Fall 2023

Exciting new plan changes await you

With Open Enrollment going on now through Oct. 31, we’ve made some exciting plan changes to help you unlock more value throughout the 2024 plan year.

See what’s new! Starting Jan. 1, 2024, the following plan changes will apply to medical, pharmacy and dental.

Medical:

• Spring Health: You will have access to behavioral health telehealth services via phone, tablet, or computer that includes mental health therapy, psychiatry, care navigation, digital cognitive behavioral therapy. To access Spring Health, you will want to log in to your Member Dashboard account (effective 1/1/24).
• Virta: If you or enrolled dependent have type 2 diabetes, you will now have access to Virta Health, a virtual clinic for type 2 diabetes reversal and prevention. You can eat your way to better health thanks to personalized food plans and support from medical providers, professional coaches and digital health tools, at no cost to you. Eligible members will receive an invite to the program.
• Out-of-Area (OOA) dependents: Out-of-area children are assigned to an out-of-area network, which is their primary network. To receive the in-network benefit level, they must see a provider in the OOA network. Services by providers outside of the out-of-area or primary networks, including those within a 30-mile radius, are subject to the out-of-network benefit level.
• Facial electrolysis: Coverage for facial electrolysis is now covered for members with the diagnosis of Polycystic Ovary Syndrome (PCOS) and hirsutism.
• Travel and Lodging (T&L) coverage: We will reimburse T&L cost for the patient plus one adult companion for authorized, covered services when an in-network provider is not available within 50 miles of member’s home; covered services are not available in the member’s state residence due to law or regulation, when such services are received in another state as legally permissible; or services in which a COE is recommend. Reimbursement is limited to $5,000 annually.

Pharmacy:

• Copay Max Plus Program (Access Guidance): This industry-leading copay program allows you to use the full benefit of manufacturer assistance to offset their costs at the point-of-sale (PoS).
  • Assistance no longer accrues towards the deductible and out-of-pocket max
  • Applies to more than 450 drugs
  • Letters will be sent to affected members by 11/1.
• There is currently a combined $35k annual benefit maximum for medical and pharmacy fertility expenses. Effective 1/1/24, there will now be a $25k annual benefit maximum for medical expenses with an unlimited pharmacy maximum.
• Pharmacy network: CVS out-of-network claims will no longer be reimbursed.

Dental

• No changes.

Don’t forget to take your Health Assessment

New this year, Moda partnered with a new vendor called Sprout to offer this year’s Health Assessment. You will access the new Health Assessment the same way you did last year, through your Member Dashboard account but you will need to create a Sprout to take your Health Assessment.

When you take part in the Health Engagement Model (HEM):

• PEBB pays you a taxable incentive of $17.50 per month.
• If you decide not to take part, you will have a higher deductible.

Take your Health Assessment

Take these easy steps to get started.

1. Log in to your Member Dashboard. If you don’t have an account, select “Create an account.” You’ll need your Moda Health member ID to complete your registration.
2. Once you’re in, scroll down and choose “Health Risk Assessment.”
3. Press “Sign up” to create a Sprout account.
4. After you’ve entered your account information, follow the instructions to take your Health Assessment.

To learn more, please visit our PEBB’s HEM Program webpage.