Your medical plan options

During open enrollment, you’ll choose one of the available plans that meets your preferences and needs. Each is supported by our tiered network approach.

2025 Summary of Benefits and Coverage

We want you to choose the plan that works best for you. Here are some helpful tips to guide you.

EPO: The Exclusive Provider Organization

The EPO plan may be right for you if:

  • You want to pay lower monthly premiums.
  • You want flexibility in choosing providers with the lowest out-of-pocket costs (copay and coinsurance) when you visit a provider in the PeaceHealth Network (Tier I).
  • Most of your care comes from Tier I providers (including PeaceHealth, ZoomCare, CIN community providers and Joint Ventures).
  • You live near Tier I providers.
  • You do not use any out-of-network providers.

PPO: The Preferred Provider Organization

The PPO plan may be right for you if:

  • You don’t mind paying more in premiums.
  • You want flexibility in choosing providers and seek care from both Tier I and Tier II providers but want to pay lower out-of-pocket costs when seeing Tier II providers than under the EPO.
  • You want coverage when going out-of-network for some care.

ABHP: The Account-Based Health Plan

The ABHP plan may be right for you if:

  • You want to pay less each month for your plan.
  • You want flexibility in choosing providers and seek care from both Tier I and Tier II providers but don’t mind paying higher deductibles and out-of-pocket costs.
  • In addition to the HSA contribution made by PeaceHealth, you intend to put money into your health savings account (HSA) as well, lowering your taxable income and helping you save pre-tax dollars for your health expenses (deductibles, coinsurance and prescription drugs).
  • Note: if you or your family members have chronic or high-cost conditions this plan may not be right for you. While preventive care is covered at 100%, all other services require that you meet the higher deductible. If you have family members enrolled, the family deductible must be met before the plan begins to provide benefits for any family member. 
A man on the phone with an inhaler for chronic illness

Choosing the right plan when you have a chronic condition

Moda Health is happy to support the enhanced chronic condition program (ECC) in all three plan options. When you enroll in this program, you will have a $0 cost share for certain medications, personalized guidance from health coaches and case managers, and medication support for the following conditions:

  • Asthma
  • Diabetes
  • Coronary Artery Disease
  • Heart Failure
  • Hypertension
  • Depression
  • Chronic obstructive pulmonary disease (COPD)

The ECC program will have 4 tiers that participating Caregivers will be placed into based on their current health and risk. Caregivers can maintain their ECC benefit eligibility by completing the requirements of each tier. 

  • High acuity tier requires regular one-on-one engagement with a case manager
  • Moderate and Low acuity tier requires regular one-on-one engagement with a health coach
  • Maintenance tier requires you to complete an annual wellness visit and remain adherent to your prescribed medications

Moda Health wants to make the transition of your care easy. If you are enrolled in the ECC program prior to Jan. 1, 2025, you will automatically be enrolled in the program with no changes to your benefit for the first 6 months of your plan. This timeline is to ensure that you have plenty of time to meet the goals of ECC, which includes taking your maintenance medication as prescribed by your doctor and having an annual wellness visit.

ECC program outreach

Moda will be communicating with you throughout the time you are in the ECC program. We will send out an initial communication in January welcoming you to Moda ECC and explaining the program requirements. In May, we will be letting you know how you are doing meeting the program goals, if there is risk of losing your ECC benefit and whether your tier level will change beginning July 1st.  It will explain any actions you need to take in order to ensure you can continue to be successful with the program. 

A few important notes

  1. Prescriptions must be filled at the following eligible pharmacies:

    • PeaceHealth RiverBend Outpatient Pharmacy
    • PeaceHealth Southwest Medical Center Outpatient Pharmacy
    • PeaceHealth St. John Medical Center Outpatient Pharmacy

  2. You must meet participation requirements.

  3. All pediatric dependents are automatically enrolled in the maintenance phase of ECC once identified with a qualifying conditions of asthma, diabetes or depression

If you have any questions about ECC, please contact the Moda Health Navigator team 833-599-8602

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Copyright © 2025 Moda, Inc. All rights reserved.

Health plans in Oregon and Alaska provided by Moda Health Plan, Inc.

This site is meant to help you learn about plans and healthcare for you and your family. This site is subject to change in order to comply with state and federal law, including the Affordable Care Act (ACA) and related regulations, and connectivity with the federal Marketplace. If questions regarding benefits arise, the summary of benefits and coverage document is the master resource.

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