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Provider Plan Documents and Forms | 2025

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2025 Plan Coverage Documents

HMO-POS

Peoples Health Choices 65 (HMO-POS) Greater New Orleans and Baton Rouge Area | 2025

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 | 2025

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 | 2025

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

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

Medicare Star Ratings Summary

Peoples Health Choices 65 (HMO-POS) Rural Southeast | 2025

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 Giveback LA-4 (HMO-POS) | 2025

Plan Overview for Peoples Health Medicare Advantage Giveback LA-4 (HMO-POS) – An overview of plan benefits

Annual Notice of Changes for Peoples Health Medicare Advantage Giveback LA-4 (HMO-POS) – A summary of plan benefit changes compared to the previous year and other important plan details

Evidence of Coverage for Peoples Health Medicare Advantage Giveback LA-4 (HMO-POS) – 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 Giveback LA-4 (HMO-POS) – 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) | 2025

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 Medicare Advantage Patriot No Rx LA (HMO-POS) | 2025

Plan Overview for Peoples Health Medicare Advantage Patriot No Rx LA – An overview of plan benefits

Evidence of Coverage for Peoples Health Medicare Advantage Patriot No Rx LA – 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 Patriot No Rx LA – 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) | 2025

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) | 2025

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

HMO-POS C-SNP

Peoples Health Complete Care LA-5 (HMO-POS C-SNP) | 2025

Plan Overview for Peoples Health Complete Care LA-5 – An overview of plan benefits

Evidence of Coverage for Peoples Health Complete Care LA-5 – Information about plan benefits, membership, covered and noncovered services, member rights and responsibilities, and other important plan details

Summary of Benefits for Peoples Health Complete Care LA-5 – A general summary of plan benefits

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

Medicare Star Ratings Summary

Peoples Health Complete Care LA-6 (HMO-POS C-SNP) | 2025

Plan Overview for Peoples Health Complete Care LA-6 – An overview of plan benefits

Evidence of Coverage for Peoples Health Complete Care LA-6 – Information about plan benefits, membership, covered and noncovered services, member rights and responsibilities, and other important plan details

Summary of Benefits for Peoples Health Complete Care LA-6 – A general summary of plan benefits

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

Medicare Star Ratings Summary

Peoples Health Complete Care LA-7 (HMO-POS C-SNP) | 2025

Plan Overview for Peoples Health Complete Care LA-7 – An overview of plan benefits

Evidence of Coverage for Peoples Health Complete Care LA-7 – Information about plan benefits, membership, covered and noncovered services, member rights and responsibilities, and other important plan details

Summary of Benefits for Peoples Health Complete Care LA-7 – A general summary of plan benefits

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

Medicare Star Ratings Summary

HMO-POS D-SNP

Peoples Health Secure Complete (HMO-POS D-SNP) | 2025

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 Dual Complete LA-S5 (HMO-POS D-SNP) | 2025

Plan Overview for Peoples Health Dual Complete LA-S5 – An overview of plan benefits

Evidence of Coverage for Peoples Health Dual Complete LA-S5 – Information about plan benefits, membership, covered and noncovered services, member rights and responsibilities, and other important plan details

Summary of Benefits for Peoples Health Dual Complete LA-S5 – 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) | 2025

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

PPO

Peoples Health Choices (PPO) | 2025

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) | 2025

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

Other Important Documents, Links and Forms | 2025

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

Information on what services are covered by our plan and what Louisiana Medicaid covers. 

2025 Peoples Health Dual Complete LA-S5 (HMO-POS D-SNP) and Louisiana Medicaid Benefits Comparison Chart (Coming Soon)

2025 Peoples Health Secure Health (HMO-POS D-SNP) and Louisiana Medicaid Benefits Comparison Chart (Coming Soon)

205 Peoples Health Secure Complete (HMO-POS D-SNP) and Louisiana Medicaid Benefits Comparison Chart (Coming Soon)

Coverage Policy Guidelines and Coverage Summaries

View coverage criteria here on the UnitedHealthcare website.

Prescription Drugs

Prior Authorization Criteria – Detailed criteria for select covered drugs (Last updated: Coming Soon) 

Step Therapy Criteria – Detailed criteria for select covered drugs (Last updated: Coming Soon)

2025 Comprehensive Formulary for Dual Complete LA-S5, Secure Health and Secure Complete (HMO-POS D-SNP) (Last updated: September 2024)

2025 Comprehensive Formulary for Choices 65 (HMO-POS), Choices Gold (HMO-POS), Choices (PPO), Medicare Advantage Giveback LA-4 (HMO-POS) (Last updated: September 2024)

2025 Comprehensive Formulary for Complete Care LA-5 (HMO-POS C-SNP), Complete Care LA-6 (HMO-POS C-SNP), Complete Care LA-7 (HMO-POS C-SNP) (Last updated: September 2024)

2025 Comprehensive Formulary for Peoples Health Group Medicare (HMO-POS) (Last updated: September 2024)

2025 Comprehensive Formulary for Peoples Health Group Medicare for OGB (HMO-POS) (Last updated: September 2024)

 

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