Moda Health Enrollment Service Area

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Moda Health Enrollment Service Area Moda Health Medicare Supplement Plan and Moda Health non Medicare PPO PERS Moda Health PPORX (Medicare Advantage)

The Value of Moda Health Plans and the PHIP Partnership The Medicare Part D prescription drug plan provides an extensive formulary 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 Health PERS Moda Health PPORX (Medicare Advantage)

PERS Moda Health PPORX (Medicare Advantage) Plan Changes Prior authorization is required for the following services: In network: Advanced imaging (MRI/CT scans, etc.) Musculoskeletal (interventional pain management, joint and spine surgery) Physical, occupational, and speech therapy Out of network: No benefit changes (courtesy authorization recommended)

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

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) 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

Moda Health Medicare Supplement Plan

Moda Health Medicare Supplement Plan Changes No benefit changes

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

Moda Health Medicare Supplement After Medicare Part B deductible has been met Medicare provider accepting assignment Billed amount $150 Medicare allows $100 Medicare provider NOT accepting assignment $150 $100 Non Medicare provider $150 N/A Limiting charge (15%) N/A $115 N/A Provider write off $50 Medicare pays 80% $80 $35 $80 $0 $0 Moda Health pays 20% $20 $20 $0 Patient owes $0 $15 $150

Moda Health Medicare Supplement Emergency and Travel Benefits MEMBER PAYS: Urgent Care 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)

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 max None $2,500 Skilled nursing facility Covered in full only after 3 full days in hospital Covered in full * Inpatient & outpatient care Covered in full Low copays and coinsurance Vision Discounts available through VSP Eye exams $20 copay Hardware $100 credit every 24 months * See ANOC 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 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: In network benefits Any Medicare provider: Out ofnetwork benefits $50,000 lifetime limit No lifetime limit Available voluntary enrollment Available Moda will contact you to enroll

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 www.silverandfit.com

Moda Health Non Medicare Plans

Moda Health Non Medicare Plans Plan Changes No benefit changes

Moda Health Non Medicare Plans Features Moda Health Core Value Plan Moda Health Select Value Plan Type of Plan PPO 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

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 a.m. 8:00 p.m., Mon Fri Online resources Be Better Tools Claims information Find Care Cost estimating tools Dedicated PERS website at www.modahealth.com/pers

Health 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

Moda Health Prescription Drug Plan

Prescription Drug Plan Plan Changes Medicare Plans The prescription drug out of pocket maximum per individual per calendar year is $5,000 Non Medicare Plans No benefit changes

Prescription Drug Plan Comprehensive list of covered medications Prescription formulary and pharmacy finder at: www.modahealth.com/pers Medication therapy management (MTM) program for members with Medicare Part D coverage Free 1:1 comprehensive personalized medication review Outcomes include decreased medication adverse side effects, improved disease management, and decreased hospitalization Prescription Price Check Tool Local pharmacy customer service available 7:00 am 8:00 pm, Mon Fri

Pharmacy Network Benefit Nationwide pharmacy network with more than 71,000 participating pharmacies Network also includes: long term care pharmacies, home infusion, Indian, tribal and urban Indian health program pharmacies, specialty pharmacies, Payless Propac special service pharmacy Mail Order Pharmacies Costco OHSU Mail Order Postal Prescription Services Walgreens Mail Service Walmart Mail Service Wellpartner Bartell Drugs Bi Mart Costco CVS Pharmacy Fred Meyer/Kroger/QFC Rite Aid Pharmacies Safeway Savon Shopko Target Walgreens Wal Mart Please note: 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.

Delta Dental of Oregon

Delta Dental of Oregon Who are we? We started providing dental coverage in 1955 as What can you expect? Flexibility 4 out of 5 of the nation s dentists participate in our Premier network Savings on dental procedures Cost predictability through predetermination of benefits No balance billing

Delta Dental of Oregon Dental Plan Changes Composite fillings are covered for posterior (back) teeth Full mouth debridement: Covered for members under age 19 once in a 2 year period Covered for members over age 19 once in a 2 year period only if there has been no cleaning within 24 months

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; and 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

Delta Dental of Oregon Access to the Delta Dental Premier National Network More than 151,000 participating providers nationwide Worldwide dental care with our Passport Dental program