Employer-sponsored plans
Medical plan options
With our plans, your clients will enjoy affordable, quality care whenever they need it. Plans vary by premiums, deductibles, copays and coinsurance. If you are looking for coverage for a client with 25 or more employees, see our innovative Equal Funding option.
PPO plans
We offer a wide selection of preferred provider organization (PPO) plans to meet your client’s specific needs. Our PPO 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, a greater selection of doctors and broader geographic coverage when visiting a PPO-contracted provider.
EPO plans
Exclusive provider organization (EPO) plans offer personalized care experience that helps your clients find get better care, and better value. Note that there are no out-of-network benefits with EPO plans except for medical emergency services and retail pharmacy services.
High-deductible health plans (HDHP) option
These plans 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. Members with this plan option can choose a financial institution that offers HSA accounts to get the tax advantages.
Medical networks
Moda Select Network
The Moda Select Network is a contracted network focused on Value Based Care (VBC). With VBC, providers and hospitals are paid based on patient health outcomes. Serving Hays, Travis and Williamson counties in the greater Austin area, the Moda Select Network directs members to manage their health in close partnership with a primary care provider (PCP) and receive high-quality care at affordable costs. The network includes a carefully selected community of PCPs, specialists and partner health systems.
American Specialty Healthcare Group (ASHG)
For more than 30 years, ASHG has been providing musculoskeletal provider network services to employer groups throughout the country. ASHG will be the network members within the state of Texas use to find outpatient providers of occupational, speech, physical and massage therapy. They will also use it to meet any alternative care needs such as chiropractic and acupuncture.
First Health network
First Health Network is the network for employer-based members who reside outside of the Moda Select Network service area but in-service area members may use First Health to receive emergency or urgent care when traveling*.
Search for providers in the First Health network
*Traveling for the purpose of seeking care does not qualify for the travel network benefit.
Pharmacy benefits
Quality pharmacy benefits through medication tiers
All Moda Health medical plans come with an option of pharmacy plans. These benefits connect members with our Preferred Drug Program, a way to save money on safe and effective prescription medications. Through the program, plans cover prescriptions by these medication tiers: value, select, preferred, non-preferred, preferred specialty and non-preferred specialty. Each tier has a copay or coinsurance amount set by the plan. Easily check to see what medications are covered for your clients. View our formulary by tier and coverage level. (large group)
Pharmacy Network
Members have access to comprehensive prescription drug benefits through the Navitus pharmacy network. The Navitus network includes more than 65,000 pharmacies nationwide. This means they can fill prescriptions almost anywhere, including local and national drug store chains. Find in-network pharmacies.
Additional services
Third-party administrative services via BenefitHelp Solutions
BenefitHelp Solutions, a Moda Health subsidiary, provides third-party administrative services, sorting through the ever-changing laws, regulations, intricate policies and guidelines of benefits management. They offer comprehensive support that includes:
- Administration of flexible spending accounts, commuter expense reimbursement accounts and health reimbursement arrangements
- Online access to account balances, claims status, payment details and claims submission
- AutoPay enhancement for direct claim submission
- Full-service COBRA administration
- Premium administration, including retiree and other group premiums
To learn more about how BenefitHelp Solutions can help you, visit the BenefitHelp Solutions website, or call 888-387-5440.
Wellbeing services
Empower your client's employees to be better in every way with Moda Wellbeing — a comprehensive collection of innovative services, programs, and tools. Learn more about Moda Wellbeing.
Vision coverage through VSP
Regular eye exams help prevent common eye diseases and help your client’s employees keep their vision strong. 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.
Funding options
View funding options including our innovative equal funding option for employer-sponsored plans
Get a quote
See our Quote Checklist to help prepare a custom quote.
Or log in to Rate Finder to generate an Equal Funding quote for groups 25-99.