Summer 2021

See what’s NEW for 2021-22!

Our 2021-22 health plans offer even more value and variety for you. See what’s new and what’s staying the same.

Get more value and variety this upcoming plan year, and enjoy some exciting additions.

As a reminder – Moda 360 is available to Moda Health medical members

Healthcare can be complicated. That’s why we created Moda 360 – your own enhanced member support team. Moda 360 consists of:

• Moda 360 Health Navigators: Moda 360 Health Navigators support you and your family by helping you navigate the sometimes-complex healthcare system. They will answer any questions you may have and serve as your guide to connect you with the care, resources and programs that will work best for you.
• Specialized behavioral health support: You can get therapy on your smartphone through our partner, Meru Health. Completely confidential, this online program provides 12 weeks of treatment to help with depression, anxiety and burnout. Access Meru Health.
• Access to a doctor via text: Enjoy fast and private access to a dedicated doctor in under a minute! Use the CirrusMD app for any health question or advice. Doctors are available 24/7 with no member cost-share. Access CirrusMD.

Effective 10/1/2021

New for medical and dental members

Moda 360 integrated medical and dental: Members with Moda Health medical and Delta Dental coverage will have Moda 360 integrated medical and dental care. This means members will talk to a Moda 360 Health Navigator every time they call – one person to help them with their medical and dental questions. The Health Navigator can help connect them with integrated disease management, education and everything needed to take good care of their oral health and overall health.

Changes to pharmacy benefits

New specialty generic drug tier: We’ve added a generic tier for specialty medications. The copay will match the traditional generic copay of $12 per 31-day supply or $36 per 90-day supply when allowed.

Navitus Health Solutions: We are changing our pharmacy benefits manager to Navitus. This means you and your enrolled family will receive a new ID card this year with new information to share with your pharmacy. Please make sure you bring your new ID card with you to your pharmacy so they can update your coverage information.

Just in case you have not received your new ID card by 10/1 and need to fill a prescription, the following information will need to be updated with your pharmacy:

• Bin: 610602
• PCN: NVT
• Rx Group ID: OEBB

You can download a digital copy of your ID card any time by logging in to your Member Dashboard.

While we anticipate minimal disruption with the transition to Navitus, any members who may be impacted by a formulary or pharmacy network change will be notified two months prior to 10/1. Any members who currently have a prior authorization on file for a medication will not need a new prior authorization.

Lastly, in order to access and view your previous pharmacy claims history in your Member Dashboard, you will need to log in to your Member Dashboard before 9/30/21 for your history to be saved.

 

New dental plan

Exclusive PPO – Incentive Plan: Delta Dental has added a new, incentive level plan that uses the same PPO network as the Exclusive PPO plan. Please note you must use a PPO provider to receive in-network benefits, there is no out-of-network coverage. Services provided by a Premier or non-contracted dentist will not be covered. You can find PPO providers in your area by using Find Care .

 

Please check with your entity on their plan selection as some entities do not offer all Moda Health medical plans or Delta Dental Plans.