Fall 2021

See what’s NEW for 2022!

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

As always, you will not need a referral from your primary care provider to see the healthcare providers you need. And, you will have access to a wide selection of in-network providers in Oregon, Southern Washington and Idaho, including Oregon Health & Science University (OHSU), Tuality Health, Legacy Health and Adventist Health.

Available for all Moda Health medical members
All medical members can access the Moda 360 program, which 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, free 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

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.

New for medical members

Infertility treatment

Moda Health is expanding the current PEBB infertility services to include the following Assistance Reproductive Technology Services (ARTs) to be covered at 100% up to $35,000 limit:

• IVF: In vitro fertilization
• ZIFT: Zygote intrafallopian transfer
• GIFT: Gamete intrafallopian transfer
• PGSD: Pre-implementation genetic diagnosis
• ICSI: Intracytoplasmic genetic diagnosis
• Ovum microsurgery
• Artificial insemination (including IUI)

Alternative care

The PEBB Moda Health medical plans will no longer have the $1,000 limit for spinal manipulation and acupuncture services. Instead, they will be subject to an annual limit:

• Spinal manipulation: 20-visit limit
• Acupuncture: 12-visit limit
• Massage therapy: $1,000 benefit maximum

Changes to pharmacy benefits

The specialty generic copay will match the generic retail cost-share:

• Full-time plan: $10 copay after the deductible
• Part-time plan: $20 copay after the deductible

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 Jan. 1, 2022, and need to fill a prescription, you will need to ask your pharmacy to update the following information:

Bin: 610602
PCN: NVT
Rx Group ID: PEBB

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 Jan. 1. Any members who currently have a prior authorization on file for a medication will not need a new prior authorization. Also, Costco will be an in-network mail-order pharmacy in addition to Postal Prescription Services (PPS). Links to the mail-order forms will be available in your Member Dashboard

Lastly, in order to access and view your previous pharmacy claims history in your Member Dashboard you will need to log in before Dec. 31, 2022, for your history to be saved.

No dental plan changes
There are no changes to the 2022 Delta Dental plans. For details about your current dental plans, see our latest PEBB brochure.

Questions?

We're here to help. Just email PEBBcustomerservice@modahealth.com or call your Moda 360 Health Navigators at 844-776-1593.