vModa Health

2019 Plan Changes

Moda Health

Medicare - Supplement

• The Prescription Drug out-of-pocket maximum per person per calendar year is $5,100

PERS Moda Health PPORX (PPO) Medicare Advantage

• This plan is no longer available

Non-Medicare

• The Core Value and Select Value plans are no longer available

ID Cards

• New ID cards will be issued for 2019

Moda Health and Delta Dental Enrollment Service Area – Nationwide

Moda Health Medicare Supplement Plan

Delta Dental of Oregon

The Value of Moda Health and the PHIP Partnership

• Enhanced Medicare Part D prescription coverage

• Comprehensive dental plan – Delta Dental of Oregon

• Moda Health Medicare Supplement medical plan:

– Nationwide coverage – Members can live anywhere in

the U.S. and access any Medicare provider

– Member generally pays nothing after Part B deductible

is met

– Medicare pays 80%, Moda pays 20% for Medicare

covered services

Moda HealthMedicare Supplement Plan

How Our Plan Works

Moda Health Medicare Supplement

Choose any Medicare doctor, specialist or hospital

• Doctor/facility bills Original Medicare

• Original Medicare bills remaining balance to Moda Health

• Virtually no paperwork

Moda Health Medicare Supplement

Benefit Coverage Member Responsibility

Deductible $183 per individual*

Medical Out-of-Pocket Maximum N/A

Primary Care Office Visit

Covered in full

Specialist Office Visit

Inpatient Hospitalization

Outpatient Surgery

Lab Tests

X-ray

Pharmacy 40% of charge up to $250 maximum

per 31-day supply

Pharmacy Out-of-Pocket Maximum $5,100 per individual

*Part B deductible, required by Medicare, listed is for 2018.

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

Moda Health Special Attributes

Personal assistance• Nurse care coordinators• Medical case managers• Health coaching programs

Phone resources• Local customer service; based in Oregon• 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 • Value added services and discounts

Moda Health Discount Services

• VSP

– Discounts on eye exams, frames, lenses and contacts

• TruHearing Choice

– Discounts on hearing aids and hearing tests

• ChooseHealthy® Program

– Discounts on:

• Massage therapy

• Chiropractic

• Acupuncture

Member Care Resources on

• 24-hour Registered Nurse Advice Line – Available 24 hours a day 7 days a week

• eDoc– Email a health expert

• Cost-estimating tools– Pharmacy

• Prescription price check, prescriptionhistory, and drug information

– Dental • Dental cost estimator tool

Mobile ID Card App

• Moda Health ecard app

allows you to email

or fax a copy of your

ID card

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

Moda HealthPart D Prescription Drug Plan

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

Delta Dental of Oregon

How Our Plan Works

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 and PPO networks

• 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

Delta Dental of Oregon

Access to the Delta Dental Premier and PPO National Networks

• More than 154,000 participating providers nationwide

• Passport Dental program -worldwide dental care