Provider Plan Documents and Forms | 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

Medicare Star Ratings Summary

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

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

Medicare Star Ratings Summary

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

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

Medicare Star Ratings Summary

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

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

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  

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

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

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

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

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

Acute Inpatient, Post-Acute Inpatient and Post-Discharge Services for Peoples Health Patients: Authorization and Ordering Process (Hospitals)

Post-Acute Inpatient and Post-Discharge Services for Peoples Health Patients: Authorization and Ordering Process (Post-acute care facilities)

Facility Documentation Update Form

SNF Discharge Communication Form

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

View coverage criteria here on the UnitedHealthcare website.

Find 2024 information here on the UnitedHealthcare website

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)

Formulary Additions

Formulary Deletions

(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)

Peoples Health Choices (PPO)

Peoples Health Patriot (PPO)

Peoples Health Secure Health (HMO-POS D-SNP)

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

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

MyLaurel Program Overview

SNF Referral Reference Sheet for Hospitals

Complex Case Management Program

Social Determinants of Health Benefit Guide

Supportive Care Program