Understanding your health plan documents
Health insurance comes with some common tools and materials that can be confusing or include terms that you’re not familiar with. Take a deeper look at what you’ll find on your member ID card and your explanation of benefits (EOB). And if you have any questions, reach out to our Customer Service team. We’re always happy to explain your plan documents.
Your member ID card
The Moda Health member ID card is your key to using your benefits. Whether you’re using a physical card, or you’re accessing a digital card on your phone, you can be ready to show it to your provider whenever you go in for care. You can also email a copy to your provider. Log into your Member Dashboard to view your member ID card now.
What to look for on your card
Each card is a little different. Your card includes your unique member ID number, the names of those covered under the plan, and which provider network you are on. If your insurance is through an employer, the card might also have the employer’s logo.
For your providers, the card includes the health plan’s group number (for filing claims) along with a phone number they can call if they have any questions.
A. Networks
This is the name of your provider network. By choosing providers, hospitals and clinics in this network, you’ll pay less for your care. When you search for care, select this network name to find in-network providers.
B. Subscriber / Dependent(s)
Subscriber is the primary account holder, or policyholder, of your plan. Dependents are family or other eligible members insured under your plan.
C. ID number
Your unique plan ID number that identifies you and your account.
D. Contact us
Customer service phone numbers for your plan.
E. Mobile PIN code
Use this code to access your mobile ID card. To access your mobile ID card, search for “Moda Health ecard” in your app store and enter your Subscriber ID, Group ID and mobile PIN code.
F. Plan deductibles and out-of-pocket maximums
Deductibles are the amounts you’ll pay before your plan starts covering costs. Out-of-pocket maximums are the most you’ll pay in any plan year before insurance covers the rest. If more than one person is covered in your plan, the amounts are listed separately for subscribers and dependents.
G. Group number
The ID number that identifies your specific health plan. It helps your providers, pharmacies and insurance company process claims correctly.
Take a look at your member ID card by logging into your Member Dashboard.
Your explanation of benefits (EOB)
An EOB shows how your plan has processed a claim for your recent care. It lists healthcare claims, what your plan paid and other important information. It’s not a bill, and because it’s sent at a particular time each month, it may not include all the amounts if your provider(s) haven’t submitted all their charges. Think of an EOB as a preview of how your benefits are covering what has been charged by your providers so far. It’s a great way to plan and budget for any upcoming invoices from your providers.
Review your latest EOB by logging in to your Member Dashboard.
Sample EOB
A. Amount billed
What your provider charged for a service.
B. Provider discount and amount not covered
This includes negotiated discounts and amounts not covered by your plan. Providers who are not in your plan’s network may charge this amount to you.
C. Amount covered
The amount that is left after provider discounts, deductibles and non-covered charges have been accounted for. Benefits are applied to this amount.
D.) Medical plan paid
How much Moda Health paid for this service.
E. Reason code(s)
More information about costs that may not be covered under your plan.
F. Member responsibility
This is how much you may need to pay your provider.
G. Not covered
How much you may owe your provider for non-covered charges.
H. Deductible
What you pay for covered services before your plan starts to pay.
I. Copay
The fixed amount you pay for a covered service.
J. Coinsurance
A percentage of how much a covered service costs after you have paid your deductible.