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Networks protect members, near and far

Each Moda Health medical plan and Delta Dental Plan of Oregon plan comes with a provider network. Each medical network is a group of licensed health professionals, clinics, pharmacies, labs and hospitals located in a certain area. These providers offer quality care and services to Moda Health members at an agreed-upon cost. Each dental network includes network dentists who accept the Delta Dental contracted fee so there will be no additional balance billing.

View our networks:

In-network care offers better value

Members get a better benefit and can save money by seeing in-network providers. These providers offer quality care and services to our members at an agreed-upon cost.

Care from out-of-network providers may also be subject to "balance billing" ‐ the difference between what the plan allows or reimburses and the providers' billed charges. In-network providers don't do this.

Is a provider in-network?

Members can find out by visiting modahealth.com and using Find Care. They choose a network and look for a doctor, dentist or facility nearby.

Questions?

We're here to help. Contact our Sales and Account Services team for friendly support.

Medical networks

Here are the medical provider networks for our Oregon small and large group members. Members save money by seeing in-network providers. Check medical plan summaries to see which medical network each small group plan includes.

Connexus Network

When your employees want our broadest selection of providers across Oregon, Connexus Network has them covered. Your employees located anywhere in Oregon can choose a plan with this network. Members can see in-network providers in all counties in Oregon and some areas in Washington and Idaho.

Coordinated Care Model (CCM) plans

Our CCM plans, powered by the Synergy network, offer patient-centered care with a team-based approach. The plans connect a primary care provider with the rest of a member's care team (other providers, specialists, etc.) to bring members the best treatments. By choosing a CCM plan, members will enjoy a team-based approach to healthcare, coordinated care across the healthcare system for better health outcomes, and a dedicated Primary Care Provider (PCP) that coordinates care. The CCM plan is the best option for members looking for partners to help them on their healthcare journey. This is also the ideal option for members who are managing an existing condition because of its laser focus on wellness, prevention and improving their quality of life.

Synergy Network

Groups located in Oregon can choose a plan with the Synergy network. The Synergy Network covers every county in Oregon. Members living or working in these areas can access care through the PCP they select.

Hospitals and health systems affiliated with the Synergy Network include:

  • Adventist Health (OHSU partner)
  • Asante
  • Bay Area Hospital
  • Blue Mountain Hospital District
  • CHI St.Anthony Hospital
  • Columbia Memorial Hospital
  • Curry Health District
  • Good Shepherd
  • Grand Ronde Hospital
  • Haney District Hospital
  • Lake Health District
  • Legacy Health
  • Lower Umpqua Hospital
  • Mercy Medical Center
  • Mid Columbia Medical Center
  • Morrow County Health District
  • Oregon Health & Science University (OHSU)
  • PeaceHealth
  • Salem Clinic
  • Salem Health
  • Samaritan Health Services
  • Santiam Memorial Hospital
  • Sky Lakes Medical Center
  • Southern Coos Hospital and Health Center
  • St.Alphonsus Medical Center
  • St.Anthony Hospital
  • St.Charles Health System
  • St.Luke's Hospital
  • Tuality Healthcare (OHSU partner)
  • Wallowa Memorial Hospital
  • Willamette Valley Medical Center

Networks outside of Oregon

Members living in states outside of Oregon can receive in-network care through the following networks.

First Choice Health Network

Members living in most counties in Washington can receive in-network care through First Choice Health Network. It includes thousands of doctors, hospitals and other medical providers across many specialties.

Private HealthCare Systems (PHCS) Network

Members living outside of Oregon or Washington in the U.S. can see providers in the PHCS Network for in-network care. It is the largest PPO medical network nationwide, with thousands of doctors and clinics, and hundreds of hospitals, to choose from. PHCS Network gives members plenty of choice.

Travel network - First Health Network

When members hit the road, care is never far away. While traveling outside the network service areas, members can receive emergency or urgent care through the First Health Network which is paid at the in-network amount. Traveling for the purpose of seeking care does not qualify for the travel network benefit. Outside the U.S., members may access any provider for emergency care at the in-network cost-sharing amount. This care is subject to balance billing. Other care received outside the U.S. is not covered.

Questions?

We're here to help. Contact our Sales and Account Services team for friendly support.

Dental networks

Each Delta Dental of Oregon plan comes with a Delta Dental network. It includes thousands of dentists across the state, and the country.

To learn more about our dental networks go to DeltaDentalOR.com.

Questions?

We're here to help. Contact our Sales and Account Services team for friendly support.

Networks protect members, near and far

Health happens, whether employees are at home or on the road, so we've made it easy for them to find in-network coverage.

Each Moda Health medical plan and Delta Dental of Alaska plan comes with a provider network. Each medical network is a group of licensed health professionals, clinics, pharmacies, labs and hospitals located in a certain area. These providers offer quality care and services to Moda Health members at an agreed-upon cost. Each dental network includes network dentists who accept the Delta Dental contracted fee so there will be no additional balance billing.

View our networks:

In- and out-of-network care

It's important to remember that members may pay more for services from out of-network providers than from in-network providers. Out-of-network providers may balance bill members the difference between the maximum plan allowance and their billed charges.

Medical networks

Choose one in-state network to offer employees — either Endeavor Select or Pioneer.

Endeavor Select

This Alaska network covers participating physicians, clinics and ancillary providers throughout the state. It includes Alaska Regional Hospital as the preferred provider of acute care services in the Anchorage area. Members can see First Choice PPO panel providers in Alaska for in-network care.

PHCS Network outside Alaska

For care outside Alaska, these members can see providers in the PHCS Network for in-network care. It is the largest PPO medical network nationwide, with thousands of doctors and clinics, and hundreds of hospitals to choose from. PHCS Network gives members plenty of choice and lower out-of-pocket costs.

Pioneer Network (for residents in the Municipality of Anchorage, Fairbanks North Star, Ketchikan Gateway, Kenai Peninsula, Mat-Su Boroughs and Prince of Wales-Hyder Census Area)

The Pioneer Network was developed to provide cost-effective, coordinated care. Pioneer offers three benefit levels (tiers) of healthcare:

  • Tier One – Includes Central Peninsula Hospital, Alaska Regional Hospital, PeaceHealth Ketchikan Medical Center, Bartlett Regional Hospital, Mat-Su Regional Medical Center, South Peninsula Hospital and other Tier One contracted providers.
  • Tier Two – It includes the First Choice Network in Alaska.
  • Tier Three – All other Alaska providers not in Tier One or Tier Two.

Members can use any professional provider or hospital. However, Tier Three providers can balance bill. Members receive the best benefit by using Tier One providers.

First Health Network outside Alaska

Services received outside Alaska are covered at the Tier One benefit level for urgent and emergency care through providers in the First Health Network. Care outside of Alaska is not covered except for:

  • Emergency services
  • Coverage through medical travel support
  • Coverage through out-of-state contracted providers
  • Medically necessary non-emergency services that are prior-authorized by Moda Health

Is a provider in-network?

Members can find out by visiting modahealth.com and using Find Care. They choose a network and look for a doctor, dentist or facility nearby.

Dental networks

Each Delta Dental of Alaska plan comes with a Delta Dental network. It includes thousands of dentists across the state, and the country.

To learn more about our dental networks go to DeltaDentalAK.com,

Questions?

We're here to help. Contact our Sales and Account Services team for friendly support.

Networks protect members, near and far

Each Moda Health medical plan and Delta Dental Plan of Oregon plan comes with a provider network. Each medical network is a group of licensed health professionals, clinics, pharmacies, labs and hospitals located in a certain area. These providers offer quality care and services to Moda Health members at an agreed-upon cost. Each dental network includes network dentists who accept the Delta Dental contracted fee so there will be no additional balance billing.

View our networks:

In-network care offers better value

Members get a better benefit and can save money by seeing in-network providers. These providers offer quality care and services to our members at an agreed-upon cost.

Care from out-of-network providers may also be subject to "balance billing" ‐ the difference between what the plan allows or reimburses and the providers' billed charges. In-network providers don't do this.

Is a provider in-network?

Members can find out by visiting modahealth.com and using Find Care. They choose a network and look for a doctor, dentist or facility nearby.

Questions?

We're here to help. Contact our Sales and Account Services team for friendly support.

2019 medical networks

Here are the 2019 medical provider networks for our Oregon small and large group members. Members save money by seeing in-network providers. Check medical plan summaries to see which medical network each small group plan includes.

Connexus Network

Our traditional PPO plans give members access to the Connexus Network, one of the largest PPO medical networks in Oregon. Members will enjoy access to more than 80 hospitals and 26,000 providers in Oregon, Washington and Idaho. In-network and out-of-network benefits are available, and no primary care selection is required. PPO plans may be the best option for members looking for statewide coverage.

Coordinated Care Model (CCM) plans

Our CCM plans, powered by the Synergy and Summit networks, offer patient-centered care with a team-based approach. The plans connect a primary care provider with the rest of a member's care team (other providers, specialists, etc.) to bring members the best treatments, facilitated through a Medical Home. By choosing a CCM plan, members will enjoy a team-based approach to healthcare, and a dedicated Medical Home that coordinates care across the healthcare system for better health outcomes. The CCM plan is the best option for members looking for partners to help them on their healthcare journey. This is also the ideal option for members who are managing an existing condition because of its laser focus on wellness, prevention and improving their quality of life.

Synergy Network

Groups located in western Oregon can choose a plan with this network. Members living or working in these areas can access care through the nearby Medical Home they select.

Hospitals and health systems affiliated with the Synergy Network include:

  • Adventist Health
  • Asante
  • Bay Area Hospital
  • Columbia Memorial Hospital
  • Legacy Health
  • Mercy Medical Center
  • Mid-Columbia Medical Center
  • Oregon Health Science University (OHSU)
  • PeaceHealth
  • Salem Clinic
  • Salem Health
  • Samaritan Health Services
  • Santiam Hospital
  • Sky Lakes Medical Center
  • St. Charles Health System
  • Tillamook Regional Medical Center
  • Tuality Healthcare (OHSU partner)
  • Willamette Valley Medical Center

Synergy Network covers these counties:

Benton, Clackamas, Clatsop, Columbia, Coos, Crook, Curry, Deschutes, Douglas, Hood River, Jackson, Jefferson, Josephine, Klamath, Lane, Lincoln, Linn, Marion, Multnomah, Polk, Tillamook, Wasco, Washington and Yamhill.

Summit Network

Groups located in eastern Oregon can choose a plan with this network. Members living or working in this area can access care through the nearby medical home they select.

Hospitals and health systems affiliated with the Summit Network include:

  • Blue Mountain Hospital
  • Good Shepard Health Care System
  • Grande Ronde Hospital
  • Harney District Hospital
  • Pioneer Memorial Hospital - Heppner
  • Saint Alphonsus Medical Center ‐ Baker City, Boise, Nampa and Ontario
  • St. Anthony Hospital
  • St. Luke's Regional Medical Center
  • Wallowa Memorial Hospital

Summit Network covers these counties:

Baker, Gilliam, Grant, Harney, Lake, Malheur, Morrow, Sherman, Umatilla, Union, Wallowa and Wheeler.

Medical homes make care personal

Members can find out more information about Medical Homes by visiting modahealth.com/medicalhome.

Networks outside of Oregon

Members living in states outside of Oregon can receive in-network care through the following networks.

First Choice Health Network

Members living in most counties in Washington can receive in-network care through First Choice Health Network. It includes thousands of doctors, hospitals and other medical providers across many specialties.

Private HealthCare Systems (PHCS) Network

Members living outside of Oregon or Washington in the U.S. can see providers in the PHCS Network for in-network care. It is the largest PPO medical network nationwide, with thousands of doctors and clinics, and hundreds of hospitals, to choose from.

Travel network - First Health Network

When members hit the road, care is never far away. While traveling outside the network service areas, members can receive emergency or urgent care through the First Health Network which is paid at the in-network amount. Traveling for the purpose of seeking care does not qualify for the travel network benefit. Outside the U.S., members may access any provider for emergency care at the in-network cost-sharing amount. This care is subject to balance billing. Other care received outside the U.S. is not covered.

Questions?

We're here to help. Contact our Sales and Account Services team for friendly support.

2019 dental networks

Each Delta Dental of Oregon plan comes with a Delta Dental network. It includes thousands of dentists across the state, and the country.

Depending on the plan type, members access dentists in the Delta Dental Premier or PPO network. Members save money by seeing participating, in-network dentists.

Here are the 2019 dental provider networks for our Oregon small and large group members. Check dental plan summaries to see which dental network each small group plan includes.

Delta Dental Premier® Network

This is the largest dental network in Oregon and across the country. It includes more than 2,400 providers in Oregon and over 155,000 Delta Dental Premier dentists nationwide.

Delta Dental PPO NetworkSM

This is one of the largest preferred provider organization (PPO) dental networks in Oregon and across the country. It includes more than 1,300 participating providers in Oregon and offers access to over 110,000 Delta Dental PPO dentists nationwide.

Questions?

We're here to help. Contact our Sales and Account Services team for friendly support.

Networks protect members, near and far

Health happens, whether employees are at home or on the road, so we've made it easy for them to find in-network coverage.

Each Moda Health medical plan and Delta Dental of Alaska plan comes with a provider network. Each medical network is a group of licensed health professionals, clinics, pharmacies, labs and hospitals located in a certain area. These providers offer quality care and services to Moda Health members at an agreed-upon cost. Each dental network includes network dentists who accept the Delta Dental contracted fee so there will be no additional balance billing.

View our networks:

In- and out-of-network care

It's important to remember that members may pay more for services from out of-network providers than from in-network providers. Out-of-network providers may balance bill members the difference between the maximum plan allowance and their billed charges.

2019 provider networks

Choose one in-state network to offer employees ‐ either Endeavor Providence, Endeavor Select or Pioneer.

Endeavor Providence

This Alaska network covers participating physicians, clinics and ancillary providers throughout the state. It includes Providence Alaska Medical Center as the preferred provider of acute care services in the Anchorage area. Members can see First Choice PPO panel providers in Alaska for in-network care.

Endeavor Select

This Alaska network covers participating physicians, clinics and ancillary providers throughout the state, with the exception of the Kenai Peninsula Borough. It includes Alaska Regional Hospital as the preferred provider of acute care services in the Anchorage area. Members can see First Choice PPO panel providers in Alaska for in-network care.

PHCS Network outside Alaska

For members who choose the Endeavor Providence or Endeavor Select networks, their network outside of Alaska is the PHCS Network.

For care outside Alaska, these members can see providers in the PHCS Network for in-network care. It is the largest PPO medical network nationwide, with thousands of doctors and clinics, and hundreds of hospitals to choose from. PHCS Network gives members plenty of choice and lower out-of-pocket costs.

Pioneer Network (NEW option for residents in the Kenai Peninsula Borough)

The Pioneer Network was developed to provide cost-effective, coordinated care for residents of the Kenai Peninsula Borough. Pioneer offers three benefit levels (tiers) of healthcare:

  • Tier One ‐ For Kenai Peninsula Borough residents seeking coordinated care in the community.
  • Tier Two ‐ For Alaskans seeking care outside of the Kenai Peninsula Borough. It includes First Choice Network in Alaska and Alaska Regional Hospital.
  • Tier Three ‐ All other Alaska providers not in Tier One or Tier Two.

Members can use any professional provider or hospital. However, Tier Three providers can balance bill. Members receive the best benefit by using Tier One providers.

First Health Network outside Alaska

For members who choose the Pioneer network, their network outside of Alaska is the First Health Network. Services received outside Alaska are covered at the Tier One benefit level for urgent and emergency care through providers in the First Health Network.

Is a provider in-network?

Members can find out by visiting modahealth.com and using Find Care. They choose a network and look for a doctor, dentist or facility nearby.

2019 dental networks

Each Delta Dental of Alaska plan comes with a Delta Dental network. It includes thousands of dentists across the state, and the country.

Depending on the plan type, members access dentists in the Delta Dental Premier or PPO network. Members save money by seeing participating, in-network dentists.

Here are the 2019 dental provider networks for our Alaska small group members. Check dental plan summaries to see which dental network each plan includes.

Delta Dental Premier® Network

This is the largest dental network in Alaska and nationally. It includes more than 440 providers in Alaska and over 155,000 Delta Dental Premier Dentists nationwide, serving 50 states, the District of Columbia, Puerto Rico, Guam, the Northern Mariana Islands and the Virgin Islands.

Delta Dental PPO Networksm

The preferred provider option (PPO) dental network in Anchorage, Mat-Su Valley and Fairbanks North Star includes over 190 participating providers and offers access to over 110,000 Delta Dental PPO Dentists nationwide.

Questions?

We're here to help. Contact our Sales and Account Services team for friendly support.

Hello.

We have exciting news to share. ODS is changing its name to Moda Health.

Moda comes from the latin term "modus" and means "a way". We picked it because that's what we are here to do: help our communities find a way to better health.

Together, we can be more, be better.

Please select the state you live in, or the state where your employer is headquartered, so we can tailor your experience:

Hello.

Please select the state you live in, or the state where your employer is headquartered, so we can tailor your experience:

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