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Moda Health Enrollment Service Area
Moda Health Medicare Supplement Plan and Moda Health Non-Medicare PPO Plans
PERS Moda Health PPORX Plan (Medicare Advantage)
The Value of Moda Health Plans and the PHIP Partnership
• Enhanced Medicare Part D prescription coverage
• Comprehensive dental plan – Delta Dental Plan of Oregon
• Moda Health offers two Medicare medical plans:
– Moda Health Medicare Supplement: Nationwide coverage; Supplements Medicare’s 80% reimbursement with an additional 20% reimbursement
– PERS Moda Health PPORX (PPO): Statewide Medicare Advantage plan with low copays and out-of-pocket maximum
How our plan works
• Resident of the state of Oregon
• Choose any Medicare doctor nationwide
– Medicare Advantage Network:in-network benefits
– Any Medicare provider nationwide: out-of-network benefits
PERS Moda Health PPORX (Medicare Advantage)
How our plan works
Advantages
– Low copays
– No primary care physician (PCP) selection required
– No deductibles
– No referrals, including specialists
– Plan available statewide
– Ability to see any Medicare provider
PERS Moda Health PPORX (Medicare Advantage)
Service Moda Health PPORX (PPO)
Urgent Care (Worldwide coverage) $20 copay
Emergency Room (Worldwide coverage)
$65 copay
Ambulance - ground or air $50 copay (one way)
Out of Area Travel - Inside the U.S. Out-of-network copay applies*
Out of Area Travel - Outside the U.S. Covers urgent care, emergency and ambulance at out-of-network copay,
no lifetime max
12-month visitor travel benefit
Emergency and Travel Benefits
PERS Moda Health PPORX (Medicare Advantage)
* When traveling, for in-network benefits, enroll in the PPORX travel benefit by calling our customer service.
How Our Plan Works
Moda Health Medicare Supplement
Nationwide service area
– Must be a resident of the U.S.
Choose any Medicare doctor, specialist or hospital
– Doctor bills Original Medicare
– Original Medicare bills remaining balance to Moda Health
– Virtually no paperwork
Medicare provider accepting
assignment
Billed amount $150
Medicare allows $100
Limiting charge (15%)
N/A
Provider write-off $50
Medicare pays 80% $80
Moda Health pays 20%
$20
Patient owes $0
Non-Medicareprovider
$150
N/A
N/A
$0
$0
$0
$150
After Medicare Part B deductible has been met…
Moda Health Medicare Supplement
Medicare provider NOT accepting
assignment
$150
$100
$115
$35
$80
$20
$15
Urgent Care
Covered in full after deductible anywhere in U.S.
Emergency Room
Ambulance - ground or air
Outside of the United States
Covers urgent care, ER and ambulance at 80% coinsurance. The member will pay 20% coinsurance.
Coverage limited to $50,000 per member (lifetime)
MEMBER PAYS:
Emergency and Travel Benefits
Moda Health Medicare Supplement
Differences between the Moda Medicare Plans
Moda Health Medicare Supplement
PERS Moda Health PPORX (Medicare Advantage)
Calendar year deductible Part B deductible None
Out-of-pocket maximum None $2,500
Skilled nursing facilityCovered in full only after
3 full days in hospitalCovered in full *
Inpatient & outpatient care
Covered in full Low copays and
coinsurance
Vision Discounts availableEye exams - $20 copayHardware - $100 credit
every 24 months
* See Annual Notice of Changes and Evidence of Coverage for additional details
Differences between the Moda Medicare Plans
Moda Health Medicare Supplement
PERS Moda Health PPORX (Medicare Advantage)
Residency Requirement Resident of U.S. Resident of Oregon
Provider Access Any Medicare provider
Moda MedicareAdvantage providers: In-
network benefits
Any Medicare provider: Out-of-network benefits
Coverage for travel outside the U.S.
$50,000 lifetime limit No lifetime limit
Personal Assistance Programs (Health coaching, Nurse care coordinators, Medical case managers)
Available –voluntary enrollment
Available –Moda will contact you to
enroll
Your Membership Includes*:
• Membership at a participating fitness center or 2 Home Fitness Program kits per year
• For more information and locations visit www.silverandfit.com
Exercise & Healthy Aging Program
FeaturesModa Health
Core Value PlanModa Health
Select Value Plan
Type of Plan PPO
Deductible $500 $1,000
Provider Access In-Plan or Out-of-Plan
Primary Care Physician
Not Required
Referral Requirement Not Required
NetworkConnexus (Oregon, Idaho & SW Washington)
First Choice Health (Remainder of Washington)Private Healthcare Systems (PHCS) (All other states)
Alternative Care Included
Moda Health Non-Medicare Plans
Moda Health Special Attributes
Personal assistance• Nurse care coordinators• Medical case managers• Health coaching programs
Phone resources• Local customer service with calls answered in 30 seconds• Customer service hours are 7:00 am – 8:00 pm, Monday – Friday
Online resources • Dedicated PERS website at www.modahealth.com/pers• Benefit specific detail• myModa• Claims information• Find Care
Member Care Resources on
• 24-hour Registered Nurse Advice Line
• Cost-estimating tools:
– Medical
• Healthcare Cost Estimator
– Pharmacy
• Prescription price check, prescription
history, and drug information
– Dental
• Dental Optimizer – dental cost estimator
Pharmacy Network Benefit
• Moda PHIP Formulary
– Covers a comprehensive list of covered medications available online at
www.modahealth.com/pers
• MTM Program
– Medication Therapy Management (MTM) program included for Medicare members
– Free 1:1 comprehensive personalized medication review
• Local pharmacy customer service available 7:00 am – 8:00 pm, Monday – Friday
• Over 71,000 participating pharmacies nationwide
Participating Pharmacies*
Bi-Mart Rite Aid
Costco Safeway
CVS Pharmacy Walgreens
Fred Meyer/Kroger/QFC Walmart
* Not all contracted network pharmacies are listed. Pharmacies contracted with Moda may change at any time. Moda will notify you if your pharmacy is no longer included in the network. Contact pharmacy customer service for more details.
Mail Order Pharmacies*
Costco
Postal Prescription Services
Walgreens Mail Service
Walmart Mail Service
Delta Dental of Oregon
Who are we?We started providing dental coverage in 1955 as ODS.
What can you expect?• Flexibility
• 4 out of 5 of the nation’s dentists participate in our Premier network
• Savings on dental procedures
• No balance billing
Delta Dental of Oregon
Calendar Year Deductible ………………………………………………………….$25
Calendar Year Benefit Maximum…………………………………………..$1,500
Preventive……………………………………………………………………………..100%*
Basic………………………………………………………………………………………….80%
Major ……………………………………………………………………………………….50%
* Deductible waived for preventive services. Preventive charges do not accumulate to calendar year benefit maximum
Delta Dental of Oregon
Additional Dental Benefits:
• Oral Health Total Health Program*
– Additional cleanings available if you are diabetic or in your third trimester of pregnancy
• 4 Periodontal maintenance cleanings per calendar year for members with periodontal disease*
* Call our customer service for more information
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