moda health & delta dental · moda will notify you if your pharmacy is no longer included in...
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Moda Health & Delta Dental
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Moda Health and Delta Dental Plan of OregonNationwide
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The Value of Moda Health and the PHIP Partnership
• Enhanced Medicare Part D prescription coverage
• Patient-centered dental plan — Delta Dental Plan of Oregon
• Moda Health Medicare Supplement medical plan:
– Offering this plan to PERS members for nearly 30 years
• Covers Part B excess charges
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How Our Plan Works
Moda Health Medicare Supplement
Nationwide Coverage
─ Members can live anywhere in the U.S. and see any Medicare provider or hospital
Doctor/Facility Bills Original Medicare
Original Medicare bills remaining balance to Moda Health
Virtually no paperwork
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How Our Plan Works
Moda Health Medicare Supplement
Part A: Moda pays the member responsibility for Medicare covered services
Part B: Member pays nothing after Part B deductible is met for Medicare covered services
Medicare pays 80%, Moda pays 20% for Medicare covered services
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Moda Health Medicare Supplement
Benefit Coverage Member Responsibility
Part B deductible $198 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
Generics:
40% up to $250 max for a 93-day supply
Brands & Specialty:
40% up to $250 max for 31-day supply
Pharmacy out-of-pocket maximum $6,350 per individual
*Must meet Part B deductible, required by Medicare; listing is for 2020.
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Urgent care
Covered in full* 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
*Must meet Part B deductible, as required by Medicare.
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Moda Health Medicare SupplementFormulary and Participating Pharmacies
• A comprehensive list of covered medications is available online at: modahealth.com/pers
• Local pharmacy customer service hours 7 a.m. – 8 p.m., Monday through Friday
* 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.
Over 71,000 participating pharmacies*
Bi-Mart Rite Aid
Costco Safeway
CVS Pharmacy Walgreens
Fred Meyer/ Kroger/QFC
Walmart
Mail order pharmacies*
Costco
Postal Prescription Services
Walgreens Mail Service
Walmart Mail Service
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Personal Assistance
• Nurse care coordination• Medical case management• Health coaching programs
Phone Resources
• Local customer service; based in Portland and Bend, Oregon• Average call answered within 30 seconds• Customer service hours are 7:30 a.m. – 5:30 p.m., Monday through
Friday
Online Resources
• Dedicated PERS website at modahealth.com/pers• Member handbooks• Member Dashboard - myModa• Explanation of Benefits (EOBs)
Moda Health Special Attributes
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Moda Health Special Attributes
VSP
Discounts on eye exams, frames, lenses and contacts
ChooseHealthy® Program
– Discounts on:
• Massage therapy
• Chiropractic
• Acupuncture
Silver&Fit®
– Membership at a participating fitness center or 2 home fitness kits per year
THESE ADDITIONAL SERVICES ARE NOT INSURANCE.
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Moda Health — Extra Benefits
TruHearing Benefit
$45 hearing exam copay
$699 or $999 hearing aid options
One routine hearing exam per calendar year
Coverage Also Includes:
2 hearing aids allowed per calendar year
3 follow-up visits for fitting and adjustment
Local, professional care from an accredited provider in your area
A worry-free purchase with a 45-day trial and 3-year warranty
48 batteries per hearing aid included with non-rechargeable models
All content ©2019 TruHearing, Inc. All Rights Reserved. TruHearing® is a registered trademark of TruHearing, Inc. All other trademarks, product names, and company names are the property of their respective owners
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Member Care Resources on
24-hour Registered Nurse Advice Line – Available 24 hours a day, 7 days a week
eDoc – Email physicians, pharmacists and dentists
Prescription price check tool– View prescription history and drug
information
ID card – View, email or order your ID card from a
mobile phone or computer