Medical plans
With our plans, your employees will enjoy affordable, quality care whenever they need it. Plans vary by premiums, deductibles, copays and coinsurance.
PPO plans
We offer a wide selection of preferred provider organization (PPO) plans to meet your specific needs. Our PPO plans combine great benefits with access to PPO contracted physicians and hospitals to help members save money. Members can visit any provider they choose, but they’ll get the best benefits, a greater selection of doctors and broader geographic coverage when visiting a PPO-contracted provider.
EPO plans
EPO plans are designed to offer a personalized care experience that helps members find their way to better care, value and health. There are no out-of-network benefits with an EPO plan except for medical emergency services and retail pharmacy services. All healthcare provider and specialists must be in the Moda Select Network or the member will be responsible for the full cost of out-of-network services.
High-deductible health plans (HDHP)
These plans are compatible with a health savings account (HSA). Having an HDHP allows members to use tax-free funds for eligible healthcare expenses. They can simply check to see if their financial institution has an HSA. Members with this plan option can choose a financial institution that offers HSA accounts to get the tax advantages.
Equal Funding option
Moda Health is proud to offer Equal Funding as an option for employers who value cost control and transparency when purchasing a health plan. With Equal Funding, you get greater financial transparency while still offering your employees a wide range of benefits and the support to get the most out of them.
How Equal Funding works
Moda Health’s Equal Funding plan allows employers to pay for their maximum exposure over 12 predictable monthly payments. Once the policy period ends, if there is a surplus position, an administrative fee credit will be applied to the following policy year.
The plan contains three components:
- A self-funded medical plan, which covers medical services and pharmacy expenses for your employees
- An agreement with Moda Health that provides third-party administration for claims processing, billing, customer service and other administrative services
- A stop-loss insurance policy from Moda Health that helps protect your employers from large catastrophic claims by a covered individual(s), and provides overall protection if combined medical and pharmacy claims exceed the expected annual limit
Why Equal Funding is different
With Equal Funding, if covered claims are higher than expected, the stop-loss insurance policy will cover them. However, if healthcare claims are lower than expected, employers will receive a credit toward the next plan year's administrative fees. The premium equivalent includes the cost of estimated healthcare claims and fixed-cost items (administrative fees and stop-loss insurance premiums). This calculated amount is considered employers' “maximum liability” to eliminate surprises at the end of the year. A portion of the monthly payments will go toward a claims funding account, which covers employees’ eligible claims. At the end of the year, the claims funding payments will be compared with the actual claims costs. If actual claims costs for the year are less than expected, the plan has a surplus.
Self-insured (ASO) option
An arrangement between an employer and Moda Health where we provide administrative services, such as the processing of claims or communication of benefits to subscribers, to the employees of the employer. The employer is responsible for paying the cost of the healthcare service provided.
Contact us about funding options
Medical networks
Moda Select Network
The Moda Select Network is a contracted network focused on Value Based Care (VBC). With VBC, providers and hospitals are paid based on patient health outcomes. Serving Hays, Travis and Williamson counties in the greater Austin area, the Moda Select Network directs members to manage their health in close partnership with a primary care provider (PCP) and receive high-quality care at affordable costs. The network includes a carefully selected community of PCPs, specialists and partner health systems.
American Specialty Healthcare Group (ASHG)
For more than 30 years, ASHG has been providing musculoskeletal provider network services to employer groups throughout the country. ASHG will be the network members within the state of Texas use to find outpatient providers of occupational, speech, physical and massage therapy. They will also use it to meet any alternative care needs such as chiropractic and acupuncture.
First Health network
When members hit the road, care is never far away. While traveling outside the network service areas, members can receive emergency or urgent care through the First Health Network, which is paid at the in-network amount.*
Outside the U.S., members may access any provider for emergency care at the in-network cost-sharing amount. This care is subject to balance billing. Other care received outside the U.S. is not covered.
*Traveling for the purpose of seeking care does not qualify for the travel network benefit.
Additional services
Third party administrative services via BenefitHelp Solutions
BenefitHelp Solutions, a Moda Health subsidiary, provides third-party administrative services, sorting through the ever-changing laws, regulations, intricate policies and guidelines of benefits management. They offer comprehensive support that includes:
- Administration of flexible spending accounts, commuter expense reimbursement accounts and health reimbursement arrangements
- Online access to account balances, claims status, payment details and claims submission
- AutoPay enhancement for direct claim submission
- Full-service COBRA administration
- Premium administration, including retiree and other group premiums
Based on your funding type and plan, you may have access to some of these services. To learn more about how BenefitHelp Solutions can help you, visit the BenefitHelp Solutions website, or call 888-387-5440.
More info
Pharmacy plans
We’ve got your employees’ pharmacy needs covered with affordable plans and a network of 58,000 pharmacies nationwide.
Moda Wellbeing
Empower your employees to be better in every way with Moda Wellbeing — a comprehensive collection of innovative services, programs and tools.