Provider Plan Documents and Forms | 2024
You must have Adobe Acrobat to view some of these documents. Click here to download Adobe Acrobat Reader.
How to setup Adobe Acrobat to read PDFs
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
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
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
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
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
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
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
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
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
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
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.
Authorization and Recertification Documents
Home Health Agency Update/Recertification Form – to update home health services for members, as well as to request recertification for continuation of services
Medical Necessity Form – to submit authorization requests for Peoples Health patients via fax
Outpatient Services for Peoples Health Patients: Ordering and Authorization Process
Prescription Drugs
Prior Authorization Criteria – Detailed criteria for select covered drugs (Last updated: April 2024)
Step Therapy Criteria – Detailed criteria for select covered drugs (Last updated: April 2024)
2024 Comprehensive Formulary for Secure Health and Secure Complete (HMO-POS D-SNP) (Last updated: April 2024)
2024 Comprehensive Formulary for Choices 65 (HMO-POS), Gold (HMO-POS), Choices (PPO), Medicare Advantage LA-0004 (HMO-POS) (Last updated: April 2024)
2024 Comprehensive Formulary for Group (HMO-POS) (Last updated: April 2024)
2024 Comprehensive Formulary for Group for OGB (HMO-POS) (Last updated: April 2024)
Provider Directories
(Last updated: April 25, 2024)
Peoples Health Choices 65 (HMO-POS) Greater New Orleans and Baton Rouge Area
Peoples Health Choices 65 (HMO-POS) Northshore
Peoples Health Choices 65 (HMO-POS) Southland
Peoples Health Choices 65 (HMO-POS) Rural Southeast
Peoples Health Medicare Advantage LA-0004 (HMO-POS)
Peoples Health Choices Gold (HMO-POS)
Peoples Health Secure Health (HMO-POS D-SNP)
Peoples Health Secure Complete (HMO-POS D-SNP)
Electronic Funds Transfer Documents
Find 2024 information here on the UnitedHealthcare website
Benefit Comparison Grids for Peoples Health Special Needs Plans
Information on what services are covered by our plan and what Louisiana Medicaid covers.
2024 Peoples Health Secure Health (HMO-POS D-SNP) and Louisiana Medicaid Benefits Comparison Chart
2024 Peoples Health Secure Complete (HMO-POS D-SNP) and Louisiana Medicaid Benefits Comparison Chart