Peoples Health Group Medicare Office of Group Benefits (OGB) | 2025

The Peoples Health plan offered through OGB is a Medicare Advantage Prescription Drug plan. We designed it exclusively for OGB retirees, and it features the coordinated care Peoples Health is known for, as well as the flexible out-of-network coverage you may want.

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Looking for Peoples Health Group Medicare (HMO-POS)? Click here.

Member Website and App | 2025

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Plan Benefits for Peoples Health Group Medicare | 2025

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) Office of Group Benefits (OGB)	In-network	Out-of-network
Out-of-Pocket Maximum	$2,500	Does not apply
Doctor Visits & NurseLine
Primary Care Provider Visit	$0	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 per day	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.)	$5	$5
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)	$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 or a DME 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	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 most Part D covered vaccines, including Shingrix, from network providers.

90-day supplies of maintenance medications are available at retail pharmacies and by mail order.

You will pay a maximum of $35 for each 1-month supply of Part D-covered insulin drugs through all drug payment stages, except the catastrophic coverage stage, where you pay $0.

You will pay a $0 copay for most Part D-covered vaccines, including Shingrix.

Initial Coverage Period

30-Day Drug Supply

90-Day Drug Supply

Tier 1

Tier 2

Tier 3

$20

$40

Tier 4

$40

$80

Tier 5

20%*

* coinsurance

The Medicare Prescription Payment Plan: Starting Jan. 1, 2025, if you spend more than $2,000 for covered Part D prescription drugs each year, you may want to participate in the Medicare Prescription Payment Plan. This payment plan spreads your out-of-pocket prescription drug costs over the remainder of the calendar year. Learn more about the Medicare Prescription Payment Plan.


Peoples Health Group Medicare (HMO-POS) Office of Group Benefits (OGB)	Your Cost
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 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 - $2,000 Coverage Maximum
Dental - Preventive (X-rays, cleanings, exams - 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 and More | 2025

Doctors, Hospitals, Providers

Routine Vision Providers

Behavioral Health Providers

Pharmacy
Locations

Fitness Center Locations

Dental Providers

PERS Provider

Medications

Hearing

*Fitness network is subject to change. For the most accurate listing, including premium gyms, log in to your member website.

Important Documents | 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

Vendor List | 2025

DOWNLOAD THE GROUP OGB VENDOR LIST


Benefit Type	Vendor Name	Contact Information
Hearing Aids	UnitedHealthcare Hearing	1-866-445-2071 uhchearing.com/retiree
Routine Vision Services	UnitedHealthcare Vision	1-866-877-5403 peopleshealthretiree.com
Routine Dental Benefit	UnitedHealthcare Dental	1-800-807-9904 peopleshealthretiree.com
Prescription Drug Home Delivery	Optum Home Delivery, a service of OptumRx	1-888-279-1828 peopleshealthretiree.com
NurseLine	Nurseline	1-877-365-7949
Personal Emergency Response System	Lifeline	1-855-595-8485 lifeline.com/uhcgroup
Fitness Benefit	Renew Acitve	1-866-877-5403 peopleshealthretiree.com
Behavioral Health (including virtual visits)	Optum Behavioral Health	1-877-566-7913 liveandworkwell.com/?pin=PHPMA

How to Enroll | 2025

By Mail

Write to us and request an enrollment packet.

Indicate your group plan – either:

Peoples Health Group Medicare OR
Peoples Health Group Medicare for Office of Group Benefits Enrollment Packet Request
Three Lakeway Center
3838 N. Causeway Blvd.
Suite 2500
Metairie, LA 70002

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