How health and dental plans work

Your way to better health

Health plans can help you get well and stay healthy. That’s because they cover some of the costs of the care you receive. Those costs might include a doctor visit, hospital stay, prescription medications, mental health treatment or physical therapy.

When you buy a health plan, the insurance company pays part of your medical costs if you get sick or hurt. Almost all plans have a deductible, a cost you must cover before the plan starts to pay.

Many plans come with extras, like free health coaching, fitness tips and a nurse advice line. Moda Health plans include these resources and more. As a member, you can access them by logging in to myModa, your personalized website, from your desktop computer or mobile device.

Health plan coverage basics

In Moda Health medical plans, most in-network preventive care is fully covered. In-network providers have contracted with us to help get you the best rates. Preventive care includes women’s annual exams, well-baby care, routine physicals, immunizations and more. Benefit amounts vary for other types of care and procedures.

Costs you are responsible for paying include:

  • Premium – The monthly amount you pay for your plan.
  • Deductible – The amount you pay for care that requires you to cover some costs before the health plan starts paying.
  • Copayment (copay) – A set dollar amount you pay for a service, like a doctor’s appointment.
  • Coinsurance – The percentage of a medical bill you pay, usually after you meet your deductible.

Once you meet your out-of-pocket maximum, the plan covers eligible expenses at 100 percent up to the allowed amount. Deductibles, coinsurance and copays count toward your out-of-pocket maximum.

Healthy teeth, happy smiles

Dental plans work similarly to medical insurance plans. You pay a monthly premium that entitles you to benefits like regular checkups, cleanings, x-rays and other services that promote dental health. Some plans provide coverage for dentures or certain types of oral surgery.

Moda’s individual and family dental coverage gives you access to Delta Dental, one of the nation’s largest dental networks.

Dental plan coverage basics

Dental plans offer three classes of coverage. Each class provides specific types of treatment and covers each one at a certain percentage. Limitations and exclusions may apply. Benefit levels vary from plan to plan, so be sure to read your benefits information carefully.

Costs you are responsible for paying include:

  • Premium – The monthly amount you pay for your dental plan.
  • Deductible – The amount you pay for care that requires you to cover some costs before the dental plan starts paying.
  • Coinsurance – The percentage of a dental bill you pay, usually after you meet your deductible.
  • Costs that exceed the dental annual maximum – There is a maximum dollar amount a dental plan will pay toward the cost of dental care for members ages 19 and over within a calendar year. There is an annual maximum that applies to out of network benefits only for members under age 19.

Learn how to pick the right plan.