Moda Health & Delta Dental

2020 Plan Year ChangesModa Health

Medicare — Supplement

• The prescription drug out-of-pocket maximum per person for the calendar year is $6,350

• Now covers Medicare Part B excess charges

• Hearing benefits added

• New ID cards will be issued for medical members

Moda Health and Delta Dental Plan of OregonNationwide

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

How Our Plan WorksModa 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

How Our Plan WorksModa Health Medicare Supplement

Part A: Moda pays the member responsibility for Medicare covered servicesPart B: Member pays nothing after Part B deductible is met for Medicare covered services

Medicare pays 80%, Moda pays 20% for Medicare covered services

Moda Health Medicare SupplementBenefit Coverage Member ResponsibilityPart B deductible $185 per individual*Medical out-of-pocket maximum N/APrimary care office visit

Covered in full*

Specialist office visitInpatient hospitalizationOutpatient surgeryLab testsX-ray

Pharmacy

Generics:40% up to $250 max for a 93-day supplyBrands & 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 2019 (as 2020 is not available at this time).

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 BenefitsModa Health Medicare Supplement

*Must meet Part B deductible, as required by Medicare.

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

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

FridayOnline Resources

• Dedicated PERS website at modahealth.com/pers• Member Handbooks• myModa (Member Dashboard)• Explanation of Benefits (EOBs)

Moda Health Special Attributes

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.

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

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

Delta Dental Plan of Oregon

Health through Oral Wellness Program®– Offers enhanced dental benefits and related

care to members with a greater risk for oral diseases. Learn more at deltadentalor.com/oralwellness/members

2020 Plan ChangesDelta Dental Plan of Oregon

How Our Plan WorksDelta Dental Plan 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 and PPO networks

Savings on dental procedures No balance billing

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. Preventive charges do not accumulate to the calendar year benefit maximum.

Delta Dental Plan of Oregon

Additional Benefits:

• Health through Oral Wellness®

• Oral Health, Total Health program* – Additional cleanings available for members with diabetes or

pregnant women in their third trimester

• 4 periodontal maintenance cleanings per calendar year for members with periodontal disease*

* Call our customer service team to learn more.

Delta Dental Plan 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

• Digital dental tools Find a dentist Ask a dentist Dental cost estimator