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Peoples Health Group Medicare
(HMO-POS) | 2024
The Peoples Health Group Medicare (HMO-POS) plan includes prescription drug coverage and a point-of-service (POS) option. This allows you to see providers who may not be part of the plan’s network for certain services. Our plan prioritizes coordinated, in-network care for which Peoples Health is known.
Peoples Health Group Medicare
(HMO-POS) | 2024
The Peoples Health Group Medicare (HMO-POS) plan includes prescription drug coverage and a point-of-service (POS) option. This allows you to see providers who may not be part of the plan’s network for certain services. Our plan prioritizes coordinated, in-network care for which Peoples Health is known.
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Looking for Peoples Health Group Medicare (HMO-POS) Office of Group Benefits (OGB)? Click here.
Member Website and App | 2024
We’ve partnered with UnitedHealthcare to bring you expanded online resources. Use the member website and app for instant access to your plan and health care information—anytime, anywhere.
Member Website
Your member website makes it easy to use your plan benefits and manage your health information. Create an account to:
- View plan documents
- See details from your doctor visits
- Find network providers and pharmacies
Member App
Want plan information at your fingertips? Download your member app! Use the buttons below or search “UnitedHealthcare” in the Apple App Store® or Google Play™ store.
Plan Benefits for Peoples Health Group Medicare | 2024
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 (semiprivate room and board, days 1-20) | $0 | $0 |
| Skilled Nursing Facility Care (semiprivate 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 |
| 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 | 20% coinsurance |
| 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 | |
| Health Clubs, Online Classes, Brain Health Exercises and More | $0 |
| Vision Services | |
| Routine Eye Exam | $0 |
| Glasses or Contact Lenses ($200 allowance) | $0 |
| Hearing Services | |
| Hearing Aids ($750 allowance) | $0 |
| Routine Hearing Exam | $0 |
| Dental - $2,500 Coverage Maximum | |
| Dental - Preventive (X-rays, cleanings, exams, fluoride - coverage frequency varies) | $0 |
| Dental - Comprehensive/Restorative | $0 |
| Dental - Bridges and Dentures | 50% coinsurance |
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 (semiprivate room and board, days 1-20) | $0 | $0 |
| Skilled Nursing Facility Care (semiprivate 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 |
| 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 | 20% coinsurance |
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 | |
| Health Clubs, Online Classes, Brain Health Exercises and More | $0 |
| Vision Services | |
| Routine Eye Exam | $0 |
| Glasses or Contact Lenses ($200 allowance) | $0 |
| Hearing Services | |
| Hearing Aids ($750 allowance) | $0 |
| Routine Hearing Exam | $0 |
| Dental - $2,500 Coverage Maximum | |
| Dental - Preventive (X-rays, cleanings, exams, fluoride - coverage frequency varies) | $0 |
| Dental - Comprehensive/Restorative | $0 |
| Dental - Bridges and Dentures | 50% coinsurance |
Notes:
Costs listed are based on use of network providers.
Authorization is required for certain services.
Find Doctors, Medications & More | 2024
Important Documents | 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
Vendor List | 2024
| Benefit Type | Vendor Name | Contact Information | |
 | Hearing Aids | UnitedHealthcare Hearing | 1-866-445-2071 uhchearing.com/retiree |
 | Routine Vision Services | UnitedHealthcare Vision | 1-866-556-8167 peopleshealthretiree.com |
 | Routine Dental Benefit | UnitedHealthcare Dental | 1-877-265-9200 peopleshealthretiree.com |
 | Prescription Drug Home Delivery | Optum Home Delivery, a service of OptumRx | 1-888-279-1828 optumrx.com |
 | NurseLine | Nurseline | 1-877-365-7949 |
 | Over-the-Counter Items Credit | Solutran | 1-833-216-6709 healthybenefitsplus.com/uhcretiree |
 | Personal Emergency Response System | Lifeline | 1-855-595-8485 lifeline.com/uhcgroup |
 | Fitness Benefit | Renew Active | 1-866-556-8167 uhcrenewactive.com |
 | Behavioral Health (Including virtual visits) | Optum Behavioral Health | 1-877-566-7913 liveandworkwell.com/?pin=PHPMA |