vModa HealthModa HealthModa HealthModa Health

Moda Health Enrollment Service Area

1. The Medicare Part D prescription drug plan provides an extensive formulary

2. Comprehensive dental plan

3. 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

The Value of Moda Health Plans

and the PHIP Partnership

Moda HealthMedicare Plans

Moda HealthPERS Moda Health PPORX (PPO)

Medical Plan

Resident of the state of Oregon

Choose any Medicare doctor

• Low copays

• No primary care physician (PCP) selection required

• No deductibles

• No referrals, including specialists

• Prior authorizations may be required for some in-network services and

medications

• Accepted by every hospital

PERS Moda Health PPORX (PPO) Medical Plan

How Our Plan Works

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

PERS Moda Health PPORX (PPO) Medical Plan

Emergency and Travel Benefits

12-month visitor travel benefit

Moda HealthMedicare Supplement Plan

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

Moda Health Medicare Supplement Plan

How Our Plan Works

Moda Health Medicare Supplement Plan

After individual Medicare Part B deductible is met…

Medicare-contracted

provider accepting

assignment

Medicare-contracted

provider NOT

accepting assignment

Non-

Medicare

provider

Billed amount $150 $150 $150

Medicare allows $100 $100 N/A

Limiting charge (15%) N/A $115 N/A

Provider write-off $50 $35 N/A

Medicare pays 80% $80 $80 N/A

Moda Health pays 20% $20 $20 N/A

Patient owes $0 $15 $150

Urgent Care

Covered in full after deductible anywhere in

U.S.

Emergency Room

Ambulance(ground or air)

Outside of the United

StatesCovers urgent care, ER and ambulance at 80% coinsurance. The

member will pay 20% coinsurance.

Coverage limited to $50,000 lifetime per member

Moda Health Medicare Supplement Plan

Emergency and Travel Benefits

MEMBER PAYS:

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 7:30 a.m. – 5:30 p.m., Mon – Fri

Online resources (www.modahealth.com)

• Be Better Tools

• Claims information

• Physician finder

• Treatment Cost Navigator

• Dedicated PERS website at www.modahealth.com/pers

Moda Health Special Attributes

Moda Health Services

Be Better Tools on myModa

• 24-hour Registered Nurse Advice Line

• Cost-estimating tools:

• Treatment Cost Navigator (medical)

• Prescription Price Check (pharmacy)

• Dental Optimizer (dental)

Mobile ID Card App

Your Membership Includes*:

• Membership at a participating fitness facility

• The choice to enroll in a Home Fitness Program and choose 2 kits out of 17

• For more information and locations visit www.silverandfit.com

Exercise & Healthy Aging Program

Moda HealthNon-Medicare Plans

Moda Health Non-Medicare Plans

FeaturesModa Health

Core Value Plan

Moda 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

• PPO (Preferred Provider Organization) available to PHIP non-

Medicare members throughout the U.S.

• Network is dependent on where the member lives

• Travel Network allows members to use in-network providers while

traveling around the U.S.

• Plan provides comprehensive medical coverage, as well as emergency

& urgent care services

• Moda Health non-Medicare plans include pharmacy benefits

Moda Health Non-Medicare Medical Benefit

Plans

Moda HealthPrescription Drug Plan

• Comprehensive list of covered medications

• Prescription formulary and pharmacy finder at: www.modahealth.com/pers

• Personal assistance with medications through medication therapy

management (MTM) and prescription safety programs

• Free 1:1 comprehensive personalized medication review

• Outcomes include decreased medication adverse side effects, improved disease

management, and decreased hospitalization

• Our Prescription Price Check Tool through myModa allows you to get

information about medications, including prices and generic options

• Mail order medications available through our mail order companies

• Local pharmacy customer service available 7:00 am – 8:00 pm, Mon–Fri

Moda Health Rx

Pharmacies BenefitNationwide pharmacy network with more than 71,000

participating pharmacies

Our chain pharmacies are available throughout the

United States

Network also includes: long term care pharmacies,

home infusion, Indian, tribal and urban Indian health

program pharmacies, Payless Drug special service

pharmacy

Network Pharmacies

Bartell Drugs Rite Aid Pharmacy

Bi-Mart Safeway Pharmacy

Costco Pharmacy Savon Pharmacy

CVS Pharmacy Shopko Pharmacy

Fred Meyer Target Pharmacy

Kmart Pharmacy Walgreens Pharmacy

QFC Pharmacy Wal-Mart Pharmacy

Mail Order Pharmacies

Costco Mail Order

OHSU Mail Order

Postal Prescription Services

Walgreens Mail Service - Arizona

Walmart Mail Order

Wellpartner

*Not all contracted network pharmacies are listed. Pharmacies contracted with your health plan may change at any time. Your health plan

will notify you if your pharmacy is no longer included in the network. Please contact your health plan for more details.

Payless Drug Special Service Pharmacy

www.PayLessDrug.com

Delta Dental Plan of Oregon

Delta Dental Plan of Oregon

Who are we?

• We started as in 1955, providing dental coverage for the

ILWU (International Longshoremen & Warehouse Union)

What can you expect?

• Flexibility in choosing your dentist

• 4 out of 5 of the nation’s dentists participate in the Delta Dental

Premier network

• Savings on dental procedures achieved through contracts with our

providers

• Cost predictability through predetermination of benefits

• No balance billing if you go to a Premier network provider

Delta Dental Plan of Oregon

• Calendar Year Deductible . . . . . . . . . . . . . . . . . $25

• Calendar Year Benefit Maximum . . . . . . . . . . . . . . . . . $1,500

• Preventive . . . . . . . . . . . . . . . . . . . . . . . . . 100%*

• Basic . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80%

• Major . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50%

* Deductible waived for preventive services; and preventive charges do not accumulate to calendar year benefit maximum

Delta Dental Plan of Oregon

Please note that if you did not have 12 months of continuous employer-sponsored dental insurance

immediately prior to enrolling in the PHIP plan, you could have a 12-month waiting period for basic and

major services.

Access to the Delta Dental Premier

National Network

• More than 151,000 participating providers nationwide

• Worldwide dental care with our Passport Dental program

• Includes the Oral Health Total Health program

• Up to a total of 4 periodontal maintenance cleanings in a

calendar year for members with periodontal disease