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Peoples Health HMO-POS (Medicare Advantage Plan)

Overview

Peoples Health Group Medicare (HMO-POS) through the Office of Group Benefits offers more coverage than Medicare alone, including extra benefits such as routine vision and routine dental coverage, a free health club membership, and prescription drug coverage.

Founded in Louisiana, Peoples Health provides coordinated and personalized service tailored to your needs and has served Office of Group Benefits retirees since 2008.

Medical & Prescription Benefits

Covered Benefit Member Share
Plan Year Deductible $0
Out-of-Pocket Maximum (In-Network) $2,500
Out-of-Pocket Maximum (Out-of-Network) There is no out-of-network maximum. Out-of-network services do not count toward the in-network maximum.
Primary Care / Specialist Office Visits In-network: $0 / $10 copay per visit with network providers
Out-of-network: 20% coinsurance per visit
Emergency Room $50 copay per visit
Inpatient Hospital In-network: $50/day for days 1–10 with network providers
Out-of-network (Medicare-defined cost sharing): $1,676 deductible for days 1–60, $419 copay each day for days 61–90, and $838 copay each day for days 91–150 (lifetime reserve days)
Prescription Drugs (Part D) – Tier 1 $0
Prescription Drugs (Part D) – Tier 2 $0
Prescription Drugs (Part D) – Tier 3 $20 (30-day supply)
Prescription Drugs (Part D) – Tier 4 $40 (30-day supply)
Prescription Drugs (Part D) – Tier 5 20% coinsurance

Additional Benefits

Additional Benefit Member Share
Preventive Dental $0 copay for oral exams, cleanings, and X-rays from network providers; coverage frequency varies by service. Out-of-network dental services may have higher member costs.
Comprehensive Dental $0 copay–50% coinsurance for comprehensive services from network providers; coverage frequency varies by service. Covered up to $2,000 per year for comprehensive and preventive services. Out-of-network dental services may have higher member costs.
Diagnostic Hearing Exam $10 copay for each diagnostic hearing exam from network providers; 20% coinsurance for each exam from out-of-network providers.
Meal Benefit $0 copay for home-delivered meals from the network meal provider after an eligible hospital stay. Restrictions apply.
Respite Care $0 copay for each session with the network respite care provider, up to 12 sessions every year. This benefit is for members diagnosed with dementia. Restrictions apply.
Eyewear $0 copay for one pair of standard lenses each year from network providers; plan pays up to $200 every year for frames or contact lenses from network providers.

Contact Information

Resources / Forms