Member Resources

Ochsner Health Care Symbol

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

2024 Summary of Benefits

The benefit information provided is a summary of what we cover and what you pay. It does not list every service that we cover or list every limitation or exclusion. To get a complete list of services we cover, please refer to the “Evidence of Coverage” for your plan.

Baton Rouge/New Orleans Region Summary of Benefits ALL PLANS [pdf]

St. Tammany Summary of Benefits [pdf]

Lafayette/St. Martin Summary of Benefits [pdf]

Evidence of Coverage, Annual Notice of Changes, and Summary of Benefits

These booklets give you the details about your Medicare health care and prescription drug coverage from Jan.1 – Dec. 31, 2024. It explains how to get coverage for the health care services and prescription drugs you need.

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)

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.

Ochsner Health Plan Freedom (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 2023. For more recent information or to find Ochsner Health Plan participating pharmacies elsewhere in the United States, please use the Pharmacy Search Tool using your computer or smartphone. 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).

Pharmacy Directory (PDF)

Mail Order Pharmacy

Birdi™ 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:

  • 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

Ochsner Health Plan Part B Drugs Requiring Prior Authorization

OHP Part B Prior Authorization list V2 Dec 2023

Extra Help LIS Premium Summary Information

LIS Premium Summary (PDF)

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.

An older woman smiling in a blue circle.

Fitness Network - SilverSneakers

A woman holding a tennis racket and a tennis ball.

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

2024 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 2024 Over the Counter catalog items are not available to order until January 1, 2024.  2024 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

 

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

Notice of Privacy Practices (PDF)

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.

Member Request For Reimbursement Forms

These forms are to be used to request reimbursement for out-of-pocket expenses.

Member Reimbursement Form - General (DMR)

Member Reimbursement Form- Hearing (PDF)

Member Reimbursement Form - Part D Drugs (PDF)

Emergency Disaster Policy

Emergency Disaster Policy (PDF)

Provider Manual

The Provider Manual is a resource for participating providers of Ochsner Health Plan.

Provider Manual (PDF)

Provider Quick Reference Guide (PDF)

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