Peoples Health Group Medicare (HMO-POS) and Group Medicare OGB (HMO-POS) | 2021
Peoples Health Group Medicare (HMO-POS)
$0
Tier 1 & 2 Drugs*
A Medicare Advantage HMO plan with a point-of-service (POS) option, which lets you see providers who are not in the plan’s provider network for certain services. Not all services received from out-of-network providers are covered.
A Medicare Advantage HMO plan with a point-of-service (POS) option, which lets you see providers who are not in the plan’s provider network for certain services. Not all services received from out-of-network providers are covered.
Peoples Health Group Medicare (HMO-POS) for Office of Group Benefits (OGB)
$0
Tier 1 & 2 Drugs*
A Medicare Advantage Prescription Drug plan exclusively for Louisiana Office of Group Benefits retirees. This plan features the coordinated, in-network care for which Peoples Health is known. It also offers out-of-network coverage.
A Medicare Advantage Prescription Drug plan exclusively for Louisiana Office of Group Benefits retirees. This plan features the coordinated, in-network care for which Peoples Health is known. It also offers out-of-network coverage.
Plan Benefits for Group Medicare
The benefits below are available with this Medicare Advantage plan. To see 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 | In-network provider must be used for the out-of-network benefit |
| Preventive Care+ | ||
| Pap Smears, Pelvic Exams, Mammograms | $0 | 20% coinsurance |
| Prostate & Colorectal Cancer Screenings | $0 | 20% coinsurance |
| Bone Mass Measurement | $0 | 20% coinsurance |
| Vaccinations (flu, pneumonia) | $0 | $0 |
| Labs & Tests*+ | ||
| Lab Services, Diagnostic Tests, X-rays and Advanced Imaging (MRI, MRA, CT, PET scans etc.) | $0 | 20% coinsurance |
| Outpatient Surgery (Outpatient Hospital or Ambulatory Surgical Center) | ||
| Outpatient Surgery | $0 | 20% coinsurance |
| Inpatient Hospital Care per admission | ||
| Inpatient Deductible | $0 | Same as Medicare |
| Inpatient Stay (days 1-10) | $50 per day | Same as Medicare |
| Inpatient Stay (days 11 and beyond) | $0 | Same as Medicare |
| Emergency Care, Urgent Care & Emergency Transportation♦ | ||
| Emergency Care (worldwide) | $50 | $50 |
| Urgent Care (inside the U.S.) | $10 | $10 |
| Urgent Care (outside the U.S.) | Does not apply | $50 |
| Emergency Ambulance | $50 | $50 |
| Home Health & Skilled Nursing Facility Care | ||
| Home Health | $0 | 20% coinsurance |
| Skilled Nursing Facility Care (semi private room and board, days 1-20) | $0 | $0 |
| Skilled Nursing Facility Care (semi private 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 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 | In-network provider must be used for the out-of-network benefit |
Notes:
Authorization is required for certain services.
*See the Provider Directory for network lab and diagnostic providers.
+Office visit copay may apply.
♦Emergency care copay waived if admitted to inpatient hospital care within 24 hours for the same condition.
All drugs are COVERED through the Part D coverage gap. 90-day supplies of maintenance medications for tiers 1-4 are available at retail pharmacies and by mail order.
| Initial Coverage Period | 30-Day Supply | 90-Day Supply (from pharmacies with preferred cost-sharing |
| Tier 1* | $3 | $0 |
| Tier 2* | $10 | $0 |
| Tier 3* | $25 | $50 |
| Tier 4* | $50 | $100 |
| Tier 5* | 20% coinsurance | 30-day supply only |
*With coverage through the gap
| Peoples Health Group Medicare (HMO-POS) | Your Cost |
| Fitness | |
| Fitness Center Membership | $0 |
| Vision Services | |
| Routine Eye Exam | $15 |
| Glasses or Contact Lenses | $0 |
| Dental - $2,000 Coverage Maximum | |
| Dental - Preventive (1 set of X-rays and 2 exams and cleanings per year) | $0 |
| Dental - Comprehensive (fillings, dentures, etc.) | Copays vary $50 deductible applies |
Notes:
Costs listed are based on use of network providers.
Authorization is required for certain services.
Plan Benefits for Group Medicare for Office of Group Benefits (OGB)
The benefits below are available with this Medicare Advantage plan. To see a full list of benefits, please see the Evidence of Coverage for this plan.
| Peoples Health Group Medicare (HMO-POS) for Office of Group Benefits (OGB) | 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 | In-network provider must be used for the out-of-network benefit |
| Preventive Care+ | ||
| Pap Smears, Pelvic Exams, Mammograms | $0 | 20% coinsurance |
| Prostate & Colorectal Cancer Screenings | $0 | 20% coinsurance |
| Bone Mass Measurement | $0 | 20% coinsurance |
| Vaccinations (flu, pneumonia) | $0 | $0 |
| Labs & Tests*+ | ||
| Lab Services, Diagnostic Tests, X-rays and Advanced Imaging (MRI, MRA, CT, PET scans etc.) | $0 | 20% coinsurance |
| Outpatient Surgery (Outpatient Hospital or Ambulatory Surgical Center) | ||
| Outpatient Surgery | $0 | 20% coinsurance |
| Inpatient Hospital Care per admission | ||
| Inpatient Deductible | $0 | Same as Medicare |
| Inpatient Stay (days 1-10) | $50 per day | Same as Medicare |
| Inpatient Stay (days 11 and beyond) | $0 | Same as Medicare |
| Emergency Care, Urgent Care & Emergency Transportation♦ | ||
| Emergency Care (worldwide) | $50 | $50 |
| Urgent Care (inside the U.S.) | $10 | $10 |
| Urgent Care (outside the U.S.) | Does not apply | $50 |
| Emergency Ambulance | $50 | $50 |
| Home Health & Skilled Nursing Facility Care | ||
| Home Health | $0 | 20% coinsurance |
| Skilled Nursing Facility Care (semi private room and board, days 1-20) | $0 | $0 |
| Skilled Nursing Facility Care (semi private 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 (Medicare limits apply) | $0 | 20% coinsurance |
| Durable Medical Equipment (wheelchairs, oxygen, etc.) | 5% coinsurance | 20% coinsurance |
| Diabetes Monitoring Supplies (test strips, monitor, etc., from a preferred provider) | $0 | 20% coinsurance |
| Mental Health & Substance Abuse Treatment | ||
| Inpatient Mental Health (days 1-5) | $25 per day | Same as Medicare |
| Inpatient Mental Health (days 6-90) | $0 | Same as Medicare |
| Outpatient Mental Health or Substance Abuse Group or Individual Visit | $0 | 20% coinsurance |
| Virtual Mental Health Visit | $0 | In-network provider must be used for the out-of-network benefit |
Notes:
Authorization is required for certain services.
*See the Provider Directory for network lab and diagnostic providers.
+Office visit copay may apply.
♦Emergency care copay waived if admitted to inpatient hospital care within 24 hours for the same condition.
All drugs are COVERED through the Part D coverage gap. 90-day supplies of maintenance medications for tiers 1-4 are available at retail pharmacies and by mail order.
| Initial Coverage Period | 30-Day Supply | 90-Day Supply 90-Day Supply (from pharmacies with preferred cost-sharing) |
| Tier 1* | $0 | $0 |
| Tier 2* | $0 | $0 |
| Tier 3* | $20 | $40 |
| Tier 4* | $40 | $80 |
| Tier 5* | 20% coinsurance | 30-day supply only |
*With coverage through the gap
| Peoples Health Group Medicare (HMO-POS) for Office of Group Benefits (OGB) | Your Cost |
| Fitness | |
| Fitness Center Membership | $0 |
| Vision Services | |
| Routine Eye Exam | $15 |
| Glasses or Contact Lenses | $0 |
| Dental - $2,000 Coverage Maximum | |
| Dental - Preventive (1 set of X-rays and 2 exams and cleanings per year) | $0 |
| Dental - Comprehensive (fillings, dentures, etc.) | Copays vary $50 deductible applies |
Notes:
Costs listed are based on use of network providers.
Authorization is required for certain services.
Plan Benefits for Group Medicare
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 | In-network provider must be used for the out-of-network benefit |
| Preventive Care+ | ||
| Pap Smears, Pelvic Exams, Mammograms | $0 | 20% coinsurance |
| Prostate & Colorectal Cancer Screenings | $0 | 20% coinsurance |
| Bone Mass Measurement | $0 | 20% coinsurance |
| Vaccinations (flu, pneumonia) | $0 | $0 |
| Labs & Tests*+ | ||
| Lab Services, Diagnostic Tests, X-rays and Advanced Imaging (MRI, MRA, CT, PET scans etc.) | $0 | 20% coinsurance |
| Outpatient Surgery (Outpatient Hospital or Ambulatory Surgical Center) | ||
| Outpatient Surgery | $0 | 20% coinsurance |
| Inpatient Hospital Care per admission | ||
| Inpatient Deductible | $0 | Same as Medicare |
| Inpatient Stay (days 1-10) | $50 per day | Same as Medicare |
| Inpatient Stay (days 11 and beyond) | $0 | Same as Medicare |
| Emergency Care, Urgent Care & Emergency Transportation♦ | ||
| Emergency Care (worldwide) | $50 | $50 |
| Urgent Care (inside the U.S.) | $10 | $10 |
| Urgent Care (outside the U.S.) | Does not apply | $50 |
| Emergency Ambulance | $50 | $50 |
| Home Health & Skilled Nursing Facility Care | ||
| Home Health | $0 | 20% coinsurance |
| Skilled Nursing Facility Care (semi private room and board, days 1-20) | $0 | $0 |
| Skilled Nursing Facility Care (semi private 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 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 | In-network provider must be used for the out-of-network benefit |
Notes:
Authorization is required for certain services.
*See the Provider Directory for network lab and diagnostic providers.
+Office visit copay may apply.
♦Emergency care copay waived if admitted to inpatient hospital care within 24 hours for the same condition.
Part D Prescription Drug Coverage
All drugs are COVERED through the Part D coverage gap. 90-day supplies of maintenance medications for tiers 1-4 are available at retail pharmacies and by mail order.
| Initial Coverage Period | 30-Day Supply | 90-Day Supply (from pharmacies with preferred cost-sharing |
| Tier 1* | $3 | $0 |
| Tier 2* | $10 | $0 |
| Tier 3* | $25 | $50 |
| Tier 4* | $50 | $100 |
| Tier 5* | 20% coinsurance | 30-day supply only |
*With coverage through the gap
Additional Benefits
| Peoples Health Group Medicare (HMO-POS) | Your Cost |
| Fitness | |
| Fitness Center Membership | $0 |
| Vision Services | |
| Routine Eye Exam | $15 |
| Glasses or Contact Lenses | $0 |
| Dental - $2,000 Coverage Maximum | |
| Dental - Preventive (1 set of X-rays and 2 exams and cleanings per year) | $0 |
| Dental - Comprehensive (fillings, dentures, etc.) | Copays vary $50 deductible applies |
Notes:
Costs listed are based on use of network providers. Authorization is required for certain services.
Plan Benefits for Group Medicare for Office of Group Benefits (OGB)
Doctor and Hospital Coverage
| Peoples Health Group Medicare (HMO-POS) for Office of Group Benefits (OGB) | 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 | In-network provider must be used for the out-of-network benefit |
| Preventive Care+ | ||
| Pap Smears, Pelvic Exams, Mammograms | $0 | 20% coinsurance |
| Prostate & Colorectal Cancer Screenings | $0 | 20% coinsurance |
| Bone Mass Measurement | $0 | 20% coinsurance |
| Vaccinations (flu, pneumonia) | $0 | $0 |
| Labs & Tests*+ | ||
| Lab Services, Diagnostic Tests, X-rays and Advanced Imaging (MRI, MRA, CT, PET scans etc.) | $0 | 20% coinsurance |
| Outpatient Surgery (Outpatient Hospital or Ambulatory Surgical Center) | ||
| Outpatient Surgery | $0 | 20% coinsurance |
| Inpatient Hospital Care per admission | ||
| Inpatient Deductible | $0 | Same as Medicare |
| Inpatient Stay (days 1-10) | $50 per day | Same as Medicare |
| Inpatient Stay (days 11 and beyond) | $0 | Same as Medicare |
| Emergency Care, Urgent Care & Emergency Transportation♦ | ||
| Emergency Care (worldwide) | $50 | $50 |
| Urgent Care (inside the U.S.) | $10 | $10 |
| Urgent Care (outside the U.S.) | Does not apply | $50 |
| Emergency Ambulance | $50 | $50 |
| Home Health & Skilled Nursing Facility Care | ||
| Home Health | $0 | 20% coinsurance |
| Skilled Nursing Facility Care (semi private room and board, days 1-20) | $0 | $0 |
| Skilled Nursing Facility Care (semi private 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 (Medicare limits apply) | $0 | 20% coinsurance |
| Durable Medical Equipment (wheelchairs, oxygen, etc.) | 5% coinsurance | 20% coinsurance |
| Diabetes Monitoring Supplies (test strips, monitor, etc., from a preferred provider) | $0 | 20% coinsurance |
| Mental Health & Substance Abuse Treatment | ||
| Inpatient Mental Health (days 1-5) | $25 per day | Same as Medicare |
| Inpatient Mental Health (days 6-90) | $0 | Same as Medicare |
| Outpatient Mental Health or Substance Abuse Group or Individual Visit | $0 | 20% coinsurance |
| Virtual Mental Health Visit | $0 | In-network provider must be used for the out-of-network benefit |
Notes:
Costs listed are based on use of network providers.
Authorization is required for certain services.
*See the Provider Directory for network lab and diagnostic providers. Lab services, diagnostic tests and X-rays at a doctor’s office or outpatient hospital may have higher out-of-pocket costs.
+Office visit copay may apply.
♦Emergency care copay waived if admitted to inpatient hospital care within 24 hours for the same condition. Up to $5,000 of coverage for emergency and urgently needed care (combined) outside the U.S. and its territories.
Part D Prescription Drug Coverage
All drugs are COVERED through the Part D coverage gap. 90-day supplies of maintenance medications for tiers 1-4 are available at retail pharmacies and by mail order.
| Initial Coverage Period | 30-Day Supply | 90-Day Supply 90-Day Supply (from pharmacies with preferred cost-sharing) |
| Tier 1* | $0 | $0 |
| Tier 2* | $0 | $0 |
| Tier 3* | $20 | $40 |
| Tier 4* | $40 | $80 |
| Tier 5* | 20% coinsurance | 30-day supply only |
*With coverage through the gap
Additional Benefits
| Peoples Health Group Medicare (HMO-POS) for Office of Group Benefits (OGB) | Your Cost |
| Fitness | |
| Fitness Center Membership | $0 |
| Vision Services | |
| Routine Eye Exam | $15 |
| Glasses or Contact Lenses | $0 |
| Dental - $2,000 Coverage Maximum | |
| Dental - Preventive (1 set of X-rays and 2 exams and cleanings per year) | $0 |
| Dental - Comprehensive (fillings, dentures, etc.) | Copays vary $50 deductible applies |
Notes:
Costs listed are based on use of network providers. Authorization is required for certain services.
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Important Documents
GROUP MEDICARE DOCUMENTS
Plan Overview for Peoples Health Group Medicare – An overview of plan benefits
Annual Notice of Changes for Group Medicare – A summary of plan benefit changes compared to the previous year and other important plan details
Evidence of Coverage for Group Medicare – Information about plan benefits, membership, covered and noncovered services, member rights and responsibilities, and other important plan details
Vendor Information – A listing of providers offering benefit-related services for your plan
GROUP MEDICARE fOR OGB DOCUMENTS
Plan Overview for Peoples Health Group Medicare for Office of Group Benefits (OGB) – An overview of plan benefits
Annual Notice of Changes for Peoples Health Group Medicare for 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 for Office of Group Benefits (OGB) – Information about plan benefits, membership, covered and noncovered services, member rights and responsibilities, and other important plan details
Vendor Information – A listing of providers offering benefit-related services for your plan
How to Enroll
HOW DO I ENROLL BY APPOINTMENT?
Employer Group members should contact the employer office that administers your benefits for enrollment information.
OGB members can call 1-866-912-8304, Monday through Friday, from 8 a.m. to 8 p.m.
TTY users may call 711.
A representative can schedule an appointment for you with a licensed representative.
HOW DO I ENROLL BY MAIL?
Write to us and request an enrollment packet. The address is:
Peoples Health Group Medicare or Group Medicare for Office of Group Benefits Enrollment Packet Request
Three Lakeway Center
Attn: Sales & Membership Operations
3838 N. Causeway Blvd.
Suite 2200
Metairie, LA 70002