OEBB 2019-20 Insurance Committee Webinar Moda Health Agenda - PowerPoint PPT Presentation

OEBB 2019-20 Insurance Committee Webinar Moda Health

Agenda • Medical & Pharmacy • Overview of network & plan options Benefit changes • • PCP 360 • Vision • Overview of plan options • Dental • Overview of networks & plan options • Member Resources

Medical and Pharmacy Moda Health

Plans and network options • All OEBB plans will use the large Connexus network − Service area is statewide − Coordinated and non-coordinated-care options − Medical Plans 1-7 • Retirees & COBRA members living outside of the Connexus service area use the Moda’s rental networks: − First Choice Health Network (FCH) for residents in Washington (excluding southwest Washington) − Health InfoNet (HIN) for residents in Montana − Endeavor Providence for residents of Alaska − The Private HealthCare Systems (PHCS) is avaliable to residents of all other states. − To find in-network providers – members will want to contact Moda Medical Customer Service

How to participate in coordinated care Members must choose a PCP 360 with Moda to participate in • coordinated care and receive enhanced benefits.  A PCP 360 is a high quality provider who is willing to be held accountable for the member’s health.  Each individual covered on the plan can choose whether to participate in coordinated care and choose their own PCP 360. • Members who are participating in coordinated care will need to utilize their chosen PCP 360 for all of their primary care services. • Members can choose a PCP 360 at any time during the year.  Enhanced benefits will become effective the first of the month. • The premium remains the same, whether the member participates in coordinated care or not. Only the individual’s benefit changes. No referrals are required. • Members residing outside of the Connexus service are only eligible • for the non-coordinated benefit level.

New Moda medical plans! Deductible Out of pocket Primary care Specialist Care Urgent Care Medical Plan Non- Non- Non- Non- Non- Coordinated Coordinated Coordinated Coordinated Coordinated Coordinated Coordinated Coordinated Coordinated Coordinated Plan 1 2 $20 1 $40 1 $40 1 $400 $500 $2,850 $3,250 20% 20% 20% Plan 2 2 $20 1 $40 1 $40 1 $800 $900 $3,850 $4,250 20% 20% 20% Plan 3 2 $25 1 $50 1 $50 1 $1200 $1300 $4,850 $5,250 25% 25% 25% Plan 4 2 $25 1 $50 1 $50 1 $1600 $1700 $6,700 $7,100 25% 25% 25% Plan 5 2 $30 1,6 $50 1 $50 1 $2000 $2100 $6,800 $7,200 25% 25% 25% Plan 6 2 $6,400 2 $6,750 2 $1600 2 $1700 2 15% 20% 15% 20% 15% 20% HSA Optional Plan 7 2 $6,500 2 $6,750 2 $2000 2 $2100 2 20% 25% 20% 25% 20% 25% HSA Optional 1 Deductible waived. 2 If enrolled in a Moda medical plan, each covered individual must choose a PCP 360 with Moda for that individual to receive the enhanced “coordinated” benefit under that plan when using a provider in the Connexus network. If an individual has not chosen a PCP 360 with Moda, they will receive the “non-coordinated” benefit shown in the right column if using a provider in the Connexus network. Any services by a provider outside the Connexus network will be paid at the “out-of-network” level regardless of whether the individual has chosen a PCP 360 with Moda or not.

How to choose a PCP 360 • Members can choose their PCP 360 in one of two ways: • Online – log into MyModa Call Moda Customer Service: 866-923-0409 • • Members can choose their PCP 360 beginning in September. • Members who choose their PCP 360 by October 25 th will be receive the coordinated care enhanced benefit effective 10/1/19. • Members who choose their PCP 360 at any other point during the year will begin receiving the coordinated care enhanced benefit the first of the month the date they choose their PCP 360 with Moda.

Other benefit changes • NEW : Moda is adding coverage for infertility services, including:  Diagnosis and surgical treatment of underlying causes of infertility  Ovulation induction and intrauterine insemination This benefit will be available on all Moda medical plans 1 through 7 starting October 1, 2019.

Pharmacy benefits Medical Plans 1-5 Medical Plans 6-7 Out-of-pocket maximum Accrues towards maximum cost share Accrues towards out of pocket max Coordinated care Non-Coordinated care $4 * per 31-day supply $4 * per 31-day supply Value $4 per 31-day supply Select generic $12 per 31-day supply 20% 25% Preferred Brand 25% up to $75 per 31-day supply 20% 25% Non-preferred brand ** 50% up to $175 per 31-day supply 20% 25% Mail $8 * per 90-day supply $8 * per 90-day supply Value $8 per 90-day supply Select generic $24 per 90-day supply 20% 25% Preferred Brand 25% up to $150 per 90-day supply 20% 25% Non-preferred brand ** 50% up to $450 per 90-day supply 20% 25% Specialty Preferred brand 25% up to $200 per 31-day supply 20% 25% Non-preferred brand ** 50% up to $500 per 31-day supply 20% 25% * Deductible waived. ** A formulary exception must be approved for non-preferred brand prescription medication.

Virtual Visits • Virtual Visits  Virtual Visits connects the member with a licensed Oregon Health & Science University (OHSU) doctor, physician assistant or nurse practitioner via their computer or mobile device.  Members can get urgent care from their home. • Use Virtual Visits for:  A cold, sore throat, stuffy nose, cough, the flu, congestion and nausea  Allergy, poison ivy or oak  Bites, stings and more • Virtual Visit benefit is a $10 copay, not subject to the deductible on Medical plans 1-5. On plans 6 and 7, benefit is a $10 copay after the deductible has been met.  The Virtual Visit benefit is the same for both coordinated and non- coordinated care.

Vision Moda Health

Vision plan options – no changes! Vision Plan Options Opal Pearl Quartz Benefit Maximum $600 $400 $250 What members pay Eye examinations 0% Frequency: Once per plan year Lenses Frequency: Contacts or one pair of lenses 0% per plan year Frames Frequency: One pair per plan year for members under age 17; One pair per every two plan years for members age 17 0% and older

Vision – key things to remember • Members may see any licensed ophthalmologist, optometrist, or optician • Benefits run on a plan year basis (October 1 – September 30) • Benefit maximum includes exam and hardware

OEBB Dental Delta Dental 14

Overview of plan options • No plan changes! • We continue to offer Plans 1, 5, 6, and Exclusive PPO • Exclusive PPO plan − $1,500 constant plan − Uses Delta Dental PPO Network − No out-of-network benefits; members must use a PPO provider on this plan 15

Dental plan options Plan Options Plan 1 Plan 5 Plan 6 Exclusive PPO Network Delta Dental Premier Delta Dental PPO Deductible $50 $50 $50 $50 Benefit Maximum $2,200 $1,700 $1,200 $1,500 In-network, members pay Preventive/diagnostic 30% - 0% 30% - 0% 0% 0% Restorative 30% - 0% 30% - 0% 20% 10% Major Restorative - Crowns/onlays 30% - 0% 30% 50% 20% Prosthodontic 30% - 0% 50% 50% 20% -Implants 30% – 0% 50% 50% 20% Orthodontic 20% 20% N/A 20% (Lifetime maximum - $1,800) Occlusal guards 50% 50% 50% 50% (night guards* and athletic mouth guards) Nitrous Oxide 50% 50% 50% 50% *$250 maximum, once every 5 years. 16

Delta Dental highlights • Delta Dental Premier Network is the largest dental network in Oregon and nationwide − Over 2,400 providers in Oregon & over 156,000 providers nationwide • Last year, we added a Delta Dental PPO Network plan option − Over 1,300 providers in Oregon and over 108,000 providers nationwide − The Exclusive PPO plan uses this network option • Evidence-based approach to dentistry with a focus on preventive care • Health through Oral Wellness 17

Member Resources Moda Health

www.modahealth.com/oebb Want to learn more about health coaching? Looking for a Choosing your PCP 360? PCP 360? You’ll need to login to your myModa and follow the instructions.

Find Care • Search for providers in your network • Medical – Connexus Dental – Delta Dental Premier or Delta Dental PPO • Thinking about the Exclusive PPO plan for dental? Use Find Care to search for providers

Customer Service Available Monday through Friday, 7:30 a.m. to 5:30 p.m. • Medical/Vision − 866.923.0409 • Pharmacy − 866.923.0411 • Dental − 866.923.0410 Or email the Moda account management team at OEBB_Marketing@modahealth.com