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Medical plans fit for your clients

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

2022 Small Group plans

Our Small Group medical plans are designed to help your client's team members be their healthy best. Read more by downloading our Small group 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.

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:

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

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

Our 2022 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 Moda Select 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 Moda Select provider network in Clackamas, Multnomah and Washington counties and the Connexus network in all of Oregon, and with 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:

  • A team-based approach to healthcare
  • ACoordinated care organized across the healthcare system
  • ABetter health outcomes
  • AA 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.

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.

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

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

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.

Medical plans fit for your clients

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

2022 Small Group plans

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

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 they keep feeling their best. All Moda Health medical plans cover most routine, preventive care, including:

  • Preventive health exams
  • Well-baby care
  • Women's annual exams
  • Many immunizations
  • Colorectal cancer and other health screenings

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.

  • Gold plans. These have the 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.

Our 2022 small group medical plans come in a few shapes and sizes. Review these highlights to determine which plan types best fit your clients' needs.

Preferred provider organization (PPO) plans

These plans combine great benefits with access to PPO-contracted physicians and hospitals to help members save money. Members can visit any provider they choose, but they'll get the best benefits when visiting a PPO provider.

Pioneer Preferred provider organization (3-Tier) plans

These plans are designed to serve members living in the Municipality of Anchorage, Fairbanks North Star, Haines, Kenai Peninsula, Ketchikan Gateway, Mat-Su, Petersburg and Municipality of Skagway boroughs, City and Borough of Juneau, City and Borough of Sitka, City and Borough of Wrangell, Hoonah-Angoon Census Area 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, South Peninsula Hospital, Bartlett Regional Hospital, Mat-Su Regional Medical Center, Fairbanks Memorial Hospital, SEARHC, and other Tier one contracted providers.
  • Tier Two — 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 when permitted by law. Members receive the best benefit by using Tier One providers.

Health savings account (HSA)-compatible plans

These high-deductible health plans (HDHP) are compatible with a health savings account (HSA).

Members have the freedom to choose any financial institution for their HSA plan. They can use HSA tax-free dollars to pay for deductibles, coinsurance and other qualified expenses not covered by their health plan.

Rich benefits embedded in our plans

Pediatric dental

Embedded pediatric dental care covers members under age 19. Members can see any licensed dental care provider in Alaska or throughout the United States. Members may save money when they choose a Delta Dental Premier Network provider.

VSP

Embedded pediatric vision coverage comes with all Moda Health small group plans in Alaska through the VSP Elements plan with in-network coverage through VSP’s Choice provider network. Vision care is limited to members under age 19. Members get the best benefit by seeing licensed, in-network providers.

Embedded vision coverage for adults includes routine vision exam and eyewear through the VSP Choice plan and in-network coverage through VSP’s Choice provider network. All routine vision exams and eyewear claims are administered by VSP. Embedded vision coverage for adults is included in all small group plans except for HDHP plans.

TruHearing

Hearing aids are costly. This benefit makes them more affordable. Benefits include a routine hearing aid exam and hearing aid coverage through TruHearing. Members can schedule an appointment by calling 866-202-2170.

Travel Assist by Assist America

When members need help more than 100 miles from home or in another country, they can call Assist America for emergency medical assistance and much more:

  • Medical consultations
  • Foreign hospital admission help
  • Prescription assistance

Members can learn more at assistamerica.com, or by calling 800-304-4585.

Large Group plans

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.

Large group pharmacy plan options

Large group vision plan options

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.

2021 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 small group 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.

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:

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

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.

Our 2021 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:

  • A team-baed approach to healthcare
  • Coordinated care organized across the healthcare system
  • Better health outcomes
  • 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.

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.

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.

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

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.

Medical plans fit for your clients

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

2021 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 small group brochure:

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 they keep feeling their best. All Moda Health medical plans cover most routine, preventive care, including:

  • Preventive health exams
  • Well-baby care
  • Women's annual exams
  • Many immunizations
  • Colorectal cancer and other health screenings

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.

  • Gold plans. These have the 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.

Our 2021 small group medical plans come in a few shapes and sizes. Review these highlights to determine which plan types best fit your clients' needs.

Preferred provider organization (PPO) plans

These plans combine great benefits with access to PPO-contracted physicians and hospitals to help members save money. Members can visit any provider they choose, but they'll get the best benefits when visiting a PPO provider.

Pioneer Preferred provider organization (3-Tier) plans

These plans are designed to serve members living in the Municipality of Anchorage, Fairbanks North Star, Ketchikan Gateway, Kenai Peninsula and 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, South Peninsula Hospital, Bartlett Regional Hospital, Mat-Su Regional Medical Center 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.

Health savings account (HSA)-compatible plans

These high-deductible health plans (HDHP) are compatible with a health savings account (HSA).

Members have the freedom to choose any financial institution for their HSA plan. They can use HSA tax-free dollars to pay for deductibles, coinsurance and other qualified expenses not covered by their health plan.

Rich benefits embedded in our plans

Pediatric dental

Embedded pediatric dental care covers members under age 19. Members can see any licensed dental care provider in Alaska or throughout the United States. Members may save money when they choose a Delta Dental Premier Network provider.

VSP

Embedded pediatric vision coverage comes with all Moda Health small group plans in Alaska through the VSP Elements plan with in-network coverage through VSP’s Choice provider network. Vision care is limited to members under age 19. Members get the best benefit by seeing licensed, in-network providers.

Embedded vision coverage for adults includes routine vision exam and eyewear through the VSP Choice plan and in-network coverage through VSP’s Choice provider network. All routine vision exams and eyewear claims are administered by VSP. Embedded vision coverage for adults is included in all small group plans except for HDHP plans.

TruHearing

Hearing aids are costly. This benefit makes them more affordable. Benefits include a routine hearing aid exam and hearing aid coverage through TruHearing. Members can schedule an appointment by calling 866-202-2170.

Travel Assist by Assist America

When members need help more than 100 miles from home or in another country, they can call Assist America for emergency medical assistance and much more:

  • Medical consultations
  • Foreign hospital admission help
  • Prescription assistance

Members can learn more at assistamerica.com, or by calling 800-304-4585.

Large group plans

2021 Alaska large groups (51+) brochure

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.

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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:

Changing your location to Oregon

You can return to your previous location in the site header.