Moda Health & Delta Dental Plan of Oregon
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Moda Health & Delta Dental Plan of Oregon
Moda Health
2022 Plan Year Changes
Medicare Supplement Plan – Medicare Prescription Drug Plan
• The Prescription Drug out-of-pocket maximum per person
per calendar year is $7,050
• Routine hearing exams are covered in full, no cost-sharing
• Hearing aid hardware options include $399/$699 models. Up to two hearing
aids per calendar year, one per ear
• TruHearing has made the following changes:
• Additional copay for rechargeable hearing aids has been removed;
no cost-sharing
• Hearing aid trial period has increased to 60 days
• Batteries per aid have increased to 80 for non-rechargeable models
• Follow-up visits are unlimited for one full year
• Vision hardware allowance has increased to $200 every 2 calendar years for
lenses, frames and/or contacts
• The 24-hour Nurse line phone number has changed
Moda Health and Delta Dental of Oregon Enrollment Service Area
The Value of Moda Health and
the PHIP Partnership
• Enhanced Medicare Part D prescription coverage
• Patient-centered dental plan — Delta Dental of Oregon
• Moda Health Medicare Supplement plan
– Offering this plan to PERS members for nearly 30 years
• Covers Part B excess charges
Moda Health
How Our Plan Works
Nationwide Coverage
• Members can live anywhere in the U.S. and receive care at
any Medicare provider or hospital
Doctor/Facility Bills Original Medicare
• Original Medicare bills remaining balance to Moda Health
Moda Health
How Our Plan Works
• Part A: Moda pays the member responsibility for Medicare covered services
• Part B: Member pays nothing after Part B deductible is met for
Medicare covered services
• Medicare pays 80%, Moda pays 20% for Medicare covered services
Moda Health Medicare Supplement
Benefit Coverage Member Responsibility
Part B deductible $203 per individual*
Medical out-of-pocket maximum N/A
Primary care office visit
Specialist office visit
Inpatient hospitalization
Covered in full*
Outpatient surgery
Lab tests
X-ray
Tier 1 – Up to an $8 copay
Tier 2 – Up to a $15 copay
Tier 3 - 40% to $250 max per script
Pharmacy (per 31-day supply)
Tier 4 - 40% to $250 max per script
Tier 5 - 40% to $250 max per script
Tier 6 - $0 copay
Pharmacy out-of-pocket maximum $7,050 per individual
*Must meet Part B deductible, as required by Medicare, listing is for 2021 (as 2022 is not available at this time).
Moda Health Medicare Supplement
Emergency and Travel Benefits
Service Member Pays:
Urgent care
Emergency room Covered in full* anywhere in U.S.
Ambulance — ground or air
Covers urgent care, ER and ambulance
at 80% coinsurance. The member will
Outside of the United States pay 20% coinsurance.
Coverage limited to $50,000 per member
(lifetime)
*Must meet Part B deductible, as required by Medicare.
Moda Health
Formulary and Participating Pharmacies
• A comprehensive list of covered medications is available online at:
modahealth.com/pers
• Local pharmacy customer service hours 7 a.m. – 8 p.m., Monday through Friday
Over 63,000 participating pharmacies* Mail order pharmacies*
Bi-Mart Rite Aid Costco
Costco Safeway Postal Prescription Services
CVS Pharmacy Walgreens Kroger Columbus Central Fill
Fred Meyer/Kroger/QFC Walmart Novixus Pharmacy Services
*Not all contracted network pharmacies are listed. Pharmacies contracted with Moda may change at any time.
Moda Health will notify you if your pharmacy is no longer included in the network. Contact Moda Health
pharmacy customer service for more details.Moda Health
Special Attributes
Personal Assistance
• Nurse care coordination
• Medical case management
• Health coaching programs
Phone Resources
• Local customer service;
based in Portland and Bend, Oregon
• Customer service hours are
7:30 a.m. – 5:30 p.m.,
Monday through Friday
Online Resources
• Dedicated PERS website at
modahealth.com/pers
• Member handbooks
• Member Dashboard
• Explanation of Benefits (EOBs)Moda Health
Special Attributes
Assist America®
• Global emergency assistance program available
when 100 or more miles away from home
ChooseHealthy® Program
• Discounts on:
• Massage therapy
• Chiropractic
• Acupuncture
THESE ADDITIONAL SERVICES ARE NOT INSURANCE.Moda Health
Extra Benefits
VSP Benefit Using VSP Advantage Network Providers*
• Covered routine eye exam after $15 eye exam copay
• One routine eye exam per calendar year
Coverage Also Includes the Following Every Other Calendar Year:
• $200 allowance towards (20% discount applied prior to
allowance for prescription glasses coverage):
• Lenses
• Lens enhancements
• Frames
Or
• $200 allowance towards contact lens exam
(fitting & evaluation) and contacts
• (15% discount off contact lens exam)
*Out of network benefits available. Contact VSP for additional details.Moda Health
Extra Benefits
TruHearing™ Benefit
• $0 hearing exam copay
• $399 for Advanced or $699 for Premium hearing aid options
• One routine hearing exam per calendar year
Coverage Also Includes:
• 2 hearing aids allowed per calendar year, one per ear
• Follow-up visits are unlimited for one full year after purchase
• Local, professional care from an accredited provider in your area
• A worry-free purchase with a 60-day trial and 3-year warranty
• 80 batteries per hearing aid included with non-rechargeable models
• Premium rechargeable hearing aid options available at no additional cost
All content ©2021 TruHearing, Inc. All Rights Reserved. TruHearing® is a registered trademark of TruHearing, Inc.
All other trademarks, product names, and company names are the property of their respective owners.Member Care Resources on Member Dashboard
24 hour Registered Nurse Advice Line
• Available 24 hours a day, 7 days a week
Prescription price check tool
• View prescription history and drug
information
ID card
• View, email or order your ID card from a
mobile phone or computerHealthy Aging & Exercise Program
Your Silver&Fit® Membership includes:
• Membership at a participating fitness center, two Home DVD Fitness Program Kits and
one Stay Fit Kit per year
• Healthy Aging resources such as lifestyle coaching, online classes and streaming
exercise videos via the Silver&Fit website or ASHConnectTM Mobile App
• Fit at Home™ on Facebook with Daily Live Classes at www.facebook.com/silverandfit
• For more information and locations visit silverandfit.comDelta Dental Plan Delta Dental Plan of Oregon of Oregon
Delta Dental of Oregon 2022 Plan Changes Dental • Benefit maximum has increased to $1,750
Delta Dental of Oregon Enrollment Service Area
Delta Dental of Oregon
How Our Plan Works
Who are we?
• We started providing dental
coverage in 1955 as ODS
What can you expect?
• Flexibility
• 4 out of 5 of the nation’s
dentists participate in our
Premier and PPO networks
• Savings on dental procedures
• No balance billingDelta Dental of Oregon
Service Member Pays:
Calendar year deductible $25
Calendar year benefit maximum $1,750
Preventive* 100%
Basic Services 80%
Major services 50%
* Deductible waived for preventive services. Preventive charges do not accumulate to the calendar year benefit maximum.Delta Dental of Oregon
Additional Benefits
• Health through Oral Wellness®
• Based on risk assessment results, members may qualify for enhanced
dental benefits such as additional cleanings or fluoride treatments
• Oral Health, Total Health program
• Additional cleanings available for members with diabetes
• Periodontal maintenance cleanings
• Additional cleanings available for members with periodontal disease
Call our dental customer service team to learn more about these additional benefits.Delta Dental of Oregon Access to the Delta Dental Premier and PPO National Networks • More than 154,000 participating providers nationwide • Passport Dental program — worldwide dental care
Thank You
PERS Health Insurance Program
Toll-free: (800) 768-7377
Local: (503) 224-7377
pershealth.com
Moda Health
Toll-free: (800) 962-1533
Pharmacy Toll-free: (888) 786-7509
modahealth.com/pers
Delta Dental of Oregon
Toll-free: (844) 827-7379
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