Member Resources
Plan Documents
Evidence of Coverage, Annual Notice of Changes, and Summary of Benefits
These documents give you the details about your Medicare health care and prescription drug coverage from Jan.1 - Dec. 31. They explain how to get coverage for the health care services and prescription drugs you need.
2025 Plan Documents
Provider Directory
This directory provides a list of Ochsner Health Plan’s current network providers for Acadia, Ascension, East Baton Rouge, East Feliciana, Iberville, Jefferson, Jefferson Davis, Lafayette, Lafourche, Livingston, Orleans, Plaquemines, St. Bernard, St. Charles, St. John the Baptist, St. Landry, St. Martin, St. Tammany, Vermilion, and West Baton Rouge parishes in Louisiana.
2025 Provider Directory
Durable Medical Equipment Providers (DME)
Ochsner Health Plan Freedom and Heroes (HMO POS) members may use Point-of-Service (POS) providers that are outside of our network for an additional cost. Out-of-network/noncontracted providers are under no obligation to treat Ochsner Health Plan members, except in emergency situations. Please call our member services number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services.
Prescription Drugs and Pharmacy
Pharmacy Directory
This Pharmacy Directory provides a list of Ochsner Health Plan's participating pharmacies located within our service area.
Birdi™ Mail Order Pharmacy
Questions? Birdi is here to help!
If you have questions, please call Birdi toll-free at 1-855-873-8739 (TTY dial 711). Birdi's customer service hours are:
Monday-Friday 7:00 am - 7:00 pm Central Time
Saturday 8:00 am - 3:00 pm Central Time
Medicare Prescription Payment Plan
Member Request For Reimbursement
Formulary (List of Covered Drugs)
Premier and Freedom Plans Part D Formulary*
2025 Formulary
2025 Full List of Covered Drugs Premier and Freedom (PDF)
2025 Premier and Freedom Formulary Online Search (link)
2025 Premier and Freedom List of Drugs Requiring Prior Authorization (PDF) Effective 12/01/2025
2025 Premier and Freedom List of Drugs Requiring Step Therapy (PDF) Effective 12/01/2025
Dual (HMO D-SNP) Part D Formulary*
2025 Dual (D-SNP) Plan Full List of Covered Drugs (PDF)
2025 Dual (D-SNP) Plan Online Formulary Search (link)
2025 Dual (D-SNP) List of Drugs Requiring Prior Authorization (PDF) Effective 12/01/2025
2025 Dual (D-SNP) List of Drugs Requiring Step Therapy (PDF) Effective 12/01/2025
*For use by Dual (HMO D-SNP) plan members
Additional Information About Part D Prescription Drugs*
Important Drug and Pharmacy Information (PDF)
Medication Therapy Management (MTM) Program (PDF)
Personal Medication List (PML) Worksheet (PDF)
Prescription Drug Transition Policy (PDF)
Part D Quality Assurance Program (PDF)
Medicare Part D Prescription Redetermination Form (PDF)
Medicare Prescription Drug Coverage Determination Form (PDF)
Safer Use of Opioid Pain Medication (PDF)
*Not For Use By Ochsner Health Plan Heroes (HMO POS) Plan Members
Dental Information
DINA Dental
2025 Dental Benefits, effective January 1, 2025
2025 Dina Dental Fee Schedule - Premier, Freedom and Heroes plans (PDF)
Member Forms and Notices
Member Request For Reimbursement Forms
These forms are to be used to request reimbursement for out-of-pocket expenses.
Member Reimbursement Form - DMR Form
Member Reimbursement Form - Part D Drugs (PDF)
For Appointed Representatives submitting a Member Reimbursement Form on behalf of an Ochsner Health Plan Member, please attach a completed Appointment of Representative (AOR) form or a copy of an official Power of Attorney (POA) document to the Member Reimbursement form. Failure to include the AOR/POA form when submitting on behalf of the Member could result in dismissal of the request for payment.
Notice Of Non-Discrimination
Notice of Non-Discrimination (PDF)
Multi-language Interpreter Services
Notice Of Privacy Practices
Filing A Complaint
If you find the information we provided prior to enrollment misleading or unclear, you can file a complaint with Medicare. If your complaint is related to a sales agent, please provide the agent's name if possible.
To file a complaint with Medicare, call 1-800-MEDICARE or visit Medicare's grievance/coverage determination page on Medicare.gov at this link: https://www.medicare.gov/MedicareComplaintForm/home.aspx
1-800-MEDICARE is available 24 hours a day, 7 days a week, except some federal holidays. TTY users can call 1-877-486-2048.