Member Plan Documents and Forms | 2024
View important 2024 plan documents and forms on this page.
If you are a plan member and would like any of the following documents mailed to you, please call customer service toll-free at 1-877-369-1907, seven days a week, from 8 a.m. to 8 p.m. TTY users may call 711. If you contact us on a weekend or holiday, we will reach out to you within one business day. You should receive the document within two weeks of your request.
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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
Prescription Drugs
Prior Authorization Criteria – Detailed criteria for select covered drugs (Last updated: November 2024)
Step Therapy Criteria – Detailed criteria for select covered drugs (Last updated: November 2024)
2024 Comprehensive Formulary for Secure Health and Secure Complete (HMO-POS D-SNP) (Last updated: November 2024)
2024 Comprehensive Formulary for Choices 65 (HMO-POS), Gold (HMO-POS), Choices (PPO), Medicare Advantage LA-0004 (HMO-POS) (Last updated: November 2024)
2024 Comprehensive Formulary for Group (HMO-POS) (Last updated: November 2024)
2024 Comprehensive Formulary for Group for OGB (HMO-POS) (Last updated: November 2024)
Provider Directories
(Last updated: Oct. 10, 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)
Privacy
Notice of Privacy Practices – Description of how your medical information may be used and disclosed and how you can get access to this information