Member Resources
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Plan Documents | Provider Directory | Drug List |Â Drugs and Pharmacy |Â Dental | Durable Medical Equipment (DME) | Diabetes Supplies | Fitness | M3P | Over-the-Counter | Vision | Vendor Contacts | Forms & Notices
Online Tools
You'll need your Ochsner Health Plan ID card to register.
Click on the link to visit the MedImpact member portal. Once you register, you can sign into your account to:
- Check drug prices
- View benefit highlights
- View prescription history
You'll need your Ochsner Health Plan ID card to register.
Click on the link to visit the FlexCard member portal. Once you register, you can sign into your account to:
- Shop OTC products
- View purchase history
- Check your balance
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.
2024 Plan Documents
Baton Rouge / New Orleans Region (Ascension, East Baton Rouge, East Feliciana, Iberville, Jefferson, Lafourche, Livingston, Orleans, St. Charles, St. John the Baptist, West Baton Rouge)
Evidence of Coverage - Baton Rouge / New Orleans Region (PDF)
Annual Notice of Changes - Baton Rouge / New Orleans Region 2024 (PDF)
Summary of Benefits - Baton Rouge / New Orleans Region 2024 (PDF)
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Baton Rouge / New Orleans Region (Ascension, East Baton Rouge, East Feliciana, Iberville, Jefferson, Lafourche, Livingston, Orleans, St. Charles, St. John the Baptist, West Baton Rouge)
Evidence of Coverage - Baton Rouge / New Orleans Region (PDF)
Annual Notice Of Changes - Baton Rouge / New Orleans Region 2024 (PDF)
Summary of Benefits - Baton Rouge / New Orleans Region 2024 (PDF)
Baton Rouge / New Orleans Region (Ascension, East Baton Rouge, East Feliciana, Iberville, Jefferson, Lafourche, Livingston, Orleans, St. Charles, St. John the Baptist, West Baton Rouge)
Evidence of Coverage - Baton Rouge / New Orleans Region (PDF)
Summary of Benefits - Baton Rouge / New Orleans Region 2024 (PDF)
Northshore Region: St. Tammany
Evidence of Coverage - St. Tammany (PDF) updated May 24, 2024
Northshore Region: St. Tammany Parish
Evidence of Coverage - St. Tammany (PDF)Â
Lafayette Region: Lafayette Parish and St. Martin Parish
2025 Plan Documents
Baton Rouge / New Orleans Region (Ascension, East Baton Rouge, East Feliciana, Iberville, Jefferson, Lafourche, Livingston, Orleans, Plaquemines, St. Bernard, St. Charles, St. John the Baptist, West Baton Rouge)
2025 Evidence of Coverage - Baton Rouge / New Orleans Region (PDF)
2025 Annual Notice of Changes - Baton Rouge / New Orleans Region (PDF)
2025 Summary of Benefits - Baton Rouge / New Orleans Region (PDF)
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Baton Rouge / New Orleans Region (Ascension, East Baton Rouge, East Feliciana, Iberville, Jefferson, Plaquemines, Lafourche, Livingston, Orleans, St. Bernard, St. Charles, St. John the Baptist, West Baton Rouge)
2025 Evidence of Coverage - Baton Rouge / New Orleans Region (PDF)
2025 Annual Notice Of Changes - Baton Rouge / New Orleans Region (PDF)
2025 Summary of Benefits - Baton Rouge / New Orleans Region (PDF)
Baton Rouge / New Orleans Region (Ascension, East Baton Rouge, East Feliciana, Iberville, Jefferson, Lafourche, Livingston, Orleans, St. Charles, St. John the Baptist, West Baton Rouge)
2025 Evidence of Coverage - Baton Rouge / New Orleans Region (PDF)
2025 Annual Notice of Changes - Heroes (HMO POS)
2025 Summary of Benefits - Baton Rouge / New Orleans Region (PDF)
Northshore Region: St. Tammany Parish
2025 Evidence of Coverage - St. Tammany (PDF)Â
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, Vermillion, and West Baton Rouge parishes in Louisiana.
2025 Provider Directory
2024 Provider Directory
- 2024 Online Provider Directory (link)
- 2024 Provider Directory (PDF) Updated 08/29/2024
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
Prescription Drug Member Portal
Ochsner Health Plan offers online tools to help you make informed choices regarding your formulary and copay options.
You'll need your Ochsner Health Plan ID card to register.
Click on the link to visit the MedImpact member portal. Once you register, you can sign into your account to:
- Check drug prices
- View benefit highlights
- View prescription history
Pharmacy Directory
This Pharmacy Directory provides a list of Ochsner Health Plan's participating pharmacies located within our service area, updated as of October 2024.
For more recent information or to find Ochsner Health Plan participating pharmacies elsewhere in the United States, please use the Pharmacy Search Tool, linked below.
You can also call the Ochsner Health Plan Pharmacy Help Desk listed on the back of your Ochsner Member ID Card toll-free at 1-800-910-1837. The Ochsner Health Plan Pharmacy Help Desk is open 24 hours a day, 365 days a year (including holidays).
Mail Order Pharmacy
Birdiâ„¢ is the mail order pharmacy provider for Ochsner Health Plan. Log in to www.medimpact.com or the mobile app to manage your medications. Use the portal or app as a one-stop place to:
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- Order new prescriptions or transfer from retail pharmacy.
- Refill mail-order drugs or renew expired mail-order prescriptions.
- Opt in or out of Auto Refill.
- Review estimated copay amount, last order status, and date for next refill.
- Get reminders and alerts via automated phone call, email, or text.
- View and sort your list of mail-order drugs.
- Manage account information.
- Make payments (if applicable).
- Get tax statement.
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 (M3P)
The Medicare Prescription Payment Plan is a new payment option in the prescription drug law that works with your current drug coverage to help you manage your out-of-pocket Medicare Part D drug costs by spreading them across the calendar year (January-December). Starting in 2025, anyone with a Medicare drug plan or Medicare health plan with drug coverage (like a Medicare Advantage Plan with drug coverage) can use this payment option. All plans offer this payment option and participation is voluntary.
If you select this payment option, each month you’ll continue to pay your plan premium (if you have one), and you’ll get a bill from your health or drug plan to pay for your prescription drugs (instead of paying the pharmacy). There’s no cost to participate in the Medicare Prescription Payment Plan
Before enrolling to participate in the Medicare Prescription Payment Plan, it is important that you read and understand the program. Medicare has created a fact sheet that describes how the program works.Â
Member Request For Reimbursement
Formulary (List of Covered Drugs)
Part D Formulary MAPD Plans*
2025 Formulary
2025 Full List of Covered Drugs (PDF)
2025 MAPD Formulary Online Search (link)
2025 MAPD List of Drugs Requiring Prior Authorization (PDF)
2025 MAPD List of Drugs Requiring Step Therapy (PDF)
2024 Formulary
Full List of Covered Drugs (PDF) October 2024
2024 Formulary (Drug List) changes (PDF)
Drug Price & Pharmacy Search (link)
List of Drugs Requiring Prior Authorization (PDF) October 2024
List of Drugs Requiring Step Therapy (PDF) October 2024
*Not For Use By Ochsner Health Plan Heroes (HMO POS) Plan Members
Dual (HMO D-SNP) Part D Formulary*
2025 D-SNP Plan Full List of Covered Drugs (PDF)
2025 D-SNP Online Formulary Search (link)
2025 D-SNP List of Drugs Requiring Prior Authorization (PDF)
2025 D-SNP List of Drugs Requiring Step Therapy (PDF)
*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 Program (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 (link)
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
Ochsner Health Plan Part B Drugs Requiring Prior Authorization
Extra Help LIS Premium Summary Information
Monthly Plan Premium for People who get Extra Help from Medicare to Help Pay for their Prescription Drug Costs
If you get extra help from Medicare to help pay for your Medicare prescription drug plan costs, your monthly plan premium will be lower than what it would be if you did not get extra help from Medicare.
If you get extra help, your monthly plan premium will be $0 for any of the plan(s) below. (This does not include any Medicare Part B premium you may have to pay.)
- Ochsner Health Plan Premier (HMO)
- Ochsner Health Plan Freedom (HMO-POS)
- Ochsner Health Plan premium includes coverage for both medical services and prescription drug
coverage.
If you aren't getting extra help, you can see if you qualify by calling:
- 1-800-Medicare or TTY users call 1-877-486-2048 (24 hours a day/7 days a week),
- Your State Medicaid Office, or
- The Social Security Administration at 1-800-772-1213. TTY users should call 1-800-325-0778 between 7 a.m. and 7 p.m., Monday through Friday.
If you have any questions about this notice, please call Member Services at 1-833-674-2112 (TTY users should call 711) 8:00 a.m. to 8:00 p.m. seven days a week from October 1st to March 31st and 8:00 a.m. to 8:00 p.m. Monday through Friday, April 1st to September 30th or at www.ochsnerhealthplan.com.
Dental Information
DINA Dental
Dina Dental is the network provider for Ochsner Health Plan dental benefits. For customer service, call: 1-877-649-3188 (TTY:711). Ochsner Health plan members are responsible for all non-covered services and services that exceed the benefit maximum.
Fitness Network - SilverSneakers
Network Fitness Centers
The 2024 fitness network includes the SilverSneakers Fitness Program as well as Ochsner Fitness Centers. To search for fitness centers in our network by city, zip code, full address and parish:
Ochsner Fitness Center locations include:
Ochsner Fitness Center-Downtown
Ochsner Fitness Center-Harahan
Ochsner Fitness Center-Heritage Plaza
Over the Counter Items
Over the Counter Catalog
You may need over-the-counter health and wellness products, but they may be hard to budget for. To help, your health plan offers an over-the-counter benefit that allows you to purchase some of these products and have them shipped to your home.
The 2025 Over the Counter catalog items are not available to order until January 1, 2025. Â 2025 OTC Catalog (PDF)
Vision Information
Routine Vision Care
Includes services and tests to check your eyes to keep them healthy. This includes eye exams to see if you need eyeglasses or contacts.
Medical Vision Care
Includes Medicare-covered exams and services to diagnose and treat diseases and injuries of the eye. Examples include cataract surgery and treatments for eye injuries, as well as an annual glaucoma screening.
Vision services that are covered for you
- Outpatient physician services for the diagnosis and treatment of diseases and injuries of the eye, including treatment for age-related macular degeneration. Original Medicare doesn't cover routine eye exams (eye refractions) for eyeglasses/contacts
- For people who are at high risk of glaucoma, we will cover one glaucoma screening each year. People at high risk of glaucoma include people with a family history of glaucoma, people with diabetes, African Americans who are age 50 and older and Hispanic Americans who are 65 or older
- For people with diabetes, screening for diabetic retinopathy is covered once per year
- One pair of eyeglasses or contact lenses after each cataract surgery that includes insertion of an intraocular lens (If you have two separate cataract operations, you cannot reserve the benefit after the first surgery and purchase two eyeglasses after the second surgery.)
OHP offers additional supplemental vision services to our members that include a routine eye exam along with one pair of glasses/lenses once per calendar year.
Supplemental Vision Services must be obtained from plan specified vendor. See website at www.ochsnerhealthplan.com for more information.
*Out-of-pocket expenses for supplemental benefits do not count towards the maximum out-of-pocket
Vision Services Provider
Community Eye Care (CEC)
1-844-498-9518
8:00 a.m. - 8:00 p.m., 7 Days a week
www.cecvision.com
What you must pay when you get these services
Medicare covered services
- $20 copayment for Medicare covered eye exam.
- $0 copayment for Medicare-covered glaucoma screening.
- $0 copayment for Medicare-covered diabetic retinopathy screening.
- $0 copayment for one pair of Medicare-covered standard Eyeglasses (lenses and frames) or contact lenses after cataract surgery.
Supplemental Vision Services*:
$20 copayment for 1 routine vision exam every year.
$0 copayment up to the $400 eyewear allowance for:
- up to one pair of eyeglasses (lenses and frames) every year
- up to one pair of contact lenses every year
Members are responsible for all costs over and above the allowance amount.
Services NOT covered by Medicare
Routine eye examinations, eyeglasses, radial keratotomy, LASIK surgery, and other low vision aids.
Vendor Contacts
Benefit | Vendor | Contact |
Dental | DINA Dental | 1-877-649-3188 |
8:00 a.m. – 5:00 p.m. M-F | ||
Dina Dental | ||
Fitness Centers | SilverSneakers | 1-888-423-4632 (TTY 711) |
7:00 a.m. – 7:00 p.m. M-F | ||
SilverSneakers.com | ||
Flex Card Hearing, Over-the Counter, Transportation*, Utilities* | Ochsner Health Plan Flex Card Services | 1-855-638-1420 (TTY 711) |
7:00 a.m. – 10:00 p.m. M-F | ||
https://flex.ochsnerhealthplan.com/ | ||
Vision | Community Eye Care (CEC) | 1-844-498-9518 |
8:00 a.m. – 8:00 p.m., 7 Days a week | ||
www.cecvision.com |
DURABLE MEDICAL EQUIPMENT PROVIDERS | ||
Ochsner Total Health Solutions | 3211 North Causeway Blvd. Metairie, LA 70002 | (504) 834-8114 Website |
AllStar Medical Equipment | 430 Jefferson Hwy, Ste. A Jefferson, LA 70121 | (504) 833-3778 Website |
DME Direct LLC | 105 Harbor Circle New Orleans, LA 70126 | (504) 288-3799 |
Ochsner Home Medical Equipment, LLC | 501 Coolidge St. New Orleans, LA 70121 | (504) 842-5531 |
AdaptHealth Patient Care Solutions LLC | 3445 N Causeway Blvd, Ste. 202 Metairie, LA 70002 | (855) 404-6727 Website |
DIABETES MANAGEMENT SUPPLIES | ||
Adapt Health | 10 Commerce Ct New Orleans, LA 70123 | 1-888-738-7929 |
Download the Durable Medical Equipment (DME) and Diabetes Management Supplies Provider Sheet [PDF]
Member Forms and Notices
Notice Of Non-Discrimination
Notice of Non-Discrimination (PDF)
Multi-language Interpreter Services
Notice Of Privacy Practices
Member Request For Reimbursement Forms
These forms are to be used to request reimbursement for out-of-pocket expenses.
Member Reimbursement Form - General (DMR)
Emergency Disaster Policy
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.