oebb 2017-18 open enrollment: medical and pharmacy€¦ · • medical & pharmacy • overview...
TRANSCRIPT
• Medical & Pharmacy• Overview of networks & plan options • Benefit changes
• Member Resources• myModa• Find Care• The Well• Customer Service
Agenda
• Preferred Provider Organization (PPO) plans− Connexus Network
◦ Retirees & COBRA members living outside of Connexus service area use Moda’s rental networks
− Service area is statewide− Birch, Cedar, Dogwood, and Evergreen plans
• Coordinated Care Model (CCM) plans− Synergy or Summit Network− Service areas based on counties
◦ Synergy Network available in western & central Oregon◦ Summit Network available in eastern Oregon
− Alder, Birch, Cedar, Dogwood, and Evergreen plans
Plan types and network options
Medical plan lineup – no changes!
Medical Plan Deductible Out-of-Pocket Max Cost Share
In-Network Out-of-Network In-Network Out-of-
Network In-Network Out-of-Network
AlderCCM only
$400 $800 $3,000 $6,000 $6,850 NA
Birch CCM & PPO
$800 $1,600 $4,000 $8,000 $6,850 NA
CedarCCM & PPO
$1,200 $2,400 $5,000 $10,000 $6,850 NA
DogwoodCCM & PPO
$1,600 $3,200 $6,850 $13,700 $6,850 NA
Evergreen (HSA)CCM & PPO $1,600 $3,200 $6,550 $13,100 N/A NA
*This table reflects in-network deductibles and out-of-pocket limits
CCM plan options (Synergy & Summit Networks)
Medical Plan Deductible Out-of-pocket Medical home
Incentive careMedical home primary care
Specialist care
Urgent care
Alder $400 $3,000 $10* $20* 20% $50*
Birch $800 $4,000 $15* $30* 20% $50*
Cedar $1,200 $5,000 $15* $30* 20% $50*
Dogwood $1,600 $6,850 $15* $30* 20% $50*
Evergreen (HSA) $1,600 $6,550 20% 20% 20% 20%
PPO plan options (Connexus Network)
Medical Plan Deductible Out-of-
pocketIncentive care Primary care Specialist
careUrgent
careMH Non-MH MH Non-MH
Birch $800 $4,000 $15* 20%* $30* 20% 20% $50*
Cedar $1,200 $5,000 $15* 20%* $30* 20% 20% $50*
Dogwood $1,600 $6,850 $15* 20%* $30* 20% 20% $50*
Evergreen (HSA) $1,600 $6,550 20% 20% 20% 20% 20% 20%
*Deductible waived
Pharmacy benefits – no changes!Alder, Birch, Cedar & Dogwood
CCM PlansBirch, Cedar & Dogwood
PPO Plans
Out-of-pocket maximum Accrues towards medical OOP limit Accrues towards Max Cost Share
Retail (31-day supply)
Value $0 $4
Select Generic $8 $12
Preferred brand 25% up to $50 25% up to $75
Non-preferred brand 50% up to $150 50% up to $175
Mail (90-day supply)
Value $0 $8
Select Generic $16 $24
Preferred brand 25% up to $100 25% up to $150
Non-preferred brand 50% up to $300 50% up to $450
Specialty (31-day supply)
Preferred 25% up to $100 25% up to $200
Non-preferred 50% up to $300 50% up to $500
Evergreen CCM Evergreen PPO
Deductible (medical and Rx) $1,600/$3,200
Out-of-Pocket Maximum $6,550/$13,100
Value tier*
Retail (31-day supply) $0 $4
Mail (90-day supply) $0 $8
Major Medical Prescription Coverage
20%(subject to deductible)
Pharmacy benefits – no changes!
* Deductible waived on value tier medications
• Bariatric surgery (gastric sleeve and Roux-en-Y) coverage extended to spouse/partners and dependents age 18 and over
• New methodology for Maximum Plan Allowance− Applicable to out-of-network providers only− Communications to impacted members sent out first week of August
• Some medications may be limited to select home infusion providers and/or provider office infusion only− Communications to impacted members and providers beginning in
August
• CCM Synergy plans available to Coos and Curry counties
Benefit changes
OEBB dedicated website
www.modahealth.com/oebb
Need to access your myModa account?
Looking for a provider?
Want to review upcoming plan year materials?
• See your benefits & member handbook
• Check claims and review electronic explanations of benefits (EOBs)
• Connect with health professionals on the phone or online
• Download your member ID card
• Access Moda health tools− Momentum (go here to take your health assessment!)− Health coaching− Prescription Price Check− Healthcare Cost Estimator
myModa – your online member portal
• Search for contracted providers in your available plan options• PPO plans = Connexus Network• CCM plans = Synergy or Summit Network
Find Care – Moda’s online provider directory
• Medical/Vision−866.923.0409
• Pharmacy−866.923.0411
• Dental−866.923.0410
Or email the customer service teams by using [email protected]
Customer Service