2019 EMPLOYER BENEFIT PROGRAM OVERVIEW 2019 Employee Benefit Review - PowerPoint PPT Presentation

2019 EMPLOYER BENEFIT PROGRAM OVERVIEW

2019 Employee Benefit Review • Terminology • Moda Medical Provider Network • Medical Plans – Moda Health • Dental Plans – Standard Insurance • Vision Plan - VSP • Flexible Spending Account - PacificSource Administrators • Rate Information • Questions

TERMINOLOGY Deductible - a fixed dollar amount an insured individual must pay before the insurance company will pay for a covered service Out of Pocket Max- maximum dollar amount an insured will pay on the plan. Once the maximum is reached the insurance company will pay 100% of covered expenses for the remainder of the year Coinsurance - the cost sharing percentage the insured must pay for covered services Copays- a fixed dollar amount that the insured is responsible for paying. For example for an office visit or prescription medication Network- health care providers contracted with the insurance company that have agreed to accept negotiated discount s

MODA HEALTH PLAN S • Expanded provider network • 2 Plan Options Ø Base Plan (Synergy Network) includes Adventist. Legacy, OHSU, Tuality in Portland Metro. Go to modahealth.com for complete list Ø Buy Up Plan (Connexus Network) is one of the largest Preferred Provider Networks in Oregon and includes Providence, Legacy, OHSU, Adventist, Tuality in Portland Metro. Go to modahealth.com for complete list • Go to www.modahealth.com to search for contracted providers. Under Find Care you can search by Network. Select Synergy Network for the Base Plan and Connexus Network for the Buy Up Plan. If you are enrolling in the Base (Synergy Plan) search for Medical Homes under the Synergy Network. You must elect a Medical Home on your enrollment form in order for your election to be processed.

MEDICAL PLAN COMPARISON Plan Options $3000D Moda Synergy (Base Plan) $1500D Moda Connexus (Buy Up Plan) Deductible $3,000 Individual $1,500 Individual $6,000 Family $3,000 Family Coinsurance 20% In Network 20% In Network 40% Out of Network 40% Out of Network Out of Pocket Maximum $5,000 Individual $5,000 Individual $10,000 Family $10,000 Family Preventive Care Covered in Full Covered in Full Primary Care $20 per visit Medical Home PCP $25 per visit $40 per visit non Medical Home PCP Specialty Care $40 per visit $25 per visit Alternative Care $20 per visit/$1,500 maximum $25 per visit/$1,500 maximum Out of Network 40% after Deductible Out of Network 40% after Deductible Routine Lab and X-Ray 20% Coinsurance. Deductible waived 20% Coinsurance. Deductible waived

MEDICAL PLAN COMPARISON Plan Options $3000D Moda Synergy (Base Plan) $1500D Moda Connexus (Buy Up Plan) High T ech Imaging (CT, MRI, PET) 20% Coinsurance after Deductible 20% Coinsurance after Deductible Emergency Room $200 Copay, Deductible waived. $200 Copay, Deductible waived. Physician, Lab and other: 20% after Physician, Lab and other: 20% after Deductible Deductible Urgent Care $20 per visit $25 per visit Inpatient Hospital 20% Coinsurance after Deductible 20% Coinsurance after Deductible Outpatient Hospital 20% Coinsurance after Deductible 20% Coinsurance after Deductible Maternity Services 20% Coinsurance after Deductible 20% Coinsurance after Deductible Outpatient Mental Health $20 per visit $25 per visit Out of Network 40% after Deductible Out of Network 40% after Deductible Inpatient Mental Health 20% Coinsurance after Deductible 20% Coinsurance after Deductible

MODA PHARMACY BENEFIT Participating Retail Pharmacy 30 day supply: Value Medication - $2 Copay Select Medication- $15 Copay Preferred Medication- $45 Copay Brand Medication- $75 Copay Mail Order Pharmacy up to a 90 day supply: Value Medication - $6 Copay Select Medication- $45 Copay Preferred Medication- $135 Copay Brand Medication- $225 Copay Specialty Pharmacy up to a 30 day supply: Preferred Specialty- $225 Copay Specialty: 30% Coinsurance

PHARMACY TIER DEFINITIONS Value Medications- commonly prescribed products used to treat chronic medical conditions • Select Medications- generic medications that represent the most cost effective option from a • therapeutic category. It may include brand medication that has been identified as favorable • Preferred Medications- have been found to be clinically effective at a favorable cost when compared to other medications in the same therapeutic class and/or category (includes Preferred Specialty) • Brand Medications- medications sold under a trademark and protected name • Specialty Medications- used to treat complex chronic conditions such as Hepatitis C, Multiple Sclerosis or Rheumatoid Arthritis • Brand Substitution- Both generic and brand medication are covered. If a member requests, or the treating physician prescribes, when a generic is available, the member will be responsible for the brand cost sharing plus the difference between the generic and brand

myModa Your health. Your benefits. All at your fingertips. Get to know your benefits! myModa, your personalized member website, helps you manage your health plan and find ways to improve and maintain your health. Discover more ways > View account information, such as to better health your contact information > Email a physician, and dependents psychologist, pharmacist, > Download your digital dentist, dietitian or member ID card or fitness expert order a new one > Track healthy living habits > Check the status of using online tools pending claims, view your > Click on Find Care to personal claims history find a physician, dentist, and access claim forms pharmacist or clinic > Check drug prices before you buy > Complete health risk assessments Log in to myModa 24/7 > View the online To sign in to myModa, visit medical library modahealth.com. On the > Access exclusive right-hand side of the member savings home page, type in your username and password Easily see and and click the Go! button. manage your benefits If you don’t have a myModa > View your benefit account, creating one is Questions? eligibility and history easy. You’ll love everything We’re here to help. you can do on myModa, > Receive and view Call us toll-free at like check your benefits, electronic explanation 888-374-8907. TTY use interactive health of benefits (EOBs) users, please call 711. tools, see your Member > Review your prescription Handbook and more. history and check prices ahead of time modahealth.com Health plans in Oregon and Alaska provided by Moda Health Plan, Inc. Dental plans in Oregon provided by Oregon 14298935 (6/16) SS-1103-MED Dental Service, dba Delta Dental Plan of Oregon. Dental plans in Alaska provided by Delta Dental of Alaska.

Care programs Be Better tools Care coordination and Nurse line Respiratory Care program will give advice or information when case management you ask for it, but you will be the one Need quick advice? The friendly As a member of this program, our to decide what you want to work nurses on our Registered When you’re sick, need health coaches will work with you to on and how you will achieve it. Nurse Advice Line are available hospitalization or surgery, or identify your asthma triggers, set 24 hours a day. Just call are seriously injured, we’ll take goals, track your progress and help Spine & joint care program 866-321-7580 for guidance on: some of the work off your plate — provide the support you need to so you can focus on healing. Our You will work with coaches in the > Basic health conditions feel your best and breathe easier. nurse case managers and care areas of spine and joint disorders and symptoms coordinators will help you: Women’s Health & as well as acute and chronic pain > Treatment for minor to learn about spine and joint Maternity Care program > Navigate the injuries and burns anatomy and informed decision healthcare system As an expectant mother enrolled > Home cold and flu remedies making. You will also work with > Communicate and work in this program, you’ll get the > When to visit your doctor your coach to create a plan of with your providers to support and information you modified, joint-sparing activities support your care plan need both during and after your and techniques to use at home pregnancy. You can also talk > Understand your benefits or work. You will be supported one-on-one with a health coach > Arrange medically as you work with your provider about any women’s health topic, necessary, covered services on stretching and strengthening from breast self-exams to prenatal exercises, relaxation techniques, ordered by your provider care, from breastfeeding to diet and weight management, > Connect with community heart attack symptoms. Whether and medication management. resources you are 19, 99 or somewhere in between, a Moda Health coach eDoc is available to talk with you. Email a health professional about Lifestyle coaching program your nonurgent health concerns. eDoc keeps it private and Explore your health and any customized to you. Connect with: lifestyle changes you are > Board-certified physicians considering with a professional health coach, including: > Licensed psychologists > Nutrition � > Pharmacists > Sleep > Dentists > Stress � > Dietitians > Physical activity > Fitness experts Your health coach creates a > eDocVoice — leave a partnership with you to discuss your message for a provider, goals and create a plan of action and you’ll get a phone that feels good to you. Your coach response within 24 hours modahealth.com