Group plan documents
Below are group plan documents for our medical plans.
2024
2023
2022
2024 Small group benefit summaries
- Moda Health Connexus Platinum 250
- Moda Health Connexus Platinum 500
- Moda Health Connexus Gold 500
- Moda Health Connexus Gold 1000
- Moda Health Connexus Gold 1500
- Moda Health Connexus Gold 2000
- Moda Health Connexus Gold 2500
- Moda Health Connexus Silver 3500
- Moda Health Connexus Silver 3750
- Moda Health Connexus Silver 4500
- Moda Health Connexus Silver 5500
- Moda Health Connexus Silver 7000
- Moda Health Connexus Bronze 8550
- Moda Health Connexus Gold HDHP 1600
- Moda Health Connexus Silver HDHP 3000
- Moda Health Connexus Silver HDHP 3500
- Moda Health Connexus Bronze HDHP 5500
- Moda Health Connexus Bronze HDHP 7500
- Moda Health Oregon Standard Gold
- Moda Health Oregon Standard Silver
- Moda Health Oregon Standard Bronze
- Moda Health Select Platinum 500
- Moda Health Select Gold 500
- Moda Health Select Gold 1001
- Moda Health Select Gold 1500
- Moda Health Select Gold 2500
- Moda Health Select Silver 3500
- Moda Health Select Silver 3750
- Moda Health Select Silver 5000
- Moda Health Select Silver 5500
- Moda Health Select Bronze 7500
- Moda Health Select Silver HDHP 2000
- Moda Health Select Bronze HDHP 4850
- Moda Health Select Bronze HDHP 5500
2023 Small group benefit summaries
Vision plan benefits summaries
2023 Large group benefit summaries
Connexus PPO Medical Plan Options
- PPO-250-2500-20-10-SOB
- PPO-250-3000-25-10-SOB
- PPO-500-3000-25-10-SOB
- PPO-500-3000-25-20-SOB
- PPO-500-5000-30-20-SOB
- PPO-500-3000-20-20-SOB
- PPO-500-3500-20-20-SOB
- PPO-500-4000-25-20-SOB
- PPO-500-5000-25-20-SOB
- PPO-500-5000-35-30-SOB
- PPO-500-7150-25-20-SOB
- PPO-500-7150-35-30-SOB
- PPO-1000-3000-25-20-SOB
- PPO-1000-5000-25-20-SOB
- PPO-1000-3000-30-20-SOB
- PPO-1000-5000-30-20-SOB
- PPO-1000-3500-25-20-SOB
- PPO-1000-4500-25-20-SOB
- PPO-1000-5500-25-20-SOB
- PPO-1000-5500-35-30-SOB
- PPO-1000-7150-25-20-SOB
- PPO-1000-7150-35-30-SOB
- PPO-1500-3000-25-20-SOB
- PPO-1500-3000-30-20-SOB
- PPO-1500-5000-30-20-SOB
- PPO-1500-4000-25-20-SOB
- PPO-1500-5000-25-20-SOB
- PPO-1500-6000-25-20-SOB
- PPO-1500-6000-35-30-SOB
- PPO-1500-7150-25-20-SOB
- PPO-1500-7150-35-30-SOB
- PPO-2000-4000-25-20-SOB
- PPO-2000-6000-25-20-SOB
- PPO-2000-4000-30-20-SOB
- PPO-2000-6000-30-20-SOB
- PPO-1500-3000-30-30-SOB
- PPO-1500-5000-30-30-SOB
- PPO-2000-4000-30-30-SOB
- PPO-2000-6000-30-30-SOB
- PPO-2000-4500-25-20-SOB
- PPO-2000-5500-25-20-SOB
- PPO-2000-5500-35-30-SOB
- PPO-2000-7150-25-20-SOB
- PPO-2000-7150-35-30-SOB
- PPO-2500-5000-25-20-SOB
- PPO-2500-5000-35-30-SOB
- PPO-2500-7500-25-20-SOB
- PPO-2500-7500-35-30-SOB
- PPO-3000-5000-30-20-SOB
- PPO-3000-7000-30-20-SOB
- PPO-3000-5000-25-30-SOB
- PPO-3000-7000-25-30-SOB
- PPO-3000-5000-30-30-SOB
- PPO-3000-7000-30-30-SOB
- PPO-3000-5500-25-20-SOB
- PPO-3000-5500-35-30-SOB
- PPO-3000-7150-25-20-SOB
- PPO-3000-7150-35-30-SOB
- PPO-3000-8900-25-20-SOB
- PPO-3000-8900-35-30-SOB
- PPO-3500-7150-25-20-SOB
- PPO-3500-7150-35-30-SOB
- PPO-3500-8900-25-20-SOB
- PPO-3500-8900-35-30-SOB
- PPO-4000-7150-25-20-SOB
- PPO-4000-7150-35-30-SOB
- PPO-4000-8900-25-20-SOB
- PPO-4000-8900-35-30-SOB
- PPO-4500-7150-25-20-SOB
- PPO-4500-7150-35-30-SOB
- PPO-4500-8900-25-20-SOB
- PPO-4500-8900-35-30-SOB
- PPO-5000-8550-25-30-SOB
- PPO-5000-7150-25-20-SOB
- PPO-5000-7150-35-30-SOB
- PPO-5000-8900-25-20-SOB
- PPO-5000-8900-35-30-SOB
- PPO-6000-7150-25-20-SOB
- PPO-6000-7150-35-30-SOB
- PPO-6000-8900-25-20-SOB
- PPO-6000-8900-35-30-SOB
- PPO-7000-8900-25-20-SOB
- PPO-7000-8900-35-30-SOB
- PPO-8000-8900-25-20-SOB
- PPO-8000-8900-35-30-SOB
Connexus VBC Medical Plan Options
- VBC-250-2500-20-40-10-SOB
- VBC-250-3000-25-45-10-SOB
- VBC-500-3000-25-45-10-SOB
- VBC-500-3000-25-40-20-SOB
- VBC-500-5000-30-45-20-SOB
- VBC-500-3000-20-40-20-SOB
- VBC-500-3500-20-40-20-SOB
- VBC-500-4000-25-45-20-SOB
- VBC-500-5000-25-45-20-SOB
- VBC-500-5000-35-55-30-SOB
- VBC-500-7150-25-45-20-SOB
- VBC-500-7150-35-55-30-SOB
- VBC-1000-3000-25-40-20-SOB
- VBC-1000-5000-25-40-20-SOB
- VBC-1000-3000-30-45-20-SOB
- VBC-1000-5000-30-45-20-SOB
- VBC-1000-3000-35-50-20-SOB
- VBC-1000-5000-35-50-20-SOB
- VBC-1000-3500-25-45-20-SOB
- VBC-1000-4500-25-45-20-SOB
- VBC-1000-5500-25-45-20-SOB
- VBC-1000-5500-35-55-30-SOB
- VBC-1000-7150-25-45-20-SOB
- VBC-1000-7150-35-55-30-SOB
- VBC-1500-3000-25-40-20-SOB
- VBC-1500-5000-25-40-20-SOB
- VBC-1500-3000-30-45-20-SOB
- VBC-1500-5000-30-45-20-SOB
- VBC-1500-3000-35-50-20-SOB
- VBC-1500-5000-35-50-20-SOB
- VBC-1500-4000-25-45-20-SOB
- VBC-1500-5000-25-45-20-SOB
- VBC-1500-6000-25-45-20-SOB
- VBC-1500-6000-35-55-30-SOB
- VBC-1500-7150-25-45-20-SOB
- VBC-1500-7150-35-55-30-SOB
- VBC-2000-4000-25-40-20-SOB
- VBC-2000-6000-25-40-20-SOB
- VBC-2000-4000-30-45-20-SOB
- VBC-2000-6000-30-45-20-SOB
- VBC-2000-4000-35-50-20-SOB
- VBC-2000-6000-35-50-20-SOB
- VBC-2000-4500-25-45-20-SOB
- VBC-2000-5500-25-45-20-SOB
- VBC-2000-5500-35-55-30-SOB
- VBC-2000-7150-25-45-20-SOB
- VBC-2000-7150-35-55-30-SOB
- VBC-2500-5000-25-45-20-SOB
- VBC-2500-5000-35-55-30-SOB
- VBC-2500-7500-25-45-20-SOB
- VBC-2500-7500-35-55-30-SOB
- VBC-3000-5000-25-40-20-SOB
- VBC-3000-7000-25-40-20-SOB
- VBC-3000-5000-30-45-20-SOB
- VBC-3000-7000-30-45-20-SOB
- VBC-3000-5000-35-50-20-SOB
- VBC-3000-7000-35-50-20-SOB
- VBC-3000-5000-30-45-30-SOB
- VBC-3000-5000-35-50-30-SOB
- VBC-3000-7000-35-50-30-SOB
- VBC-3000-5500-25-45-20-SOB
- VBC-3000-5500-35-55-30-SOB
- VBC-3000-7150-25-45-20-SOB
- VBC-3000-7150-35-55-30-SOB
- VBC-3000-8900-25-45-20-SOB
- VBC-3000-8900-35-55-30-SOB
- VBC-3500-7150-25-45-20-SOB
- VBC-3500-7150-35-55-30-SOB
- VBC-3500-8900-25-45-20-SOB
- VBC-3500-8900-35-55-30-SOB
- VBC-4000-7150-25-45-20-SOB
- VBC-4000-7150-35-55-30-SOB
- VBC-4000-8900-25-45-20-SOB
- VBC-4000-8900-35-55-30-SOB
- VBC-4500-7150-25-45-20-SOB
- VBC-4500-7150-35-55-30-SOB
- VBC-4500-8900-25-45-20-SOB
- VBC-4500-8900-35-55-30-SOB
- VBC-5000-8150-30-45-20-SOB
- VBC-5000-8550-35-50-20-SOB
- VBC-5000-8550-30-45-30-SOB
- VBC-5000-8550-35-50-30-SOB
- VBC-5000-7150-25-45-20-SOB
- VBC-5000-7150-35-55-30-SOB
- VBC-5000-8900-25-45-20-SOB
- VBC-5000-8900-35-55-30-SOB
- VBC-6000-7150-25-45-20-SOB
- VBC-6000-7150-35-55-30-SOB
- VBC-6000-8900-25-45-20-SOB
- VBC-6000-8900-35-55-30-SOB
- VBC-7000-8900-25-45-20-SOB
- VBC-7000-8900-35-55-30-SOB
- VBC-8000-8900-25-45-20-SOB
- VBC-8000-8900-35-55-30-SOB
Connexus HDHP Medical Plan Options
- HDHP-3000-3000-0-SOB
- HDHP-2800-5000-20-SOB
- HDHP-2800-5000-30-SOB
- HDHP-3000-5000-20-SOB
- HDHP-5000-5000-0-SOB
- HDHP-3000-7000-30-SOB
Moda Select POS Medical Plan Options
- POS-250-2500-20-40-10-SOB
- POS-250-3000-25-45-10-SOB
- POS-500-3000-25-45-10-SOB
- POS-500-3000-20-40-20-SOB
- POS-500-3500-20-40-20-SOB
- POS-500-4000-25-45-20-SOB
- POS-500-5000-25-45-20-SOB
- POS-500-5000-35-55-30-SOB
- POS-500-7150-25-45-20-SOB
- POS-500-7150-35-55-30-SOB
- POS-1000-3500-25-45-20-SOB
- POS-1000-4500-25-45-20-SOB
- POS-1000-5500-25-45-20-SOB
- POS-1000-5500-35-55-30-SOB
- POS-1000-7150-25-45-20-SOB
- POS-1000-7150-35-55-30-SOB
- POS-1500-4000-25-45-20-SOB
- POS-1500-5000-25-45-20-SOB
- POS-1500-6000-25-45-20-SOB
- POS-1500-6000-35-55-30-SOB
- POS-1500-7150-25-45-20-SOB
- POS-1500-7150-35-55-30-SOB
- POS-2000-4500-25-45-20-SOB
- POS-2000-5500-25-45-20-SOB
- POS-2000-5500-35-55-30-SOB
- POS-2000-7150-25-45-20-SOB
- POS-2000-7150-35-55-30-SOB
- POS-2500-5000-25-45-20-SOB
- POS-2500-5000-35-55-30-SOB
- POS-2500-7500-25-45-20-SOB
- POS-2500-7500-35-55-30-SOB
- POS-3000-5500-25-45-20-SOB
- POS-3000-5500-35-55-30-SOB
- POS-3000-7150-25-45-20-SOB
- POS-3000-7150-35-55-30-SOB
- POS-3000-8900-25-45-20-SOB
- POS-3000-8900-35-55-30-SOB
- POS-3500-7150-25-45-20-SOB
- POS-3500-7150-35-55-30-SOB
- POS-3500-8900-25-45-20-SOB
- POS-3500-8900-35-55-30-SOB
- POS-4000-7150-25-45-20-SOB
- POS-4000-7150-35-55-30-SOB
- POS-4000-8900-25-45-20-SOB
- POS-4000-8900-35-55-30-SOB
- POS-4500-7150-25-45-20-SOB
- POS-4500-7150-35-55-30-SOB
- POS-4500-8900-25-45-20-SOB
- POS-4500-8900-35-55-30-SOB
- POS-5000-7150-25-45-20-SOB
- POS-5000-7150-35-55-30-SOB
- POS-5000-8900-25-45-20-SOB
- POS-5000-8900-35-55-30-SOB
- POS-6000-7150-25-45-20-SOB
- POS-6000-7150-35-55-30-SOB
- POS-6000-8900-25-45-20-SOB
- POS-6000-8900-35-55-30-SOB
- POS-7000-8900-25-45-20-SOB
- POS-7000-8900-35-55-30-SOB
- POS-8000-8900-25-45-20-SOB
- POS-8000-8900-35-55-30-SOB
Moda Select HDHP Medical Plan Options
- HDHP-POS-3000-3000-0-SOB
- HDHP-POS-2800-5000-20-SOB
- HDHP-POS-2800-5000-30-SOB
- HDHP-POS-3000-5000-20-SOB
- HDHP-POS-5000-5000-0-SOB
- HDHP-POS-3000-7000-30-SOB
Pharmacy is Embedded in the Medical Rates for HDHP Plans
Pharmacy Tiers: Value/Select/Preferred/Non Preferred/Preferred Specialty/Non Preferred Specialty
HDHP Plans: All plans include HSA administration services through Benefit Help Solutions at no additional charge.
✝ All tiers except Value are $15 or 50% (whichever is greater). This Rx plan is not Medicare Part D creditable.
2022 Small group benefit summaries
2024
2023
2024 Small group benefit summaries
Endeavor Select medical plan options
- Endeavor Select Gold 500
- EndeavorSelect Gold1000
- Endeavor Select Gold 1500
- Endeavor Select Gold 2000
- Endeavor Select Silver 2500
- Endeavor Select Silver 3000
- Endeavor-Select-Silver 4000
- Endeavor Select Bronze 6000
- Endeavor Select Bronze 9150
- Endeavor Select Gold HDHP 1600
- Endeavor Select Silver HDHP 3500
- Endeavor Select Bronze HDHP 6000
- Endeavor Select Bronze HDHP 8000
Pioneer medical plan options
- Pioneer Gold 500
- Pioneer Gold 1000
- Pioneer Gold 1500
- Pioneer Gold 2000
- Pioneer Silver 2500
- Pioneer Silver 3500
- Pioneer Silver 4000
- Pioneer Bronze 8550
- Pioneer Gold 1600 HDHP
- Pioneer Silver 2800 HDHP
- Pioneer Silver 3500 HDHP
- Pioneer Bronze 5950 HDHP
- Pioneer Bronze 7100 HDHP
2023 Small group benefit summaries
Plan name | In-network/Tier-1 benefit (per person) | Benefit Summary (SB) | SBC | ||
---|---|---|---|---|---|
Deductible | Out-of-pocket max | PCP office visit copay/coinsurance | |||
Gold | |||||
Endeavor Select Gold No-Deductible | $0 | $8,550 | 30% | ![]() |
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Endeavor Select Gold 500 | $500 | $7,500 | $30* | ![]() |
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Endeavor Select Gold 1000 | $1,000 | $6,700 | $25* | ![]() |
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Endeavor Select Gold 1500 | $1,500 | $6,000 | $25* | ![]() |
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Endeavor Select Gold 2000 | $2,000 | $6,000 | $30* | ![]() |
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Endeavor Select Gold HDHP 1500 | $1,500 | $3,500 | 20% | ![]() |
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Pioneer Gold 500 | $500 | $6,400 | $25* | ![]() |
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Pioneer Gold 1000 | $1,000 | $6,400 | $25* | ![]() |
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Pioneer Gold 1500 | $1,500 | $6,000 | $25* | ![]() |
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Pioneer Gold 2000 | $2,000 | $5,000 | $20* | ![]() |
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Pioneer Gold 1500 HDHP | $1,500 | $3,500 | 20% | ![]() |
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Silver | |||||
Endeavor Select Silver 2500 | $2,500 | $8,900 | $40* | ![]() |
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Endeavor Select Silver 3000 | $3,000 | $8,900 | $40* | ![]() |
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Endeavor-Select-Silver 4000 | $4,000 | $8,900 | $50* | ![]() |
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Endeavor Select Silver HDHP 2500 | $2,500 | $7,150 | 25% | ![]() |
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Endeavor Select Silver HDHP 3250 | $3,250 | $7,000 | 25% | ![]() |
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Pioneer Silver 2200 | $2,200 | $8,800 | $50* | ![]() |
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Pioneer Silver 2500 | $2,500 | $8,550 | $35* | ![]() |
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Pioneer Silver 3500 | $3,500 | $9,100 | $60* | ![]() |
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Pioneer Silver 4000 | $4,000 | $8,900 | $40* | ![]() |
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Pioneer Silver 2800 HDHP | $2,800 | $6,900 | 25% | ![]() |
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Pioneer Silver 3500 HDHP | $3,500 | $6,900 | 20% | ![]() |
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Bronze | |||||
Endeavor Select Bronze 8150 | $8,150 | $8,150 | 0% | ![]() |
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Endeavor Select Bronze 8550 | $8,550 | $8,550 | 0% | ![]() |
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Pioneer Bronze 6700 | $6,700 | $9,100 | $85* | ![]() |
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Pioneer Bronze 7500 | $7,500 | $9,100 | $85* | ![]() |
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Pioneer Bronze 8550 | $8,550 | $8,550 | 0% | ![]() |
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Pioneer Bronze 5950 HDHP | $5,950 | $7,000 | 40% | ![]() |
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Pioneer Bronze 6900 HDHP | $6,900 | $6,900 | 0% | ![]() |
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Endeavor Select Bronze HDHP 7000 | $7,000 | $7,000 | 0% | ![]() |
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2023 Large group benefit summaries
Endeavor Select medical plan options
- Value-500-6500-20-50-20 SOB
- Value-1000-7000-25-50-20 SOB
- Value-1500-7500-25-50-20 SOB
- Value-2000-8150-25-60-20 SOB
- Value-2500-8550-30-60-20 SOB
- Value-3000-8550-30-60-20 SOB
- Value-4000-8550-30-65-20 SOB
- Value-5000-8550-40-80-30 SOB
- Value-6000-8550-45-80-30 SOB
- Value-7000-8550-50-100-30 SOB
- Value-8550-8550-50-100-0 SOB
- PPO-0-8700-20 SOB
- PPO-500-3500-20-20 SOB
- PPO-1000-4500-25-20 SOB
- PPO-1500-4500-25-20 SOB
- PPO-2000-4500-25-20 SOB
- PPO-2500-6000-30-20 SOB
- PPO-3000-6000-30-20 SOB
- PPO-4000-6000-30-20 SOB
- PPO-5000-8550-40-30 SOB
- PPO-6000-8550-45-30 SOB
- PPO-7000-8550-50-30 SOB
- PPO-8550-8550-50-0 SOB
- HDHP-1500-3000-20 SOB
- HDHP-2000-5000-20 SOB
- HDHP-2500-5000-20 SOB
- HDHP-3000-5000-20 SOB
- HDHP-4000-6000-20 SOB
- HDHP-5000-7000-20 SOB
- HDHP-6000-7000-20 SOB
- HDHP-7000 SOB
Pioneer medical plan options
2021 Small group benefit summaries
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2021 Small group benefit summaries
Plan Tier | Plan Type | 2021 Alaska small group plans (1-50) | In-network benefit (per person) | ||||
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Deductible | Out-of-pocket max | PCP office visit copay/coinsurance | SB | SBC | |||
Gold Plans | |||||||
1-Gold | Select | Endeavor Select Gold No Deductible | $0 | $8,550 | 30% | ![]() |
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1-Gold | Select | Endeavor Select Gold 500 | $500 | $6,750 | $30/visit | ![]() |
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1-Gold | Select | Endeavor Select Gold 1000 | $1,000 | $6,750 | $30/visit | ![]() |
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1-Gold | Select | Endeavor Select Gold 1500 | $1,500 | $6,750 | $30/visit | ![]() |
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1-Gold | Select | Endeavor Select Gold 2000 | $2,000 | $6,750 | $30/visit | ![]() |
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1-Gold | Select | Endeavor Select Gold HDHP 1500 | $1,500 | $3,500 | 20% after deductible | ![]() |
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1-Gold | Select | Pioneer Gold 750 (Tier 1) | $750 | $5,000 | $25/visit | ![]() |
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1-Gold | Select | Pioneer Gold 1500 (Tier 1) | $1,500 | $5,000 | $25/visit | ![]() |
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1-Gold | Select | Pioneer Gold 1500 HDHP (Tier 1) | $1,500 | $3,500 | 20% after deductible | ![]() |
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Silver Plans | |||||||
2-Silver | Select | Endeavor Select Silver 2500 | $2,500 | $8,550 | $40/visit | ![]() |
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2-Silver | Select | Endeavor Select Silver 3000 | $3,000 | $8,550 | $40/visit | ![]() |
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2-Silver | Select | Endeavor Select Silver 4000 | $4,000 | $8,550 | $40/visit | ![]() |
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2-Silver | Select | Endeavor Select Silver HDHP 2500 | $2,500 | $6,000 | 25% after deductible | ![]() |
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2-Silver | Select | Endeavor Select Silver HDHP 3250 | $3,250 | $7,000 | 25% after deductible | ![]() |
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2-Silver | Select | Endeavor Select Silver HDHP 4000 | $4,000 | $7,000 | 25% after deductible | ![]() |
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2-Silver | Select | Endeavor Select Silver HDHP 5000 | $5,000 | $6,400 | 25% after deductible | ![]() |
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2-Silver | Select | Pioneer Silver 2500 (Tier 1) | $2,500 | $6,000 | 25% after deductible | ![]() |
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2-Silver | Select | Pioneer Silver 4000 (Tier 1) | $4,000 | $7,000 | 25% after deductible | ![]() |
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2-Silver | Select | Pioneer Silver 2500 HDHP (Tier 1) | $2,500 | $8,550 | $35/visit | ![]() |
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2-Silver | Select | Pioneer Silver 4000 HDHP (Tier 1) | $4,000 | $8,550 | $35/visit | ![]() |
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Bronze Plans | |||||||
3-Bronze | Select | Endeavor Select Bronze 4000 | $4,000 | $8,550 | 50% after deductible | ![]() |
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3-Bronze | Select | Endeavor Select Bronze 5000 | $5,000 | $8,550 | 50% after deductible | ![]() |
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3-Bronze | Select | Endeavor Select Bronze 6000 | $6,000 | $8,550 | $55/visit | ![]() |
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3-Bronze | Select | Endeavor Select Bronze 8550 | $8,550 | $8,550 | $55/visit | ![]() |
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3-Bronze | Select | Endeavor Select Bronze HDHP 7000 | $7,000 | $7,000 | 0% after deductible | ![]() |
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3-Bronze | Select | Pioneer Bronze 5000 (Tier 1) | $5,000 | $8,550 | $50/visit | ![]() |
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3-Bronze | Select | Pioneer Bronze 6500 (Tier 1) | $6,500 | $8,550 | $50/visit | ![]() |
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3-Bronze | Select | Pioneer Bronze 8550 (Tier 1) | $8,550 | $8,550 | $50/visit | ![]() |
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3-Bronze | Select | Pioneer Bronze 7000 HDHP (Tier 1) | $7,000 | $7,000 | 0% after deductible | ![]() |
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