Medical benefits and plan materials
As an OEBB member, you get access to high-quality medical care from a diverse network of providers, plus other perks to keep you healthy. Get the most out of your benefits, so you can avoid surprise costs while getting the best available care.
Coordinated care
With coordinated care, your primary care provider works with all of your specialists and other providers to make sure you get the care you need, which can mean faster ways to get care and overall cost savings.
Get money back when you see top providers with Garner
When you use Garner™ to find top doctors in your area, you can get a reimbursement up to $950 for an individual plan or $1,900 for a family plan. Plus, you know you’ll be getting care from a provider that has the highest ratings for quality care.* That means you get quality care at a higher reimbursement for you.
*This program is not insurance. Moda Health Plan, Inc. (Moda) is not affiliated with Garner. Moda has contracted Garner for this service. Moda does not aid in data collection or provider scoring and is not responsible for any reimbursement from utilizing Garner Top Providers and does not administer HRAs.
How your coverage works
To get the most from your medical plan, there are a few things to know about how your coverage works.
For more information, see our OEBB coverage FAQs.
Deductible
The amount you pay for covered services before your plan begins to pay benefits.
Coinsurance
The percentage of eligible services that you pay after you’ve met your deductible.
Copay
A fixed dollar amount for some services that you are responsible for paying when receiving care.
Out-of-pocket maximum
The most you’ll pay for eligible expenses during a plan year, including coinsurance, copay and deductible. Moda Health pays 100% of your eligible expenses for the rest of the plan year.
Maximum plan allowance (MPA)
The most Moda Health will reimburse when you receive care from an out-of-network provider. The provider may bill you for any amount over the MPA, which could leave you with high out-of-pocket costs.
PCP 360
A primary care provider who is part of a facility that has been certified by the Oregon Patient-Centered Primary Care Program or other similar programs. This means that a PCP 360 has to meet certain quality standards.
Benefit and plan material
As an OEBB member, you have the flexibility of multiple plan options. This lets you choose the deductible, coinsurance and copay amounts to match your needs.
Member handbooks
Download your member handbook for detailed information about your plan, including a description of your benefits and which services need prior authorization.
Summary of benefits and coverage
Plan summaries show how you and the plan would share the cost of covered services and answers common questions about benefits.
High Deducible Health Plans (HDHP) and Health savings account (HSA)
Moda’s medical plans 6 and 7 are High-Deductible Health Plans, which can be paired with an HSA. An HSA lets you use tax-free funds for eligible healthcare costs, including deductibles, coinsurance and other qualified expenses not covered by your health plan. HSA members enjoy a number of tax advantages, including:
- Contributions made on a tax-advantaged basis
- Unused funds carried over from year to year, growing tax-deferred
- Tax-free withdrawal of funds to pay for qualified medical expenses
To enjoy the benefits of an HSA compliant plan, you can reach out to your employer, who chooses the HSA vendor administering your plan. Your employer can provide additional information and answer your questions.
A network that connects you to thousands of providers
Your OEBB plan uses the Connexus network, one of the largest PPO networks in the state of Oregon. It includes thousands of providers to connect you with care where it’s close to you.
You’ll get the best benefits with in-network providers. If you use out-of-network providers, they may bill you for the difference between your maximum plan allowance and their charges.
Benefits while traveling
You can receive urgent or emergency care outside of your primary service area while traveling with our out-of-area network. To learn more about using this network, see our OEBB coverage FAQs.
You can find an out-of-area network provider using Find Care and selecting the Aetna® PPO Network through Aetna Signature Administrators®. You can also call our Health Navigator team at 866-923-0409.
Benefits for out-of-area dependents
If you have a dependent who lives outside your primary service area, they can receive coverage through one of our other networks, depending on where they live. Remember to update their address in the myOEBB system before they seek services. To learn more about which network your dependent should use, see our OEBB coverage FAQs.
Dual coverage
If you have dual medical coverage under OEBB (for example, as part of a married couple), you can get coverage from both plans. To see examples of how dual coverage works, see our OEBB coverage FAQs.
Injury and surgical care
Are you considering surgery? It’s important to get the care you need. But you should also understand your options.
Some treatments cost less and are less invasive than surgery. Depending on your condition or injury, anti-inflammatory medication, weight loss and modified physical activity can work just as well.
The procedures below have an additional cost tier (ACT) that require a copay in addition to any deductible and coinsurance. This is designed to encourage you to talk to your provider about less invasive treatment options.
- Arthroscopy
- Bariatric surgery
- *Hip replacement
- *Knee replacement
- Upper endoscopy
- Spine surgery for pain
*Subject to Reference Price Program for statewide (Connexus Network) plans.
LGBTQIA+ inclusive care benefits
We encourage our LGBTQIA+ members and allies to be their healthiest selves. Your OEBB benefits include inclusive preventive care, mental health support and gender-affirming care.
- Regular checkups with supportive providers can help you catch health concerns early.
- Online or in person, LGBTQIA+-friendly behavioral health resources make it easier to take care of your mental wellness.
- Transgender and non-conforming members can connect with safe, compassionate providers for a range of gender-affirming treatments.