Zoomers are assigned to a network based on where you reside (Oregon, Cowlitz and Clark counties in Washington, Seattle, or remote), but can explore networks prior to open enrollment and see which network your current provider is in. Your assigned home network will be on your member identification card.
You will be able to locate in-network providers by visiting Moda Health’s provider search tool, Find Care. This allows you to see the specific providers included in each network tier. This information may help you decide which plan is right for you.
We have developed a highly customized network with Moda Health, which is not their standard network structure. The Connexus and Aetna networks have been modified to align with our ZoomCare strategy. To confirm a provider is in-network, visit your Member Dashboard (after Jan. 1) and search Find Care or call a Moda 360 Health Navigator.
Please note, in 2025 these providers will be in Tier III and are covered at a different benefit level for the PPO and ABHP plans. There is NO coverage for them on the EPO (unless true emergency):
There are some providers in 2025 that are not in Tier II or Tier III, including the Family Care Network, which means there is no coverage for services provided.
Although the above provider groups will be Tier III (out of network) or excluded from coverage for 2025, when searching Find Care, using the links on this site, these providers will be displayed as in-network.
Prior to enrollment, here are links where you can search for providers (noting the exceptions above):
For residents of OR and SW Washington:
Tier I (PeaceHealth and ZoomCare)
This network includes:
PeaceHealth network Directory Link
*Joint ventures include Fresenius Kidney Care Longview, LLC, Mt. Baker Imaging, LLC, RiverBend Ambulatory Surgery Center, Southwest Washington Regional Surgery Center, Oregon Imaging Centers and Emerging Health, LLC
If you need additional help finding a Tier I provider, you can contact the Moda Health Navigators at 833-599-5891.
For Seattle or remote residents and dependents:
Aetna® PPO Network through Aetna Signature Administrators
Important note: While you will have access to the Aetna network, the medical plan is managed by Moda Health.
For Zoomers and dependents (all geographies):
Zoomers in Cowlitz and Clark Counties will access the Connexus Network.
Zoomers in Seattle and all other Washington counties will access the Aetna PPO Network by Aetna Signature Administrators®.
You will access the Aetna® PPO Network by Aetna Signature Administrators®.
Important note: While you will have access to the Aetna network, the medical plan is managed by Moda Health.
We have developed a highly customized network with Moda Health, which is not their standard network structure. The Connexus and Aetna networks have been modified to align with our strategy. To confirm a provider is in network, visit your Member Dashboard (after Jan. 1) and search Find Care or call a Moda Health Navigator.
Please note, in 2025 these providers will be in Tier III and are covered at a different benefit level for the PPO and ABHP plans. There is NO coverage for them on the EPO (unless true emergency):
There are some providers in 2025 that are not in Tier II or Tier III, including Family Care Network, which means there is no coverage for services provided.
Yes, you are covered for urgent and emergency services when you travel through the Aetna PPO Network by Aetna Signature Administrators®.
Note: Traveling for the purpose of receiving medical treatment or benefits is not covered (it’s also known as “medical tourism”).
Yes. In 2025, through your Moda Health medical plan, you have access to the Behavioral Health 360 program.
If you have dependents who live outside your designated network coverage area, please contact a Moda 360 Navigator at 833-599-5891 with their current address. Once their address is documented with Moda Health, your out-of-area dependents will receive in-network benefits when they see a Tier II provider using the Aetna PPO® Network, through Aetna Signature Administrators®.
We have networks and plans to cover all Zoomers. Your network is assigned based on where you live and will be on your Member ID card.
We understand that having your health plan change during the course of certain treatments or during pregnancy can be concerning. To avoid undue medical hardship and risk to you, it may be medically necessary for you to continue treatment for a period of time with your established provider, as we want you to get the care you need. If you are already scheduled for a procedure, in the middle of treatment, or pregnant, you may be eligible to have your claims paid at a higher benefit level for a specific amount of time. Please fill out and submit a Transition of Care Request Form no later than Dec. 15, 2024. If approved, your claims will be paid at the Tier II in-network benefit level for the approved course of treatment. We also have a checklist to help make your transition as easy as possible.
Yes. You can enroll in IDX identity protection at no extra cost and keep your financial and medical information safe. As of Jan. 1, 2025, you can access and enroll in this program in your Member Dashboard. Be sure to have your Member ID card with you, prior to enrolling.
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Health plans in Oregon and Alaska provided by Moda Health Plan, Inc.
This site is meant to help you learn about plans and healthcare for you and your family. This site is subject to change in order to comply with state and federal law, including the Affordable Care Act (ACA) and related regulations, and connectivity with the federal Marketplace. If questions regarding benefits arise, the summary of benefits and coverage document is the master resource.