vModa Health

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

Moda HealthPERS Moda Health PPORX

(Medicare Advantage)

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.

Moda HealthMedicare Supplement Plan

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

Moda HealthNon-Medicare Plans

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

Mobile ID Card App

• Allows you to email

or fax a copy of your

ID card

Moda HealthPrescription 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

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

Delta Dental of Oregon

Access to the Delta Dental Premier National Network

• More than 154,000 participating providers nationwide

• Passport Dental program -worldwide dental care