Moda Health

OEBB 2017-18 Open Enrollment: Medical and Pharmacy

• Medical & Pharmacy• Overview of networks & plan options • Benefit changes

• Member Resources• myModa• Find Care• The Well• Customer Service

Agenda

• Preferred Provider Organization (PPO) plans− Connexus Network

◦ Retirees & COBRA members living outside of Connexus service area use Moda’s rental networks

− Service area is statewide− Birch, Cedar, Dogwood, and Evergreen plans

• Coordinated Care Model (CCM) plans− Synergy or Summit Network− Service areas based on counties

◦ Synergy Network available in western & central Oregon◦ Summit Network available in eastern Oregon

− Alder, Birch, Cedar, Dogwood, and Evergreen plans

Plan types and network options

Medical plan lineup – no changes!

Medical Plan Deductible Out-of-Pocket Max Cost Share

In-Network Out-of-Network In-Network Out-of-

Network In-Network Out-of-Network

AlderCCM only

$400 $800 $3,000 $6,000 $6,850 NA

Birch CCM & PPO

$800 $1,600 $4,000 $8,000 $6,850 NA

CedarCCM & PPO

$1,200 $2,400 $5,000 $10,000 $6,850 NA

DogwoodCCM & PPO

$1,600 $3,200 $6,850 $13,700 $6,850 NA

Evergreen (HSA)CCM & PPO $1,600 $3,200 $6,550 $13,100 N/A NA

*This table reflects in-network deductibles and out-of-pocket limits

CCM plan options (Synergy & Summit Networks)

Medical Plan Deductible Out-of-pocket Medical home

Incentive careMedical home primary care

Specialist care

Urgent care

Alder $400 $3,000 $10* $20* 20% $50*

Birch $800 $4,000 $15* $30* 20% $50*

Cedar $1,200 $5,000 $15* $30* 20% $50*

Dogwood $1,600 $6,850 $15* $30* 20% $50*

Evergreen (HSA) $1,600 $6,550 20% 20% 20% 20%

PPO plan options (Connexus Network)

Medical Plan Deductible Out-of-

pocketIncentive care Primary care Specialist

careUrgent

careMH Non-MH MH Non-MH

Birch $800 $4,000 $15* 20%* $30* 20% 20% $50*

Cedar $1,200 $5,000 $15* 20%* $30* 20% 20% $50*

Dogwood $1,600 $6,850 $15* 20%* $30* 20% 20% $50*

Evergreen (HSA) $1,600 $6,550 20% 20% 20% 20% 20% 20%

*Deductible waived

Pharmacy benefits – no changes!Alder, Birch, Cedar & Dogwood

CCM PlansBirch, Cedar & Dogwood

PPO Plans

Out-of-pocket maximum Accrues towards medical OOP limit Accrues towards Max Cost Share

Retail (31-day supply)

Value $0 $4

Select Generic $8 $12

Preferred brand 25% up to $50 25% up to $75

Non-preferred brand 50% up to $150 50% up to $175

Mail (90-day supply)

Value $0 $8

Select Generic $16 $24

Preferred brand 25% up to $100 25% up to $150

Non-preferred brand 50% up to $300 50% up to $450

Specialty (31-day supply)

Preferred 25% up to $100 25% up to $200

Non-preferred 50% up to $300 50% up to $500

Evergreen CCM Evergreen PPO

Deductible (medical and Rx) $1,600/$3,200

Out-of-Pocket Maximum $6,550/$13,100

Value tier*

Retail (31-day supply) $0 $4

Mail (90-day supply) $0 $8

Major Medical Prescription Coverage

20%(subject to deductible)

Pharmacy benefits – no changes!

* Deductible waived on value tier medications

• Bariatric surgery (gastric sleeve and Roux-en-Y) coverage extended to spouse/partners and dependents age 18 and over

• New methodology for Maximum Plan Allowance− Applicable to out-of-network providers only− Communications to impacted members sent out first week of August

• Some medications may be limited to select home infusion providers and/or provider office infusion only− Communications to impacted members and providers beginning in

August

• CCM Synergy plans available to Coos and Curry counties

Benefit changes

Moda Health

Member Resources

OEBB dedicated website

www.modahealth.com/oebb

Need to access your myModa account?

Looking for a provider?

Want to review upcoming plan year materials?

• See your benefits & member handbook

• Check claims and review electronic explanations of benefits (EOBs)

• Connect with health professionals on the phone or online

• Download your member ID card

• Access Moda health tools− Momentum (go here to take your health assessment!)− Health coaching− Prescription Price Check− Healthcare Cost Estimator

myModa – your online member portal

• Search for contracted providers in your available plan options• PPO plans = Connexus Network• CCM plans = Synergy or Summit Network

Find Care – Moda’s online provider directory

• Online quarterly digital magazine for OEBB members

The Well

• Medical/Vision−866.923.0409

• Pharmacy−866.923.0411

• Dental−866.923.0410

Or email the customer service teams by using OEBBquestions@modahealth.com

Customer Service