Moda Health Enrollment Service Area

Transcription

1 Moda Health v

2 Moda Health Enrollment Service Area Moda Health Medicare Supplement Plan and Moda Health Non- Medicare PPO Plans PERS Moda Health PPORX Plan (Medicare Advantage)

3 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

4 Moda Health PERS Moda Health PPORX (Medicare Advantage)

5 PERS 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

6 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

7 PERS Moda Health PPORX (Medicare Advantage) Emergency and Travel Benefits 12-month visitor travel benefit Service Urgent Care (Worldwide coverage) Emergency Room (Worldwide coverage) Ambulance - ground or air Out of Area Travel - Inside the U.S. Out of Area Travel - Outside the U.S. Moda Health PPORX (PPO) $20 copay $65 copay $50 copay (one way) Out-of-network copay applies* Covers urgent care, emergency and ambulance at out-of-network copay, no lifetime max * When traveling, for in-network benefits, enroll in the PPORX travel benefit by calling our customer service.

8 Moda Health Medicare Supplement Plan

9 Moda Health Medicare Supplement How Our Plan Works 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

10 Moda Health Medicare Supplement After Medicare Part B deductible has been met 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 Medicare provider NOT accepting assignment $150 $100 $115 $35 $80 $20 $15 Non- Medicare provider $150 N/A N/A $0 $0 $0 $150

11 Moda Health Medicare Supplement Emergency and Travel Benefits Urgent Care MEMBER PAYS: Emergency Room Covered in full after deductible anywhere in U.S. 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)

12 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 facility Inpatient & outpatient care Vision Covered in full only after 3 full days in hospital Covered in full Discounts available Covered in full * Low copays and coinsurance Eye exams - $20 copay Hardware - $100 credit every 24 months * See Annual Notice of Changes and Evidence of Coverage for additional details

13 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 Coverage for travel outside the U.S. Personal Assistance Programs (Health coaching, Nurse care coordinators, Medical case managers) Any Medicare provider Moda Medicare Advantage providers: Innetwork benefits Any Medicare provider: Out-of-network benefits $50,000 lifetime limit No lifetime limit Available voluntary enrollment Available Moda will contact you to enroll

14 Exercise & Healthy Aging Program Your Membership Includes*: Membership at a participating fitness center or 2 Home Fitness Program kits per year For more information and locations visit

15 Moda Health Non-Medicare Plans

16 Moda Health Non-Medicare Plans Features Type of Plan Moda Health Core Value Plan PPO Moda Health Select Value Plan Deductible $500 $1,000 Provider Access Primary Care Physician Referral Requirement Network Alternative Care In-Plan or Out-of-Plan Not Required Not Required Connexus (Oregon, Idaho & SW Washington) First Choice Health (Remainder of Washington) Private Healthcare Systems (PHCS) (All other states) Included

17 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 Benefit specific detail mymoda Claims information Find Care

18 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

19 Mobile ID Card App Allows you to or fax a copy of your ID card

20 Moda Health Prescription Drug Plan

21 Pharmacy Network Benefit Moda PHIP Formulary Covers a comprehensive list of covered medications available online at 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* Mail Order Pharmacies* Bi-Mart Costco CVS Pharmacy Fred Meyer/Kroger/QFC Rite Aid Safeway Walgreens Walmart Costco Postal Prescription Services Walgreens Mail Service Walmart Mail Service * 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.

22 Delta Dental of Oregon

23 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

24 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

25 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

26 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