Everything you need to use your plan is at your fingertips.
10 day right to examine
We encourage you to explore every aspect of your plan. If, for any reason, you’re not satisfied with this policy, you can cancel it within ten days of the date you received your policy, regardless of when your policy goes into effect. You can cancel your policy by calling Customer Service, or the agent through whom it was purchased. If you decide to cancel your policy within the 10-day right to examine, any premiums paid will be refunded, minus the non-refundable $20 application fee.
Get started with your Member Dashboard
Member Dashboard is a personalized website that helps you manage your benefits.
As a member just log in to ModaHealth.com/memberdashboard to:
- See your outline of coverage and policy
- Download your member ID card
- Check claims and find claim forms
- Review electronic explanations of benefits (EOBs)
- And more
If you are a member and do not have a Member Dashboard account, you can sign up for one.
How to file a claim
Submission of Claims - All claims are subject to deductible and coinsurance. In no event, except absence of legal capacity, is a claim valid if submitted later than 12 months from the date the expense was incurred.
Hospital and professional provider claims – When you are hospitalized or visit a provider you must present your identification member ID card to the admitting or treating office. In most cases, the hospital or provider will submit the claim directly to Moda Health for the services. The provider will then bill you for any charges that were not covered.
Sometimes a hospital or provider will require you, at the time of discharge or treatment, to pay charges for a service that may not be a covered expense. If this happens, you must pay these amounts if you wish to accept the service. We will reimburse you if any of the charges paid are later determined to be covered by your policy, subject to your deductible and coinsurance.
When you are billed by the hospital or provider directly, you should send a copy of the bill to us with the medical claim form.
If the treatment is for an accidental injury, a statement explaining the date, time, place, and circumstances of the accident must be included with the bill.
Ambulance claims – Bills for ambulance service must show where you were picked up and taken, as well as the date of service and your name and identification number.
Out of country or foreign claims – Out-of-country care is only covered for specified conditions. When care is received outside the United States, you must provide all of the following information to us:
a. Patient’s name, subscriber’s name, and identification number
b. Statement explaining where the member was and why he or she sought care
c. Copy of the medical record (translated is preferred if available)
d. Itemized bill for each date of service
e. Proof of payment in the form of a credit card/bank statement or cancelled check
Outpatient prescription medication option (only for plans that include this feature) – When you fill an outpatient prescription medication you will need to submit a request for reimbursement if your pharmacy requires payment upfront by:
a. Completing a prescription medication claim form
b. Including an itemized prescription receipt
How to add or remove a dependent
Under certain circumstances, for example adoption, the birth of a child, divorce, or death, you may need to add or remove a dependent from your Short Term Medical policy. Adding or removing a dependent may change your rates and a new ID card will be issued. To add or remove a dependent, please call Customer Service.
My policy is ending. What are my options?
After your 30-185 day plan expires, you may apply for a second policy within a 12 month period. There is no continuous coverage between policies, and you may only have two short term medical plans within a 12 month period.
Important note: Any condition which may have existed or occurred under one policy will be a pre-existing condition under a new policy, should you apply later, and therefore, will not be covered under that new policy.
You may have other options available to you.