Provider Plan Documents and Forms | 2025
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 2024 plan documents and forms? Click here.
Looking for plan provider forms? Click here.
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
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
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
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
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
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
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
Peoples Health Group Medicare (HMO-POS) | 2025
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
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
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
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
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
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
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 servicesÂ
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
Other Important Documents, Links and Forms | 2025
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
Facility Documentation and Discharge Forms
DME, Orthotics and Prosthetics Vendors
Benefit Comparison Grids for Peoples Health Dual-Eligible Special Needs Plans
Information on what services are covered by our plan and what Louisiana Medicaid covers.Â
2025 Peoples Health Secure Health (HMO-POS D-SNP) and Louisiana Medicaid Benefits Comparison ChartÂ
2025 Peoples Health Secure Complete (HMO-POS D-SNP) and Louisiana Medicaid Benefits Comparison Chart
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: 10-29-24)Â
Step Therapy Criteria – Detailed criteria for select covered drugs
(Last updated: 10-29-24)Â
2025 Comprehensive Formulary for Dual Complete LA-S5, Secure Health and Secure Complete (HMO-POS D-SNP) (Last updated: October 2024)
2025 Comprehensive Formulary for Choices 65 (HMO-POS), Choices Gold (HMO-POS), Choices (PPO), Medicare Advantage Giveback LA-4 (HMO-POS) (Last updated: October 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: October 2024)
2025 Comprehensive Formulary for Peoples Health Group Medicare (HMO-POS) (Last updated: October 2024)
2025 Comprehensive Formulary for Peoples Health Group Medicare for OGB (HMO-POS) (Last updated: October 2024)
Provider Directories
(Last updated: November 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 Giveback LA-4 (HMO-POS)
Peoples Health Medicare Advantage Patriot No Rx LA (HMO-POS)
Peoples Health Choices Gold (HMO-POS)
Peoples Health Complete Care LA-5 (HMO-POS C-SNP)
Peoples Health Complete Care LA-6 (HMO-POS C-SNP)
Peoples Health Complete Care LA-7 (HMO-POS C-SNP)
Peoples Health Dual Complete LA-S5 (HMO-POS D-SNP)
Peoples Health Secure Health (HMO-POS D-SNP)
Peoples Health Secure Complete (HMO-POS D-SNP)
Peoples Health Clinical Program Resources
Cancer Guidance Program Reference Sheet
Optum Cancer Guidance Program FAQs
Elara Caring Healing at Home Program Overview
Advance Care Planning Coverage Guidelines
RestorixHealth In-Home Wound Care Program Overview
RestorixHealth In-Home Wound Care Patient Flyer
SNF Referral Reference Sheet for Hospitals
Complex Case Management Program
Social Determinants of Health Benefit Guide