Welcome, Salem Health employees!

Medical plan options

Prime Plan- HDP

The Prime Plan is a plan that has a higher deductible – the amount of medical expenses you pay each year before the plan begins to pay. The Prime Plan gives you more control over your healthcare and costs. It features a pre-tax spending account, called a health savings account (HSA), that helps you pay for eligible expenses. This medical plan offers three tiers of coverage. Choose any in-network tier I, tier II, or tier III physician or hospital for your care. Out-of-network coverage is limited to urgent and emergency care, massage therapy, acupuncture, spinal manipulation, and certain behavioral health services.

• Your per-paycheck contribution is the lowest of the plan options, but your deductible and out-of-pocket costs are higher.
• The deductible must be met before the plan will begin to pay for any services (other than preventive care). For family coverage the deductible is shared, meaning the entire family deductible must be met before the plan will begin to pay for any member of the family. Family coverage is considered any coverage other than employee-only coverage
• Out-of-network coverage is limited to urgent and emergency care, massage therapy, acupuncture, spinal manipulation, and certain behavioral health services
• Salem Health will contribute to your HSA: $1,650 annually for employee only coverage and $3,300 annually for family coverage (amounts are prorated for partial-year enrollments)
  • HSA contributions are pre-tax, reducing the amount in taxes you pay each pay period
  • Funds you take out of your HSA are not taxed when used for eligible medical expenses
  • If you have money left in your HSA at the end of the year, it will roll over year after year
• The Prime Plan is not Medicare Part D creditable*

Each individual situation is different, but if you are in good health, do not have a lot of high-cost prescription drug expenses, and do not expect to incur significant medical expenses in the coming year, you may want to consider the Prime Plan to take advantage of the HSA.

See the Prime HDP Summary of Benefits and Coverage for more details.

*It is important to note the prescription plan offered through the Prime - High Deductible Plan is not Medicare D creditable and is NOT expected to pay out as much as standard Medicare prescription drug coverage pays. Therefore, your coverage is considered Non-Creditable Coverage. You can find more information on the Salem Health Notice of Creditable Coverage and how this affects Health Spending Account participation here

Choice Plan - MHP

The Choice Plan offers the greatest provider choice, allowing you to choose any physician or hospital for your care. You pay the least when you receive care from a tier I network provider, more at a tier II or tier III network provider, and the most at a tier IV out-of-network provider.

• Your per-paycheck contribution is the highest of the plan options, but you have a lower deductible and out-of-pocket maximum
• You have coverage with out-of-network providers
• There is an Additional Cost Tier (additional copay) for specific elective services received from a tier II or tier III provider
• The Choice Plan is Medicare Part D creditable

See the Choice MHP Summary of Benefits and Coverage for more details.

Additional Cost Tier

The Additional Cost Tier is designed to encourage consideration of less invasive treatment alternatives.  When certain surgical procedures are performed they are subject to a copayment on top of the standard benefit level. Additional Cost Tier procedures include the following:

$100 cost tier

• Upper endoscopy
• Spinal injections
• Viscosupplementation
• Lumbar discography
• Tonsillectomy for a member under age 18 with chronic tonsillitis or sleep apnea
• Sleep studies
• Advanced imaging procedures

$500 cost tier

• Arthroscopy (knee and shoulder)
• Spine surgery
• Uncomplicated hernia repair
• Knee/hip replacement

Some Additional Cost Tier services require prior authorization. A full list of such services can be found on the Moda Health website. Contact a Health Navigator for more information regarding the Additional Cost Tier.

The Additional Cost Tier does not apply to surgical procedures or treatment that is provided by a tier I provider or facility.

Pharmacy

To receive the highest level pharmacy benefit, fill your prescriptions at Salem Health retail pharmacies.

Drug price check and pharmacy locator

• Do you want to know how much a medication costs before you purchase? Log in to your Member Dashboard, proceed to the pharmacy section, and use the “Pharmacy Tools” to check drug prices at local pharmacies.

Pharmacy network

• Members have access to the ArrayRx Core network. Use Find Care to locate a pharmacy.

Travel and out of area dependents

Your dental plan options

The dental plans administered by Delta Dental give you access to the nation’s largest network of dentists. When you see a participating in-network provider, you receive preventive care services for free (i.e., no out-of-pocket costs). With both the Delta Dental plan and the Delta Dental plus Orthodontia plan, you also:

• Receive a $1,500 annual maximum toward your dental care
• Enjoy preventive services that do not count toward your annual maximum
• Do not have benefit waiting periods

With the Delta Dental + Orthodontia Plan, both adults and children get a $1,500 lifetime maximum for orthodontic services.

Learn more about your dental plan benefits:

• Delta Dental Plan benefit summary
• Delta Dental + Orthodontia Plan benefit summary
• Preventive First Dental – Learn more about services that do not count toward your annual maximum
• Passport Dental – Learn how to access dental care when traveling anywhere in the world

Resources

Search for in-network providers

Need to find a new provider or verify if your current provider is in network? Use Find Care, the medical and dental provider search tool. Remember to either enter your subscriber ID or choose your network to ensure you find in-network providers.