Your medical plan options

During open enrollment, you’ll choose one of the available plans that meets your preferences and needs. Each is supported by our tiered network approach. We want you to choose the plan that works best for you. Here are some helpful tips to guide you.

EPO: The Exclusive Provider Organization

The EPO plan may be right for you if:

You want to pay lower monthly premiums.
You want flexibility in choosing providers with the lowest out-of-pocket costs (copay and coinsurance) when you visit a provider in the PeaceHealth and ZoomCare Network (Tier I).
Most of your care comes from Tier I providers (including ZoomCare, PeaceHealth, CIN community providers and Joint Ventures).
You live near Tier I providers.
You do not use any out-of-network providers.

PPO: The Preferred Provider Organization

The PPO plan may be right for you if:

You don’t mind paying more in premiums for increased flexibility in choosing providers.
You seek care from both Tier I and Tier II providers but want to pay lower out-of-pocket costs when seeing Tier II providers than under the EPO.
You want coverage when going out-of-network for some care.

ABHP: The Account-Based Health Plan

The ABHP plan may be right for you if:

You want to pay less each month for your plan.
You want flexibility in choosing providers and seek care from both Tier I and Tier II providers but don’t mind paying higher deductibles and out-of-pocket costs.
You would like to contribute money into a health savings account (HSA), in addition to the contributions made by ZoomCare. An HSA helps you save pre-tax dollars for your healthcare expenses (deductibles, coinsurance and prescription drugs) and lowers your taxable income. Note: if you or your family members have chronic or high-cost conditions this plan may not be right for you. While preventive care is covered at 100%, all other services require that you meet the higher deductible. If you have family members enrolled, the family deductible must be met before the plan begins to provide benefits for any family member.

A man on the phone with an inhaler for chronic illness

Choosing the right plan when you have a chronic condition

Moda Health is happy to support the enhanced chronic condition (ECC) program in all three plan options. When you enroll in this program, you will have a $0 cost share for certain medications and diabetic supplies, personalized guidance from health coaches and case managers, and medication support for the following conditions:

Asthma
Chronic obstructive pulmonary disease (COPD)
Depression
Diabetes
Heart Disease
Heart Failure
High blood pressure

The ECC program will have 4 tiers that participating Zoomers will be placed into based on their current health and risk. Zoomers must complete the requirements of each teir to receive the ECC benefit.

High acuity tier requires regular one-on-one engagement with a case manager
Moderate and Low acuity tier requires regular one-on-one engagement with a health coach
Maintenance tier requires you to complete an annual wellness visit and remain adherent to your prescribed medications (you’ll need to take your prescribed medications at least 80% of the time)

Zoomers or dependents with a new qualifying diagnosis can be enrolled in the ECC program by contacting the Health Navigator team at 833-599-5891. If after 9 months, Moda does not have claims that validate the diagnosis, members will be removed from the benefit.

A few important notes:

Prescriptions must be filled at the following eligible pharmacies*:
- PeaceHealth RiverBend Outpatient Pharmacy (this is the mail-order pharmacy for Zoomers who reside in Oregon and Washington)
- PeaceHealth Southwest Medical Center Outpatient Pharmacy
- PeaceHealth St. John Medical Center Outpatient Pharmacy
You must meet participation requirements.
All pediatric dependents are automatically enrolled in the program once identified with qualifying conditions of asthma, diabetes, or depression.

*Exceptions made only for Caregivers/dependents living outside of Alaska, Oregon, and Washington

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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.