Did you know that even if you lose your group health coverage, you may still be able to continue having health insurance through Moda Health? If you are an employee or member whose coverage terminated under a Moda Health group medical benefit plan, you may be eligible to enroll in a Moda Health Portability Plan.

All of your dependents may also get coverage under the Moda Health Portability Plan, provided that your dependents were covered under your prior plan. Dependents include your spouse and dependent children.

Eligibility for coverage under a portability plan also extends to:

• A surviving spouse of a deceased individual
• Each surviving child of a deceased individual who had no surviving spouse
• A spouse or any child who no longer qualifies as your family

This assumes that each such person was covered under your prior plan.

Requirements

You are eligible for portability coverage under this agreement if you meet all of the following requirements:

• You have been continuously covered (not counting any employment probationary period prior to coverage) for 180 days or more under one or more Oregon group health benefits plans, or you meet the eligibility requirements of the Health Insurance Portability and Accountability Act of 1996.
• You have applied for portability coverage no later than the 63rd day after termination of your prior coverage.
• You are not eligible for prior group coverage or would remain eligible for prior group coverage under the Federal Employee Retirement Income Security Act of 1974, as amended, were it not for action by the plan sponsor relating to actual or expected health condition(s) of the individual.
• You are not covered under another health benefit plan at the time that portability coverage would begin.
• You are not eligible for the federal Medicare program.
• You are an Oregon resident.

Spouse’s eligibility

Your spouse or registered domestic partner is eligible for coverage if he or she is under 65 years of age and is not covered under another health benefit plan.

Children’s eligibility

Your children are eligible if they are under age 26 and are not covered under another health benefit plan.

Plans

You must choose the plan below that is consistent with the plan you had with your former employer.

• Managed care plan | Rates | Application | Prevailing SBC | Low Cost SBC
• PPO plan | Rates | Application | Prevailing SBC | Low Cost SBC

A Uniform Glossary is available to help you understand the most common terms in healthcare.

Automatic payments

It’s easy to set up automatic payments for your coverage, so you don’t have to worry about remembering your premiums every month. Just submit an electronic funds transfer form.

Submission

Submit all documents to:

Moda Health
Attn: Billing and Eligibility department
601 S.W. 2nd Ave., Ste. 900
Portland, OR 97204-9747