Find in-network medical providers
PEBB members have in-network access to medical providers that are close to home. But with Moda Health, you get even more: money back for seeing Garner Top Providers, an out-of-area network, and many other extras.
Explore your benefits and find in-network medical providers from your Member Dashboard.
Get money back for seeing top-rated doctors
Garner™ is an PEBB member benefit that reimburses you for out-of-pocket medical costs for seeing Garner Top Providers. When you use Garner to find doctors in your area, you can get a reimbursement of:
- Up to $1,250 for an individual plan and $2,500 for a family on the Coordinated Care plan.
- Up to $1,000 for an individual plan and $2,000 for a family on the PPO plan.
Selecting a PCP 360 when choosing the Coordinated Care plan
When you choose the Coordinated Care plan you will need to select a PCP 360 to receive in-network benefits for primary care services. To select a PCP 360, you can do so through your Member Dashboard or call the Moda 360 Health Navigator team at 844-776-1593.
More support for your health
A PCP 360 is a primary care provider who has agreed to partner with you and be accountable for your health. They deliver full-circle care.
With traditional care, you’re responsible for seeking care from separate providers. But with coordinated care, your PCP 360 works with all of your specialists and other providers to make sure you get the care you need. Coordinated care gives you:
- A PCP 360 to coordinate your personalized care and services
- Faster ways to get care and extra support to reach your goals
- Overall cost savings as a result of coordinated preventive care
Virtual option for PCP 360
PEBB members can choose a virtual PCP 360 through Teladoc. This is a great way for subscribers who live outside Oregon to participate in coordinated care and receive better benefits. Just select Teladoc as your PCP 360.
Connexus network
Your PEBB plan uses the Connexus network. This is one of the largest PPO networks in the state of Oregon, Alaska, and also stretches from Southern Washington, to Idaho, and into Northern California. It includes thousands of primary care physicians and specialists to connect you with care where it’s close to you.
To see if a specific provider or clinic is in the Connexus network, you can search Find Care by name, specialty, ZIP code or city. You can also call a Moda 360 Health Navigator at 866-923-0409.
In-network vs. out-of-network care
You’ll get the best benefits with in-network providers. It’s important to know that you may pay more for services from out-of-network providers. Out-of-network providers may also bill you for the difference between your maximum plan allowance and their charges. This is known as "balance billing." In-network providers do not do this.
See our plan summaries or your Member Handbook to learn more about in-network and out-of-network benefits and costs.
Out-of-area network
When outside of the Connexus service area, you have access to in-network coverage through the Aetna® PPO Network though Aetna Signature Administrators®. Just select this network when using our Find Care tool to search for providers.
Subscribers and dependents living outside the Connexus service area
Coordinated Care Plan:
- Subscribers who have a dependents who live outside the Connexus service area, can still enroll in Coordinated Care plan. These dependents will use the Aetna PPO® Network when outside of the service area.
PPO Plan:
- Members on the plan who live in Oregon, Southwest Washington, Idaho, or Alaska, you will utilize the Connexus network. If you are outside of the service area, you will use the Aetna PPO network through Aetna Signature Administrators.
Nominate a provider
Don't see your provider in our network? To nominate a medical provider, fill out our medical provider nomination request form. Return the form to your provider's office and let them know you would like them to initiate a network participation request with Moda Health.
Please note: New providers must meet credentialing approval, network needs, state and federal regulations and other factors.
Behavioral health
Our Behavioral Health 360 program gives you different ways to access mental health support. Whether you prefer the personal guidance of a Behavioral Health Champion or the privacy of taking a self-guided assessment, your Member Dashboard makes it easy to find the mental health support that's right for you.
Have questions? We’re here to help.
If you have questions about your benefits or need help finding in-network services, call your Moda 360 Health Navigator team at 844-776-1539. You can also see our frequently asked questions to learn more about your PEBB coverage.