Medical plans fit for your group

There's a lot to think about when choosing medical benefits for your team. That's why we've made it easy to compare the details. This section highlights our current plan options.

2018 small group plan summaries

Our small group medical plans are designed to help your team members be their healthy best. Read more by downloading our full 2016 small group brochure:

Summaries of Benefits

View comparison chart of all 2018 small group medical plans

Plan Tier Plan Type 2018 Oregon small group plans (1-50) In-network benefit (per person)
Deductible Out-of-pocket max PCP office visit copay/coinsurance PDF
Platinum
1-Platinum PPO Connexus Platinum 250 $250 $2,000 $10/visit
1-Platinum PPO Synergy Platinum 250 $250 $2,000 $10/visit
1-Platinum PPO Summit Platinum 250 $250 $2,000 $10/visit
1-Platinum PPO Connexus Platinum 500 $500 $1,750 $10/visit
1-Platinum PPO Synergy Platinum 500 $500 $1,750 $10/visit
1-Platinum PPO Summit Platinum 500 $500 $1,750 $10/visit
Gold Plans
2-Gold PPO Connexus Gold 500 $500 $7,000 $20/visit
2-Gold PPO Connexus Gold 1000A $1,000 $7,000 $20/visit
2-Gold PPO Synergy Gold 1000A $1,000 $7,000 $20/visit
2-Gold PPO Summit Gold 1000A $1,000 $7,000 $20/visit
2-Gold PPO Connexus Gold 1000B $1,000 $7,000 $20/visit
2-Gold PPO Connexus Gold 1500 $1,500 $7,000 $20/visit
2-Gold Standard Moda Health Oregon Standard Gold $1,000 $6,850 $20/visit
Silver Plans
3-Silver Value Connexus Silver 2000 $2,000 $7,350 $35/visit
3-Silver Value Connexus Silver 2500 $2,500 $7,350 $35/visit
3-Silver Value Connexus Silver 3000 $3,000 $7,350 $35/visit
3-Silver Value Connexus Silver 4000 $4,000 $7,350 $35/visit
3-Silver Value Connexus Silver 5000 $5,000 $7,350 $35/visit
3-Silver HDHP Connexus Silver HDHP 2700 $2,700 $6,000 30% after deductible
3-Silver Exclusive Synergy Silver 2000 $2,000 $7,350 $35/visit
3-Silver Exclusive Summit Silver 2000 $2,000 $7,350 $35/visit
3-Silver Standard Moda Health Oregon Standard Silver $2,500 $7,350 $40/visit
Bronze Plans
4-Bronze Basic Connexus Bronze 5500 $5,500 $7,350 $40/visit
4-Bronze Basic Connexus Bronze 7350 $7,350 $7,350 $60/visit
4-Bronze HDHP Connexus Bronze HDHP 5000 $5,000 $6,650 50% after deductible
4-Bronze Standard Moda Health Oregon Standard Bronze HSA Plan $6,550 $6,550 0% after deductible

What plans include

Moda Health medical plans offer a bounty of great benefits. Here's what members can expect:

  • Choice: Quality provider networks that give members the freedom to choose the best doctor for them
  • Coverage: Comprehensive plans that protect members' well-being and connect them with preventive, specialty and pharmacy services
  • Compassion: Caring teams that support members along their health journey

Preventive care matters

Give your group members access to quality preventive care so they keep feeling their best. All Moda Health medical plans cover most routine, in-network preventive care, including:

  • Periodic health exams
  • Well-baby care
  • Women's annual exams
  • Many immunizations
  • Preventive cancer and other health screenings
  • Quality pharmacy benefits

Deciding on a plan

Plans vary by premiums, networks, deductibles, copays and coinsurance. Understanding these factors, along with metallic levels, can help you pick your group's plan options.

  • Platinum plans. These typically have the highest monthly premiums, but they cover about 90 percent of the total average cost of care.
  • Gold plans. These have the next highest monthly premiums and cover about 80 percent of the total average cost of care.
  • Silver plans. These sit somewhere in the middle, covering about 70 percent of the total average cost of care.
  • Bronze plans. These provide a little less coverage - about 60 percent of the total average cost of care - but they have lower monthly premiums.

Small groups of 1 - 50 employees

Our 2018 small group medical plans come in a few shapes and sizes. Review these highlights to determine which plan types best fit your group.

Preferred provider option (PPO) plans

These plans combine great benefits with access to PPO-contracted physicians and hospitals to help members save money. Members can visit any provider they choose, but they'll get the best benefits, a greater selection of doctors and broader geographic coverage when visiting a PPO provider.

PPO plans include:

  • Connexus plans - Members access care through Connexus Network, one of the largest PPO networks in Oregon.

Health savings account (HSA)-compliant plans

These high-deductible plans are compatible with a health savings account (HSA).

Members have the freedom to choose any financial institution for their HSA-complaint plan. They can use HSA tax-free dollars to pay for deductibles, coinsurance and other qualified expenses not covered by their health plan.

Synergy and Summit plans

Groups located in certain parts of Oregon can select one of these plans. They connect members with the Synergy or Summit provider network, great benefits and low out-of-pocket costs, close to home.

Members living or working in the network service area can access care through the nearby medical home they select.

  • Synergy plans - Groups located in the Portland metro, SW Washington, Salem, Eugene or parts of the Oregon north coast or Columbia River Gorge communities can choose to offer these plans.

    Members must live in one of these counties to enroll in a Synergy plan: Benton, Clackamas, Clatsop, Columbia, Crook, Coos, Curry, Deschutes, Douglas Hood River, Jackson, Jefferson, Josephine, Klamath, Lane, Lincoln, Linn, Marion, Multnomah, Polk, Tillamook, Wasco, Washington or Yamhill county.

    Once enrolled, members access care through the Synergy Network medical home they select.

  • Summit plans - Groups located in eastern Oregon can choose to offer these plans. Members must live in one of these counties to enroll in a Summit plan: Baker, Gilliam, Grant, Harney, Lake, Malheur, Morrow, Sherman, Umatilla, Union, Wallowa or Wheeler county.

    Once enrolled, members access care through the Summit Network medical home they select.

Medical homes make care personal

After enrolling in a Synergy or Summit plan, members choose a Moda medical home in the Synergy or Summit network. A medical home is the place members go for care and where they see their preferred doctors. These providers work together as a team to keep members healthy over time. It's a personal, and cost-effective, approach to care that can't be beat.

Pediatric vision care

Embedded pediatric vision coverage comes with all Moda Health plans in Oregon. Vision care is limited to members under age 19. Members get the best benefit by seeing licensed, in-network providers.

Vision riders

These options ensure members can focus on feeling their best. Our vision riders are available to adults and eligible dependents age 19 and over.

The small business health care tax credit

If you are a small employer, there is a tax credit that can put money in your pocket.
The small business health care tax credit benefits employers that:

  • have fewer than 25 full-time equivalent employees
  • pay an average wage of less than $50,000 a year (adjusted for inflation beginning in 2014),
  • pay a uniform percentage of employee premium for all employees that is equal to at least 50% of the premium cost of employee-only insurance coverage.

To be eligible for this credit, you must have purchased coverage through the small business health options program, also known as the SHOP marketplace.

For more information about the small business health care tax credit, visit the Affordable Care Act section of IRS website at www.IRS.gov.

Large group plans

Groups of 51+ employees

We are also proud to offer health solutions to larger groups of 51 or more employees. Your team members will enjoy all the benefits of being a Moda Health member, like access to quality providers, wellness programs and online health resources. Our health management tools make tracking group coverage easy and convenient.

Medical plans fit for your group

There's a lot to think about when choosing medical benefits for your team. That's why we've made it easy to compare the details. This section highlights our current plan options.

2018 small group plan summaries

Our small group medical plans are designed to help your team members be their healthy best. Read more by downloading our full 2017 small group brochure:

Summaries of Benefits

View comparison chart of all 2018 small group medical plans

Plan Tier Plan Type 2018 Alaska small group plans (1-50) In-network benefit (per person)
Deductible Out-of-pocket max PCP office visit copay/coinsurance PDF
Gold Plans
1-Gold Providence Endeavor Providence Gold 500 $500 $7,000 $20/visit
1-Gold Providence Endeavor Select Gold 500 $5000 $7,000 $20/visit
1-Gold Providence Endeavor Providence Gold 1000 $1,000 $7,000 $20/visit
1-Gold Select Endeavor Select Gold 1000 $1,000 $7,000 $20/visit
1-Gold Select Endeaver Providence Gold 1500 $1,500 $7,000 $20/visit
1-Gold Select Endeavor Select Gold 1500 $1,500 $7,000 $20/visit
Silver Plans
2-Silver Providence Endeavor Providence Silver 2000 $2,000 $7,350 $35/visit
2-Silver Providence Enedeavor Select Silver 2000 $2,000 $7,350 $35/visit
2-Silver Providence Endeavor Providence Silver 2500 $2,500 $7,350 $35/visit
2-Silver Providence Endeavor Select Silver 2500 $2,500 $7,350 $35/visit
2-Silver Providence Endeavor Providence Silver 3000 $3,000 $7,350 $35/visit
2-Silver Providence Endeavor Select Silver 3000 $3,000 $7,350 $35/visit
2-Silver Providence Endeavor Providence Silver 4000 $4,000 $7,350 $35/visit
2-Silver Providence Enedeavor Providence Silver HDHP 2000 $2,000 $5,250 25% after deductible
2-Silver Providence Endeavor Select Silver HDHP 2000 $2,000 $5,250 25% after deductible
2-Silver Select Enedeavor Providence Silver HDHP 2500 $2,500 $5,250 25% after deductible
2-Silver Select Endeavor Select Silver HDHP 2500 $2,500 $5,250 25% after deductible
Bronze Plans
3-Bronze Providence Endeavor Providence Bronze 40001 $4,000 $7,350 50% after deductible
3-Bronze Providence Endeavor Select Bronze 40001 $4,000 $7,350 50% after deductible
3-Bronze Providence Endeavor Providence Bronze 50001 $5,000 $7,350 50% after deductible
3-Bronze Select Endeavor Select Bronze 50001 $5,000 $7,350 50% after deductible
3-Bronze Providence Endeavor Providence Bronze 5500 $5,500 $7,350 $40/visit
3-Bronze Select Endeavor Select Bronze 5500 $5,500 $7,350 $40/visit
3-Bronze Providence Endeavor Providence Bronze 7350 $7,350 $7,350 $75/visit
3-Bronze Select Endeavor Select Bronze 7350 $7,350 $7,350 $75/visit
3-Bronze Providence Endeavor Providence Bronze HDHP 3300 $3,300 $6,600 50% after deductible
3-Bronze Select Endeavor Select Bronze HDHP 3300 $3,300 $6,600 50% after deductible
1This plan includes mandated hearing and vision. For more details contact your sales and service representative.

What plans include

Moda Health medical plans offer a bounty of great benefits. Here's what members can expect:

  • Choice: Quality provider networks that give members the freedom to choose the best doctor for them
  • Coverage: Comprehensive plans that protect members' well-being and connect them with preventive, specialty and pharmacy services
  • Compassion: Caring teams that support members along their health journey

Preventive care matters

Give your group members access to quality preventive care so they keep feeling their best. All Moda Health medical plans cover most routine, in-network preventive care, including:

  • Periodic health exams
  • Well-baby care
  • Women's annual exams
  • Many immunizations
  • Preventive cancer and other health screenings
  • Quality pharmacy benefits

Deciding on a plan

Plans vary by premiums, networks, deductibles, copays and coinsurance. Understanding these factors, along with metallic levels, can help you pick your group's plan options.

  • Gold plans. These have the highest monthly premiums and cover about 80 percent of the total average cost of care.
  • Silver plans. These sit somewhere in the middle, covering about 70 percent of the total average cost of care.
  • Bronze plans. These provide a little less coverage - about 60 percent of the total average cost of care - but they have lower monthly premiums.

Small groups of 1 - 50 employees

Our 2018 small group medical plans come in a few shapes and sizes. Review these highlights to determine which plan types best fit your group.

Preferred provider option (PPO) plans

These plans combine great benefits with access to PPO-contracted physicians and hospitals to help members save money. Members can visit any provider they choose, but they'll get the best benefits, a greater selection of doctors and broader geographic coverage when visiting a PPO provider.

Health savings account (HSA)-compliant plans

These high-deductible plans are compatible with a health savings account (HSA).

Members have the freedom to choose any financial institution for their HSA-complaint plan. They can use HSA tax-free dollars to pay for deductibles, coinsurance and other qualified expenses not covered by their health plan.

Pediatric dental and vision care

Embedded pediatric dental care comes with all small group plans in Alaska and is limited to members under age 19. Members can see any licensed dental care provider in Alaska or the country. However, choosing a Delta Dental Premier Network provider may save members money.

Embedded pediatric vision coverage comes with all Moda Health small group plans in Alaska. Vision care is limited to members under age 19. Members get the best benefit by seeing licensed, in-network providers.

Hearing and vision riders

Vision riders - These options ensure members can focus on feeling their best. Our vision plans are available to adults and eligible dependents age 19 and over.

Hearing rider - Help members tune into better health. The hearing rider pays 80% for hearing exams, testing and hardware - up to $800 over three years. The hearing benefit is included in the Expedition 4000 and 5000 Plans and pays 80% for hearing exams, testing and hardware - up to $3,000 over three years.

Embedded pediatric vision coverage also comes with all Moda Health small group plans in Alaska. Vision care is limited to members under age 19. Members get the best benefit by seeing licensed, in-network providers.

Embedded pediatric vision coverage also comes with all Moda Health small group plans in Washington. Vision care is limited to members under age 19. Members get the best benefit by seeing licensed, in-network providers.

The small business health care tax credit

If you are a small employer, there is a tax credit that can put money in your pocket.

The small business health care tax credit benefits employers that:

  • have fewer than 25 full-time equivalent employees
  • pay an average wage of less than $50,000 a year (adjusted for inflation beginning in 2014),
  • pay a uniform percentage of employee premium for all employees that is equal to at least 50% of the premium cost of employee-only insurance coverage.

To be eligible for this credit, you must have purchased coverage through the small business health options program, also known as the SHOP marketplace.

For more information about the small business health care tax credit, visit the Affordable Care Act section of IRS website at www.IRS.gov.

Groups of 51+ employees

We are also proud to offer health solutions to larger groups of 51 or more employees. Your team members will enjoy all the benefits of being a Moda Health member, like access to quality providers, wellness programs and online health resources. Our health management tools make tracking group coverage easy and convenient.

Medical plans fit for your group

There's a lot to think about when choosing medical benefits for your team. That's why we've made it easy to compare the details. This section highlights our current plan options.

2017 small group plan summaries

Our small group medical plans are designed to help your team members be their healthy best. Read more by downloading our full 2016 small group brochure:

Summaries of Benefits

View comparison chart of all 2017 small group medical plans

Plan Tier Plan Type 2017 Oregon small group plans (1-50) In-network benefit (per person)
Deductible Out-of-pocket max PCP office visit copay/coinsurance PDF
Platinum Plans
1-Platinum PPO PPO Platinum 250 $250 $2,000 $10/visit
1-Platinum PPO PPO Platinum Synergy Exclusive 250 $250 $2,000 $10/visit
1-Platinum PPO PPO Platinum Summit Exclusive 250 $250 $2,000 $10/visit
1-Platinum PPO PPO Platinum 500 $500 $1,750 $10/visit
1-Platinum PPO PPO Platinum Synergy Exclusive 500 $500 $1,750 $10/visit
1-Platinum PPO PPO Platinum Summit Exclusive 500 $500 $1,750 $10/visit
Gold Plans
2-Gold PPO PPO 500 $500 $6,000 $20/visit
2-Gold PPO PPO 1000A $1,000 $6,000 $20/visit
2-Gold PPO PPO Synergy Exclusive 1000A $1,000 $6,000 $20/visit
2-Gold PPO PPO Summit Exclusive 1000A $1,000 $6,000 $20/visit
2-Gold PPO PPO 1000B $1,000 $6,000 $20/visit
2-Gold PPO PPO 1500 $1,500 $6,000 $20/visit
2-Gold Standard Moda Health Oregon Standard Gold $1,000 $6,850 $20/visit
Silver Plans
3-Silver Value Value 2000 $2,000 $7,150 $35/visit
3-Silver Value Value 2500 $2,500 $7,150 $35/visit
3-Silver Value Value 3000 $3,000 $7,150 $35/visit
3-Silver Value Value 3500 $3,500 $7,150 $35/visit
3-Silver Value Value 5000 $5,000 $7,150 $35/visit
3-Silver Aspire Moda Health Connexus Aspire 3000 $3,000 $7,150 30%
3-Silver Aspire Moda Health Connexus Aspire 3500 $3,500 $7,150 30%
3-Silver HSA Moda Health Connexus HSA 1500 $1,500 $5,500 30% after deductible
3-Silver HSA Moda Health Connexus HSA 2000 $2,000 $5,500 30% after deductible
3-Silver HSA Moda Health Connexus HSA 2500 $2,500 $5,500 30% after deductible
3-Silver Exclusive Moda Health Synergy Exclusive 2000 $2,000 $7,150 $35/visit
3-Silver Exclusive Moda Health Summit Exclusive 2000 $2,000 $7,150 $35/visit
3-Silver Standard Moda Health Oregon Standard Silver $2,500 $6,850 $35/visit
Bronze Plans
4-Bronze Basic Moda Health Connexus Basic 6500 $7,150 $7,150 0% after deductible
4-Bronze Standard Moda Health Oregon Standard Bronze $7,150 $7,150 $70 after deductible
4-Bronze Fundamental Moda Health Connexus Fundamental 4000 $4,000 $7,150 50% after deductible
4-Bronze Fundamental Moda Health Connexus Fundamental 5000 $5,000 $7,150 50% after deductible

What plans include

Moda Health medical plans offer a bounty of great benefits. Here's what members can expect:

  • Choice: Quality provider networks that give members the freedom to choose the best doctor for them
  • Coverage: Comprehensive plans that protect members' well-being and connect them with preventive, specialty and pharmacy services
  • Compassion: Caring teams that support members along their health journey

Preventive care matters

Give your group members access to quality preventive care so they keep feeling their best. All Moda Health medical plans cover most routine, in-network preventive care, including:

  • Periodic health exams
  • Well-baby care
  • Women's annual exams
  • Many immunizations
  • Preventive cancer and other health screenings
  • Quality pharmacy benefits

Deciding on a plan

Plans vary by premiums, networks, deductibles, copays and coinsurance. Understanding these factors, along with metallic levels, can help you pick your group's plan options.

  • Platinum plans. These typically have the highest monthly premiums, but they cover about 90 percent of the total average cost of care.
  • Gold plans. These have the next highest monthly premiums and cover about 80 percent of the total average cost of care.
  • Silver plans. These sit somewhere in the middle, covering about 70 percent of the total average cost of care.
  • Bronze plans. These provide a little less coverage - about 60 percent of the total average cost of care - but they have lower monthly premiums.

Small groups of 1 - 50 employees

Our 2017 small group medical plans come in a few shapes and sizes. Review these highlights to determine which plan types best fit your group.

Preferred provider option (PPO) plans

These plans combine great benefits with access to PPO-contracted physicians and hospitals to help members save money. Members can visit any provider they choose, but they'll get the best benefits, a greater selection of doctors and broader geographic coverage when visiting a PPO provider.

PPO plans include:

  • Connexus plans - Members access care through Connexus Network, one of the largest PPO networks in Oregon.

Health savings account (HSA)-compliant plans

These high-deductible plans are compatible with a health savings account (HSA).

Members have the freedom to choose any financial institution for their HSA-complaint plan. They can use HSA tax-free dollars to pay for deductibles, coinsurance and other qualified expenses not covered by their health plan.

Synergy and Summit plans

Groups located in certain parts of Oregon can select one of these plans. They connect members with the Synergy or Summit provider network, great benefits and low out-of-pocket costs, close to home.

Members living or working in the network service area can access care through the nearby medical home they select.

  • Synergy plans - Groups located in the Portland metro, SW Washington, Salem, Eugene or parts of the Oregon north coast or Columbia River Gorge communities can choose to offer these plans.

    Members must live in one of these counties to enroll in a Synergy plan: Benton, Clackamas, Clark, Clatsop, Columbia, Hood River, Jackson, Josephine, Klamath, Lane, Lincoln, Linn, Marion, Multnomah, Polk, Tillamook, Wasco, Washington or Yamhill county.

    Once enrolled, members access care through the Synergy Network medical home they select.

  • Summit plans - Groups located in eastern Oregon can choose to offer these plans. Members must live in one of these counties to enroll in a Summit plan: Baker, Gilliam, Grant, Harney, Lake, Malheur, Morrow, Sherman, Umatilla, Union, Wallowa or Wheeler county.

    Once enrolled, members access care through the Synergy Network medical home they select.

Medical homes make care personal

After enrolling in a Synergy or Summit plan, members choose a Moda medical home in the Synergy or Summit network. A medical home is the place members go for care and where they see their preferred doctors. These providers work together as a team to keep members healthy over time. It's a personal, and cost-effective, approach to care that can't be beat.

Pediatric vision care

Embedded pediatric vision coverage comes with all Moda Health plans in Oregon. Vision care is limited to members under age 19. Members get the best benefit by seeing licensed, in-network providers.

Vision riders

These options ensure members can focus on feeling their best. Our vision riders are available to adults and eligible dependents age 19 and over.

The small business health care tax credit

If you are a small employer, there is a tax credit that can put money in your pocket.
The small business health care tax credit benefits employers that:

  • have fewer than 25 full-time equivalent employees
  • pay an average wage of less than $50,000 a year (adjusted for inflation beginning in 2014),
  • pay a uniform percentage of employee premium for all employees that is equal to at least 50% of the premium cost of employee-only insurance coverage.

To be eligible for this credit, you must have purchased coverage through the small business health options program, also known as the SHOP marketplace.

For more information about the small business health care tax credit, visit the Affordable Care Act section of IRS website at www.IRS.gov.

Large group plans

Groups of 51+ employees

We are also proud to offer health solutions to larger groups of 51 or more employees. Your team members will enjoy all the benefits of being a Moda Health member, like access to quality providers, wellness programs and online health resources. Our health management tools make tracking group coverage easy and convenient.

Medical plans fit for your group

There's a lot to think about when choosing medical benefits for your team. That's why we've made it easy to compare the details. This section highlights our current plan options.

2017 small group plan summaries

Our small group medical plans are designed to help your team members be their healthy best. Read more by downloading our full 2017 small group brochure:

Summaries of Benefits

View comparison chart of all 2017 small group medical plans

Plan Tier Plan Type 2017 Alaska small group plans (1-50) In-network benefit (per person)
Deductible Out-of-pocket max PCP office visit copay/coinsurance PDF
Gold Plans
1-Gold Providence PPO 500 (Providence) $500 $6,000 $20/visit
1-Gold Providence PPO 1000 (Providence) $1,000 $6,000 $20/visit
1-Gold Providence PPO 1500 (Providence) $1,500 $6,000 $20/visit
1-Gold Select PPO 500 (Select) $500 $6,000 $20/visit
1-Gold Select PPO 1000 (Select) $1,000 $6,000 $20/visit
1-Gold Select PPO 1500 (Select) $1,500 $6,000 $20/visit
Silver Plans
2-Silver Providence PPO 2500 (Providence) $2,500 $7,150 $40/visit
2-Silver Providence PPO 3000 (Providence) $3,000 $7,150 $40/visit
2-Silver Providence Value 2000 (Providence) $2,000 $7,150 $35/visit
2-Silver Providence Value 3000 (Providence) $3,000 $7,150 $35/visit
2-Silver Providence Value 4000 (Providence) $4,000 $7,150 $35/visit
2-Silver Providence Moda Health Providence Caliber 2000 $2,000 $7,150 35%
2-Silver Providence Moda Health Providence Caliber 2500 $2,500 $7,150 35%
2-Silver Providence Moda Health Providence HSA 2000 $2,000 $5,250 25% after deductible
2-Silver Providence Moda Health Providence HSA 2500 $2,500 $5,250 25% after deductible
2-Silver Select PPO 2500 (Select) $2,500 $7,150 $50/visit
2-Silver Select PPO 3000 (Select) $3,000 $7,150 $50/visit
2-Silver Select Value 2000 (Select) $2,000 $7,150 $35/visit
2-Silver Select Value 3000 (Select) $3,000 $7,150 $35/visit
2-Silver Select Value 4000 (Select) $4,000 $7,150 $35/visit
2-Silver Select Moda Health Select Caliber 2000 $2,000 $7,150 35%
2-Silver Select Moda Health Select Caliber 2500 $2,500 $7,150 35%
2-Silver Select Moda Health Select HSA 2000 $2,000 $5,250 25% after deductible
2-Silver Select Moda Health Select HSA 2500 $2,500 $5,250 25% after deductible
Bronze Plans
3-Bronze Providence Moda Health Providence Expedition 4000 $4,000 $7,150 50% after deductible
3-Bronze Providence Moda Health Providence Expedition 5000 $5,000 $7,150 50% after deductible
3-Bronze Providence Moda Health Providence Vital 7150 $7,150 $7,150 $75/visit
3-Bronze Select Moda Health Select Expedition 4000 $4,000 $7,150 50% after deductible
3-Bronze Select Moda Health Select Expedition 5000 $5,000 $7,150 50% after deductible
3-Bronze Select Moda Health Select Vital 7150 $7,150 $7,150 $75/visit

What plans include

Moda Health medical plans offer a bounty of great benefits. Here's what members can expect:

  • Choice: Quality provider networks that give members the freedom to choose the best doctor for them
  • Coverage: Comprehensive plans that protect members' well-being and connect them with preventive, specialty and pharmacy services
  • Compassion: Caring teams that support members along their health journey

Preventive care matters

Give your group members access to quality preventive care so they keep feeling their best. All Moda Health medical plans cover most routine, in-network preventive care, including:

  • Periodic health exams
  • Well-baby care
  • Women's annual exams
  • Many immunizations
  • Preventive cancer and other health screenings
  • Quality pharmacy benefits

Deciding on a plan

Plans vary by premiums, networks, deductibles, copays and coinsurance. Understanding these factors, along with metallic levels, can help you pick your group's plan options.

  • Gold plans. These have the highest monthly premiums and cover about 80 percent of the total average cost of care.
  • Silver plans. These sit somewhere in the middle, covering about 70 percent of the total average cost of care.
  • Bronze plans. These provide a little less coverage - about 60 percent of the total average cost of care - but they have lower monthly premiums.

Small groups of 1 - 50 employees

Our 2017 small group medical plans come in a few shapes and sizes. Review these highlights to determine which plan types best fit your group.

Preferred provider option (PPO) plans

These plans combine great benefits with access to PPO-contracted physicians and hospitals to help members save money. Members can visit any provider they choose, but they'll get the best benefits, a greater selection of doctors and broader geographic coverage when visiting a PPO provider.

Health savings account (HSA)-compliant plans

These high-deductible plans are compatible with a health savings account (HSA).

Members have the freedom to choose any financial institution for their HSA-complaint plan. They can use HSA tax-free dollars to pay for deductibles, coinsurance and other qualified expenses not covered by their health plan.

Pediatric dental and vision care

Embedded pediatric dental care comes with all small group plans in Alaska and is limited to members under age 19. Members can see any licensed dental care provider in Alaska or the country. However, choosing a Delta Dental Premier Network provider may save members money.

Embedded pediatric vision coverage comes with all Moda Health small group plans in Alaska. Vision care is limited to members under age 19. Members get the best benefit by seeing licensed, in-network providers.

Hearing and vision riders

Vision riders - These options ensure members can focus on feeling their best. Our vision plans are available to adults and eligible dependents age 19 and over.

Hearing rider - Help members tune into better health. The hearing rider pays 80% for hearing exams, testing and hardware - up to $800 over three years. The hearing benefit is included in the Expedition 4000 and 5000 Plans and pays 80% for hearing exams, testing and hardware - up to $3,000 over three years.

Embedded pediatric vision coverage also comes with all Moda Health small group plans in Alaska. Vision care is limited to members under age 19. Members get the best benefit by seeing licensed, in-network providers.

Embedded pediatric vision coverage also comes with all Moda Health small group plans in Washington. Vision care is limited to members under age 19. Members get the best benefit by seeing licensed, in-network providers.

The small business health care tax credit

If you are a small employer, there is a tax credit that can put money in your pocket.

The small business health care tax credit benefits employers that:

  • have fewer than 25 full-time equivalent employees
  • pay an average wage of less than $50,000 a year (adjusted for inflation beginning in 2014),
  • pay a uniform percentage of employee premium for all employees that is equal to at least 50% of the premium cost of employee-only insurance coverage.

To be eligible for this credit, you must have purchased coverage through the small business health options program, also known as the SHOP marketplace.

For more information about the small business health care tax credit, visit the Affordable Care Act section of IRS website at www.IRS.gov.

Groups of 51+ employees

We are also proud to offer health solutions to larger groups of 51 or more employees. Your team members will enjoy all the benefits of being a Moda Health member, like access to quality providers, wellness programs and online health resources. Our health management tools make tracking group coverage easy and convenient.

Medical plans fit for your group

At Moda Health, we’re excited about helping your employees start a journey to be better.

For our part, we’ll provide a network of doctors and specialists, expert health coaches, caring customer service reps and some of the greatest innovators in healthcare. For your part, we’ll ask that each member come ready to be the MVP of his or her health. Don’t worry — we’ll help inspire them.

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Getting in-network care is easy

We know that health issues don’t always happen when and where it’s convenient. That’s why we’ve made it easier than ever to get to an in-network provider.

2015 group (1-50) (1-50) medical plans — options they’ll love

Whatever your employees’ healthcare demands, Moda Health offers a range of flexible plans to fit. And, we give members the freedom to pick the coverage that suits them best.

There’s a lot to think about. If you have questions, just call the Moda Health Sales and Account Service team at 503-243-3948 907-278-2626 or toll-free at 800-578-1402 888-374-8910. Or, contact your Moda Health-appointed agent.

Plan ‘tiers’ make choosing easier

Our medical small group (1-50) (1-50) plans fall into one of three tiers: gold, silver and bronze. Gold plans cost a little more, but they cover more, too. Silver plans land somewhere in the middle. Bronze plans provide a little less coverage, but employees will save money on monthly premiums. Knowing about these tiers may help you find and choose the best plan for you.

Take a look at the charts below to compare care costs and average monthly rates by tier.

View comparison chart of all 2015 small group medical plans

Percentages shown reflect what you pay for covered vision
Click to view by plan category
Plan Tier Plan Type 2015 Oregon small group plans (1-50) In-network benefit (per person)
Deductible Out-of-pocket max PCP office visit copay/coinsurance PDF

* Deductible waived

** Plan pays for first five visits with a copay, which may be used for either PCP office visits or urgent care for illness or injury. Thereafter, the deductible and coinsurance apply.

*** Plan pays for first three visits with a copay, which may be used for either PCP office visits or urgent care for illness or injury. Thereafter, the deductible and coinsurance apply.

Gold Plans
1-Gold PPO PPO 500 $500 $4,000 $15/visit*
1-Gold PPO PPO 1000A $1,000 $4,000 $15/visit*
1-Gold PPO PPO 1000B $1,000 $4,000 $15/visit*
1-Gold PPO PPO 1500 $1,500 $4,000 $15/visit*
1-Gold Standard Oregon Standard Gold $1,300 $6,350 $20/visit*
Silver Plans
2-Silver PPO PPO 2000 $2,000 $6,600 $25/visit*
2-Silver PPO PPO 3000 $3,000 $6,600 $25/visit*
2-Silver Value Value 1500 $1,500 $6,600 $35/visit*
2-Silver Value Value 2000 $2,000 $6,600 $35/visit*
2-Silver Value Value 2500 $2,500 $6,600 $35/visit*
2-Silver Value Value 3000 $3,000 $6,600 $35/visit*
2-Silver Value Value 3500 $3,500 $6,600 $35/visit*
2-Silver Beneficial Beneficial 1500 $1,500 $5,500 $35/visit* (X5)
Silvesfsfsr Plans
2-Silver Beneficial Beneficial 2000 $2,000 $5,500 $35/visit* (X5)
30% for subsequent visits**
2-Silver HSA HSA 1500 $1,500 $5,250 20%
2-Silver HSA HSA 2000 $2,000 $5,250 20%
2-Silver Focus Focus 2000 $2,000 $6,600 $35/visit* (X5)
30% for subsequent visits**
2-Silver Focus - Rose City Focus — Rose City 2000 $2,000 $6,660 $35/visit* (X5)
30% for subsequent visits**
2-Silver Standard Oregon Standard Silver $2,500 $6,350 $35/visit*
Bronze Plans
3-Bronze Beneficial Beneficial 3500 $3,500 $6,600 $35/visit* (X3)
50% for subsequent visits***
3-Bronze Beneficial Beneficial 4000 $4,000 $6,600 $35/visit* (X3)
50% for subsequent visits***
3-Bronze Beneficial Beneficial 4500 $4,500 $6,600 $35/visit* (X3)
50% for subsequent visits***
3-Bronze Beneficial Beneficial 5000 $5,000 $6,600 $35/visit* (X3)
50% for subsequent visits***
3-Bronze HSA HSA 3000 $3,000 $6,450 30%
3-Bronze HSA HSA 4000 $4,000 $6,450 30%
3-Bronze HSA HSA 5000 $5,000 $6,450 30%
3-Bronze Focus Focus 5000 $5,000 $6,600 $35/visit* (X3)
50% for subsequent visits***
3-Bronze Focus - Rose City Focus — Rose City 5000 $5,000 $6,600 $35/visit* (x3)
50% for subsequent visits***
3-Bronze Standard Oregon Standard Bronze $5,000 $6,350 $60

View comparison chart of all 2015 small group medical plans

Click to view by plan category
Plan Tier Plan Type 2015 Alaska small group health plans
(1-50)
In-network benefit (per person)
Deductible Out-of-pocket max PCP office visit copay/coinsurance Endeavor Providence PDF Endeavor Select PDF

* Deductible waived

** Plan pays for first five visits with a copay, which may be used for either PCP office visits or urgent care for illness or injury. Thereafter, the deductible and coinsurance apply.

*** Plan pays for first three visits with a copay, which may be used for either PCP office visits or urgent care for illness or injury. Thereafter, the deductible and coinsurance apply.

Gold Plans
1-Gold PPO PPO 500 $500 $4,000 $15/visit*
1-Gold PPO PPO 1000 $1,000 $4,000 $15/visit*
1-Gold PPO PPO 1500 $1,500 $4,000 $15/visit*
2-Silver PPO PPO 2000 $2,000 $6,600 $25/visit*
2-Silver PPO PPO 3000 $3,000 $6,600 $25/visit*
2-Silver Value Value 1500 $1,500 $6,600 $35/visit*
2-Silver Value Value 2000 $2,000 $6,600 $35/visit*
2-Silver Value Value 3000 $3,000 $6,600 $35/visit*
2-Silver Value Value 4000 $4,000 $6,600 $35/visit*
2-Silver Beneficial Beneficial 1500 $1,500 $5,500 $35/visit* (x5)
30% for subsequent visits**
2-Silver Beneficial Beneficial 2000 $2,000 $5,500 $35/visit* (x5)
30% for subsequent visits**
2-Silver Beneficial Beneficial 3000 $3,000 $5,500 $35/visit* (x5)
30% for subsequent visits**
2-Silver HSA HSA 2000 $2,000 $5,250 20%
3-Bronze Beneficial Beneficial 4000 $4,000 $6,600 $35/visit* (x3)
50% for subsequent visits**
3-Bronze Beneficial Beneficial 4500 $4,500 $6,600 $35/visit* (x3)
50% for subsequent visits**
3-Bronze Beneficial Beneficial 5000 $5,000 $6,600 $35/visit* (x3)
50% for subsequent visits**
3-Bronze HSA HSA 3000 $3,000 $6,450 30%
3-Bronze HSA HSA 4000 $4,000 $6,450 30%
3-Bronze HSA HSA 5000 $5,000 $6,450 30%
3-Bronze HSA HSA 6000 $6,000 $6,000 0%

View comparison chart of all 2015 small group vision riders

VEO VEO V100 V100 V1003 V1003

*Contact lenses are covered in lieu of regular lenses and frames.

Vision exam benefits are all subject to the calendar-year benefit maximum. Percentages shown reflect what members pay for covered vision exam. Noncovered, excluded service are the member's responsibility and do not apply toward the calendar year benefit maximum.

What employees pay per calendar year
Benefit maximum $200 $200 $300
Eye examinations (including refraction) 0% 0%* 0%*
Lenses Not covered 0%* 0%*
Frames Not covered 0%* 0%*

Find group plans by category

Take a look at our 2015 group medical plan categories. Review highlights to compare plans and determine which plans best fit your group.

PPO plans

Use contracted physicians and hospitals to save money. Members can visit any provider they choose, but they’ll get the best benefits, more choices in doctors and broader geographic coverage when visiting a contracted provider. Plan highlights include:

  • Annual in-network deductibles ranging from $500 to $3,000
  • Copays as low as $15 for in-network office, urgent care and spinal and other manipulationschiropractic, naturopathic and acupuncture care visits.

Standard plans

Use contracted physicians and hospitals to save money. Members can visit any provider they choose, but they’ll get the best benefits, more choices in doctors and broader geographic coverage when visiting a PPO provider. Plan highlights include:

  • Annual in-network deductibles ranging from $2,000 to $5,000
  • Copays as low as $20 for in-network PCP office visits

Value PPO plans

If you want a PPO plan, but are also looking for lower premiums, our Value PPO plans give you a broad range of higher deductibles. With higher copays and maximum out-of-pocket expenses, these plans offer the best combination of quality and value. Plan highlights include:

  • Annual, in-network deductible choices ranging from $1,500 to $3,000
  • Copays as low as $35 for in-network office, urgent care and spinal and other manipulationschiropractic, naturopathic and acupuncture care visits.

Beneficial PPO plans

Our Beneficial PPO plans are another great option for groups who want lower premium costs through higher deductibles and office visit copy limitations. Plan highlights include:

  • Annual, in-network deductible choices ranging from $1,500 to $5,000
  • Copays as low as $35 for in-network office, urgent care and spinal and other manipulationschiropractic, naturopathic and acupuncture care visits.

HSA plans

A Moda Health HSA-qualified, high deductible plan allows members to use tax-free funds for eligible healthcare expenses. Simply check to see if your bank account has an HSA option.

Focus plans

Our Focus plans encourage your employees to take charge of their health. Members who seek care within our Community Care Network enjoy better benefits and high-quality, individualized care from an interconnected group of providers. Plan highlights include:

  • Annual, in-network deductible choices of $2,000 and $5,000
  • Access to Community Care Network

Focus plan options

Focus — Rose City plans

Similar to our Focus plans, these plans utilize the Rose City Network. Our Rose City plans are also only available through Cover Oregon. Plan highlights include:

  • Annual, in-network deductible choices of $2,000 and $5,000
  • Access to Rose City Network
  • Only available for purchase through CoverOregon.com

Focus — Rose City plan options

Vision riders

These medical plan riders ensure that employees can focus on feeling their best. Our vision riders are available to adults and eligible dependents age 19 and over.

Vision rider options

Hearing rider

Beginning the first year that benefits are used, the hearing rider pays 80% for hearing exams, testing and hardware — up to $800 over three years. We think your group will like the sound of that.

Hearing rider option

Questions?

We’re here to help. Just call the Moda Health Sales and Account Service team at 503-243-3948 907-278-2626 or toll-free at 800-578-1402 888-374-8910. Or, contact your producer.

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