Resources
Explore the policies, documents, notices and resources that define how Moda Health does business with our members, providers, employers and other partners.
Moda Health at-a-glance
Moda Health has nearly 1,000 employees, living and serving members in four states: Alaska, Idaho, Oregon and Texas. We offer affordable, quality health plans for individuals, families, and businesses, small and large. At Moda Health, we're passionate about helping you on your journey to be better. Since 1955, we've been helping our members with evidence-based health plans, diverse provider networks, innovative member programs, and our signature, caring customer service.
At Moda, we believe there's always a better way. Being – and doing – better is at the core of everything we do. It's in our DNA. Our companies offer insurance services, healthcare business solutions, care services and delivery, all working together to build healthy communities.
At Moda, we're committed to making healthcare work better for everyone. This goal isn't one of equality; it's one of equity. That's why we have been working for many years to weave the pillars of DEI into everything we do.
Diversity: We value, respect and celebrate people of all backgrounds, identities and abilities, and we actively seek to identify how uniqueness makes us better.
Equity: We strive to understand the underlying causes of outcome disparities and work toward increasing justice and fairness in our processes, procedures and systems – within both our company and our communities.
Inclusion: We are committed to creating environments wherein every individual has an equal opportunity to belong and can be recognized for their inherent worth and dignity.
The Policy Committee of the Moda Health Board of Directors oversees all our quality programs. Our Medical Quality Improvement Committee (MQIC) does the legwork to make sure our programs run smoothly. We represent key service areas of our health plan by including senior executives and the company’s chief medical officer as members of the MQIC. Using tools designed specifically for healthcare, our committee monitors, measures and evaluates the quality of services our members receive.
Moda Health annual work plan
Each year, we write a work plan of our quality initiatives and goals to improve member experience and satisfaction. The work plan keeps us on track and helps us monitor our progress throughout the year.
Moda Health annual quality evaluation
Our annual quality evaluation documents our quality improvement activities. These activities include specific initiatives, goals and outcomes. We study the results to find out how much our efforts improved member experience and satisfaction. We identify issues that kept us from reaching our goals. This annual assessment directs our work plan and priorities for the following year.
What the No Surprises Act means to you
Unexpected bills can be stressful. Even more so when they are emergency medical bills. Now, if you are on an individual medical plan or on most group health plans, the federal No Surprises Act (NSA) protects you from these unexpected costs by reducing the amount you are billed.
Here's how it works
Starting Jan. 1, 2022, out-of-network providers caring for you at in-network facilities, air ambulance providers and providers of emergency services may only charge you the cost-sharing, such as your deductible and coinsurance, that you would have paid for in-network services. These providers cannot charge you more than this – this is called balance billing is prohibited under the NSA.
This applies to most insured and self-funded group health plans and individual medical plans. It applies in all states. It does not apply to short-term medical plans, dental only, vision only, Medicaid, Medicare Supplemental or Medicare Advantage plans.
The NSA is broader than existing Oregon surprise billing protections. It applies to all emergency services and any services performed by non-participating providers included in a visit to a participating facility. This could include:
- A lab test or durable medical equipment (DME) device provided by an out-of-network provider while you're being treated at a participating facility (even if the lab or equipment provider is not located at the facility)
- Post-stabilization services following an emergency until you can be safely transferred to an in-network facility
- Air ambulance providers
For help with surprise billing or more information about NSA, contact us at 888-217-2363, or the Oregon Department of Financial Regulation (DFR) at DFR.InsuranceHelp@dcbs.oregon.gov or 888-877-4894.