Medical plans fit for your clients

Your clients have a lot to think about when choosing their medical benefits. That's why we've made it easy to compare the details. This section highlights our current plan options.

2020 small group plan summaries

Our small group medical plans are designed to help your client's team members be their healthy best. Read more by downloading our full 2020 small group brochure:

• 2020 Small groups of 1 - 50 brochure

All plans include a provider network, a group of licensed medical 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.

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. In-network providers don't do this. See our plan benefit summaries to learn more about in-network and out-of-network benefits and costs. Members can also review their Member Handbook for details. Eligible enrolled children living outside of the plan's network service areas can receive in-network care through the First Health Network.

Summaries of Benefits

View comparison chart of all 2020 small group medical plans

new Plan Tier Plan Type 2020 Oregon small group plans (1-50) In-network benefit (per person) Deductible Out-of-pocket max PCP office visit copay/coinsurance SB SBC Platinum 1-Platinum Connexus Platinum 250 $250 $2,000 $10/visit 1-Platinum Synergy Platinum 250 $250 $2,000 $10/visit 1-Platinum Connexus Platinum 500 $500 $2,000 $10/visit 1-Platinum Synergy Platinum 500 $500 $2,000 $10/visit Gold 2-Gold Connexus Gold 500 $500 $7,500 $20/visit 2-Gold Synergy Gold 500 $500 $7,500 $20/visit 2-Gold Connexus Gold 1000 $1,000 $7,500 $20/visit 2-Gold Synergy Gold 1000 $1,000 $7,500 $20/visit 2-Gold Connexus Gold 1500 $1,500 $7,500 $20/visit 2-Gold Synergy Gold 1500 $1,500 $7,500 $20/visit 2-Gold Connexus Gold 2000 $2,000 $7,500 $20/visit 2-Gold Synergy Gold 2000 $2,000 $7,500 $20/visit 2-Gold Moda Health Oregon Standard Gold 1,000 $7,300 $20/visit Silver 3-Silver Connexus Silver 2500 $2,500 $8,150 $40/visit 3-Silver Synergy Silver 2500 $2,500 $8,150 $40/visit 3-Silver Connexus Silver 3000 $3,000 $8,150 $40/visit 3-Silver Synergy Silver 3000 $3,000 $8,150 $40/visit 3-Silver Connexus Silver 4000 $4,000 $8,150 $40/visit 3-Silver Synergy Silver 4000 $4,000 $8,150 $40/visit 3-Silver Connexus Silver 5000 $5,000 $8,150 $40/visit 3-Silver Synergy Silver 5000 $5,000 $8,150 $40/visit 3-Silver Connexus Silver HDHP 2800 $2,800 $5,855 30% after deductible 3-Silver Moda Health Oregon Standard Silver $3,550 $8,150 $40/visit Bronze 4-Bronze Connexus Bronze 5500 $5,500 $8,150 $40/visit 4-Bronze Connexus Bronze 8150 $8,150 $8,150 $60/visit 4-Bronze Connexus Bronze HDHP 5000 $5,000 $6,650 50% after deductible 4-Bronze Moda Health Oregon Standard Bronze $7,900 $7,900 $45/visit

What plans include

Moda Health medical plans offer a bounty of great benefits. Here's what members can expect:

• Choice: Quality provider networks that give members the freedom to choose the best doctor for them
• Coverage: Comprehensive plans that protect members' well-being and connect them with preventive, specialty and pharmacy services
• Compassion: Caring teams that support members along their health journey

Preventive care matters

Give your clients access to quality preventive care so their employees keep feeling their best. All Moda Health medical plans cover most routine, in-network preventive care, including:

• Periodic health exams
• Well-baby care
• Women's annual exams
• Many immunizations
• Preventive cancer and other health screenings
• Quality pharmacy benefits

Deciding on a plan

Plans vary by premiums, networks, deductibles, copays and coinsurance. Understanding these factors, along with metallic levels, can help your clients pick the right group plan option.

• Platinum plans. These typically have the highest monthly premiums, but they cover about 90 percent of the total average cost of care.
• Gold plans. These have the next highest monthly premiums and cover about 80 percent of the total average cost of care.
• Silver plans. These sit somewhere in the middle, covering about 70 percent of the total average cost of care.
• Bronze plans. These provide a little less coverage - about 60 percent of the total average cost of care - but they have lower monthly premiums.

Small groups of 1 - 50 employees

Our 2020 small group medical plans come in a few shapes and sizes. Review these highlights to determine which plan types best fit your clients' needs.

Coordinated Care Model (CCM)

Our CCM plans, powered by the Synergy network, offer patient-centered care with a team-based approach. The plans connect a primary care provider (PCP) with the rest of a member’s care team (other providers, specialists, etc.) to bring members the best treatments.

Clients located across Oregon can select CCM plans. They connect members with the Synergy provider network, great benefits and low out-of-pocket costs, close to home.

Members living or working in the network service area can access care through the PCP they select. Each member and their covered family members can pick the same PCP or a different one – it’s up to them.
PCPs work with members on the best treatments for them. This team-based approach offers:

• Personalized care centered on your members
• Faster, easier ways to find and access quality care
• Coordinated care to support members’ and their families’ health goals
• Lower out-of-pocket costs when using a PCP.

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.

Traditional Preferred Provider Organization (PPO) plans

By choosing a traditional PPO plan, your clients will enjoy access to more than 65 hospitals and 23,000 providers in Oregon, Washington and Idaho, with in-network and out-of-network benefits available. No primary care selection is required. Traditional PPO plans offer the broadest provider coverage.

Our traditional PPO plans give members access to the Connexus Network.

HDHP plans

These high-deductible health plans (HDHP) are compatible with a health savings account (HSA). Having an HDHP allows members to use tax-free funds for eligible healthcare expenses. They can simply check to see if their financial institution has an HSA option.

Pediatric vision care

Embedded pediatric vision coverage comes with all Moda Health plans in Oregon. Pediatric vision care is limited to members under age 19. Members get the best benefit by seeing licensed, in-network providers.

Vision riders

These options ensure members can focus on feeling their best. Our vision plans are available to adults and eligible dependents age 19 and over.

Vision rider options

• Vision: Eye Exam Only
• Vision 200 Max
• Vision 300 Max
• Vision 400 Max
• Vision 500 Max

The small business health care tax credit

If your client is a small employer, there is a tax credit that can put money in your pocket.

The small business health care tax credit benefits employers that:

• have fewer than 25 full-time equivalent employees
• pay an average wage of less than $53,000 a year (adjusted for inflation annually),
• pay a uniform percentage of employee premium for all employees that is equal to at least 50% of the premium cost of employee-only insurance coverage.

Oregon does not have an online Small Business Health Options Program (SHOP), but small businesses can still be eligible for this credit. To be considered for the Small Business Health Care Tax Credit in Oregon, small businesses must offer their employees a medical plan certified by the Oregon Health Insurance Marketplace.

For more information visit www.healthcare.oregon.gov and click on Types of Coverage, then click on Coverage for small businesses.

Large group plans

Groups of 51+ employees

We are also proud to offer health solutions to larger groups of 51 or more employees. Your client's team will enjoy all the benefits of being a Moda Health member, like access to quality providers, wellness programs and online health resources. Our health management tools make tracking group coverage easy and convenient.