

Vendor Information – A listing of providers offering benefit-related services

Medicare Star Ratings Summary

Peoples Health Choices 65 (HMO-POS) Rural Southeast | 2024

Plan Overview for Peoples Health Choices 65 Rural Southeast – An overview of plan benefits

Annual Notice of Changes for Peoples Health Choices 65 Rural Southeast – A summary of plan benefit changes compared to the previous year and other important plan details

Evidence of Coverage for Peoples Health Choices 65 Rural Southeast – Information about plan benefits, membership, covered and noncovered services, member rights and responsibilities, and other important plan details

Summary of Benefits for Peoples Health Choices 65 Rural Southeast – A general summary of plan benefits

Vendor Information – A listing of providers offering benefit-related services

Medicare Star Ratings Summary

Peoples Health Medicare Advantage LA-0004 (HMO-POS) | 2024

Plan Overview for Peoples Health Medicare Advantage LA-0004 – An overview of plan benefits

Evidence of Coverage for Peoples Health Medicare Advantage LA-0004 – Information about plan benefits, membership, covered and noncovered services, member rights and responsibilities, and other important plan details

Summary of Benefits for Peoples Health Medicare Advantage LA-0004 – A general summary of plan benefits

Vendor Information – A listing of providers offering benefit-related services

Medicare Star Ratings Summary

Peoples Health Choices Gold (HMO-POS) | 2024

Plan Overview for Peoples Health Choices Gold – An overview of plan benefits

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

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

Summary of Benefits for Peoples Health Choices Gold – A general summary of plan benefits

Vendor Information – A listing of providers offering benefit-related services

Medicare Star Ratings Summary

Peoples Health Choices (PPO) | 2024

Plan Overview for Peoples Health Choices – An overview of plan benefits

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

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

Summary of Benefits for Peoples Health Choices – A general summary of plan benefits

Vendor Information – A listing of providers offering benefit-related services 

Medicare Star Ratings Summary

Peoples Health Patriot (PPO) | 2024

Plan Overview for Peoples Health Patriot – An overview of plan benefits

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

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

Summary of Benefits for Peoples Health Patriot – A general summary of plan benefits

Vendor Information – A listing of providers offering benefit-related services

Medicare Star Ratings Summary  

Peoples Health Secure Complete (HMO-POS D-SNP) | 2024

Plan Overview for Peoples Health Secure Complete – An overview of plan benefits

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

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

Summary of Benefits for Peoples Health Secure Complete – A general summary of plan benefits

Vendor Information – A listing of providers offering benefit-related services

Medicare Star Ratings Summary

Peoples Health Secure Health (HMO-POS D-SNP) | 2024

Plan Overview for Peoples Health Secure Health – An overview of plan benefits

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

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

Summary of Benefits for Peoples Health Secure Health – A general summary of plan benefits

Vendor Information – A listing of providers offering benefit-related services

Medicare Star Ratings Summary

Peoples Health Group Medicare (HMO-POS) | 2024

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

Summary of Benefits for Peoples Health Group Medicare – A general summary of plan benefits

Vendor Information – A listing of providers offering benefit-related services

Peoples Health Group Medicare (HMO-POS) Office of Group Benefits (OGB) | 2024

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

Summary of Benefits for Peoples Health Group Medicare (HMO-POS) Office of Group Benefits (OGB) A general summary of plan benefits

Vendor Information – A listing of providers offering benefit-related services

Other Important Documents, Links and Forms | 2024

If you’re looking for other resources not listed below, visit the UnitedHealthcare provider website.

Facility Documentation and Discharge Forms

Benefit Comparison Grids for Peoples Health Special Needs Plans

Coverage Policy Guidelines and Coverage Summaries

View coverage criteria here on the UnitedHealthcare website.

Electronic Funds Transfer Documents

Find 2024 information here on the UnitedHealthcare website

Prescription Drugs

Prior Authorization Criteria – Detailed criteria for select covered drugs (Last updated: July 2024) 

Step Therapy Criteria – Detailed criteria for select covered drugs (Last updated: July 2024)

2024 Comprehensive Formulary for Secure Health and Secure Complete (HMO-POS D-SNP) (Last updated: July 2024)

2024 Comprehensive Formulary for Choices 65 (HMO-POS), Gold (HMO-POS), Choices (PPO), Medicare Advantage LA-0004 (HMO-POS) (Last updated: July 2024)

2024 Comprehensive Formulary for Group (HMO-POS) (Last updated: July 2024)

2024 Comprehensive Formulary for Group for OGB (HMO-POS) (Last updated: July 2024)

 

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