Summary of Benefits
Premier Plan (HMO)
Freedom Plan (HMO POS)
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)
Freedom Plan (HMO POS)
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.
You 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.
LIS Premium Summary Form
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.
This document is a partial formulary and includes only some of the drugs covered by
Ochsner Health Plan.
- Partial List of Covered Drugs (PDF)
- Full List of Covered Drugs (PDF)
- Search the full formulary
- Formulary Changes - 1/21/22 (PDF)
Additional Information About Prescription Drugs
- Drugs That Require Prior Authorization (PDF)
- Step Therapy (PDF)
- Important Drug and Pharmacy Information (PDF)
- Medication Therapy Management Program (PDF)
- Personal Medication List (PDF)
- Medicare Part D Coverage Determination Form (link)
- Prescription Drug Transition Policy (PDF)
- Part D Quality Assurance Program (PDF)
- Prescription Redetermination Form (PDF)
- Prescription Drug Coverage Determination/Exception Request Form - Online Request Form (PDF)
- Prescription Drug Prior Authorization Form (PDF)
- Safer Use of Opioid Pain Medication (PDF)
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, and View prescription history:
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.
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 (Ochsner Hearing Solutions)
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).
Network Fitness Centers
Here is a list of Ochsner Fitness Centers in our network:
Ochsner Fitness Center-Downtown
701 Poydras Street
New Orleans, LA 70139-7727
Ochsner Fitness Center-Harahan
1200 S. Clearview Parkway
Harahan LA 70123-2335
Ochsner Fitness Center-Heritage Plaza
111 Veterans Memorial Boulevard
Metairie LA, 70005-3064
To search for additional fitness centers in our network by city, zip code, full address and parish:
Request for Enrollment
This is an individual enrollment request for to enroll in a medicare advantage plan (part C)
Notice Of Non-Discrimination
Notice Of Privacy Practices
Filing A Complaint
If you are an enrollee and wish 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.
The Provider Manual is a resource for participating providers of Ochsner Health Plan.
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