Resource Library

Summary of Benefits

Download a complete summary of benefits for the The Premier Plan (HMO) or the Freedom Plan (HMO POS)

Premier Plan (HMO)

• Summary of Benefits (PDF) - Full color
• Summary of Benefits (PDF) - Grey scale

Freedom Plan (HMO POS)

• Summary of Benefits (PDF) - Full color
• Summary of  Benefits (PDF) - Grey scale

Evidence of Coverage

These booklets give you the details about your Medicare health care and prescription drug coverage from Jan.1 – Dec. 31, 2022. It explains how to get coverage for the health care services and prescription drugs you need.

Premier Plan (HMO)

• Evidence of Coverage (PDF) - Pages 1-117
• Evidence of Coverage (PDF) - Pages 118-232

Freedom Plan (HMO POS)

• Evidence of Coverage (PDF) - Pages 1-121
• Evidence of Coverage (PDF) - Pages 122-240

Provider Directory

This directory provides a list of Ochsner Health Plan ’s current network providers for Ascension, East Baton Rouge, East Feliciana, Iberville, Jefferson, Lafourche, Livingston, Orleans, St. Charles, St. John the Baptist, St. Tammany, and West Baton Rouge parishes in Louisiana.

• Provider Directory (PDF)
   

Pharmacy Directory

This directory provides a list of Ochsner Health Plan ’s in-network pharmacies available in Louisiana, updated as of Oct. 15, 2021. For more recent information or other questions, please contact Ochsner Health Plan by phone or leverage the contact us form. 

• Pharmacy Directory (PDF)

Formulary

This document is a partial formulary and includes only some of the drugs covered by
Ochsner Health Plan.

• Partial List of Covered Drugs (PDF)

Vendor Contact Sheet

As an Ochsner Health Plan member, you get additional benefits. Please call the vendors
directly for information or call Members Services at 1-833-674-2112 (TTY:711).

• Vendor Contact Sheet (PDF)

Request for Enrollment

This is an individual enrollment request for to enroll in a medicare advantage plan (part C) 

• Request for Enrollment (PDF)