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2025-26 Open Enrollment

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Medical �and pharmacy

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The individual deductible for all medical plans increased by $300.

The individual out-of-pocket maximum (OOPM) for all medical plans increased by $900.

The family deductibles and family OOPMs are now 2x the individual deductibles and OOP maximums instead of 3x.

This change does not apply to the plan 6 and 7 as the family deductible and OOP maximums are already the 2x the individual amounts.

The following copays of medical plans 1-5 increased by $5 dollars:

PCP 360 (Primary Care) office visits
Primary care office visits with a provider other than your chosen PCP 360
Specialist office visits
Mental Health office visits and chemical dependency services
Alternative care office visits
Virtual Care (does not apply to CirrusMD)
Urgent Care
Incentive Care office visits (for asthma, heart conditions, cholesterol, high blood pressure, diabetes

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OEBB plan Changes (Effective 10/1/25)

National Aetna PPO Network

Effective 10/1/25, If you are living in Moda’s service area (Oregon, SW Washington, and Idaho) you will have access to the national Aetna PPO network for care beyond urgent and emergent care.

Diagnostic breast exams

Currently, mammograms are covered in full on all plans, and additional diagnostic and supplemental breast exams are covered in full on plans 1-5.
Effective 10/1/25, additional diagnostic and supplemental breast exams will also be covered in full on plans 6 and 7.

Evicore’s Site of Care (SOC) program

OEBB is adding eviCore SOC program for musculoskeletal (MSK) and advanced imaging.
The SOC program will ensure members and providers are selecting economically appropriate places to deliver care.

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Medical plan overview


Medical plan	Individual Deductible		Family Deductible		Individual Out-of-Pocket		Family Out of Pocket		Primary care and Mental Health/SUPD		Specialist care/Urgent Care		Alternative Care
Medical plan	Coordinated	Non-coordinated	Coordinated	Non-Coordinated	Coordinated	Non-coordinated	Coordinated	Non-Coordinated	Coordinated	Non-coordinated	Coordinated	Non-coordinated	Coordinated	Non-coordinated
Plan 1²	$700	$800	$1,600		$3, 750	$4,150	$8,300		$25¹	20%	$45¹	20%	$45¹	20%
Plan 2²	$1,100	$1,200	$2,400		$4,750	$5,150	$10,300		$25¹	20%	$45¹	20%	$45¹	20%
Plan 6²�HSA optional	$1,900	$2,000	$4,000		$7,300	$7,650	$15,300		15%	20%	15%	20%	15%	20%
Plan 7²�HSA optional	$2,300	$2,400	$4,800		$7,400	$7,650	$15,300		20%	25%	20%	25%	20%	25%

The deductibles, out-of-pocket maximums and copays increased for the 2025-26 plan year.

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Coordinated care: PCP 360 and better benefits

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Choosing a PCP 360

Call a Moda 360 Health Navigator at 866-923-0409 or email them at oebbquestions@modahealth.com

Log in to your Member Dashboard to select a PCP 360 or chat with a �Moda 360 Health Navigator

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Pharmacy benefits – no changes�

	Medical Plans 1 & 2	Medical Plans 6-7
Out-of-pocket maximum	Accrues towards out-of-pocket maximum	Accrues towards out-of-pocket maximum
		Coordinated Care	Non-Coordinated Care
Value	$4 per 31-day supply	$4* per 31-day supply	$4* per 31-day supply
Select generic	$12 per 31-day supply	20%	25%
Preferred brand	25% up to $75 per 31-day supply	20%	25%
Non-preferred brand **	50% up to $175 per 31-day supply	20%	25%
Mail
Value	$8 per 90-day supply	$8* per 90-day supply	$8* per 90-day supply
Select generic	$24 per 90-day supply	20%	25%
Preferred brand	25% up to $150 per 90-day supply	20%	25%
Non-preferred brand **	50% up to $450 per 90-day supply	20%	25%
Specialty***
Generic	$12 per 31-day supply or $36 dollars �when allowed 90-day supply	20%	25%
Preferred brand	25% up to 200$ per 31-day supply	20%	25%
Non-preferred brand **	50% up to $500 per 31-day supply	20%	25%

^*Deductible waived

^**A formulary exception must be approved for non-preferred brand prescription medication

***Allows 90-day fills for select specialty medications (2 times the copay)

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Effective 10/1/25, Moda is excited to share the �new Garner program available to OEBB members.

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OEBB is adding Garner 10/1/2025

Garner is a benefit that helps members find the best doctors and reimburses for out-of-pocket medical costs when you visit these doctors.

Garner analyzes millions of insurance claims to identify the best doctors based on real patient outcomes. These doctors follow medical best practices and keep people healthier.

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The doctor you choose has �a big impact on your health

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How Garner identifies Top Providers

Doctors cannot pay to influence Garner.

Garner identifies Top Providers who:

Follow current medical research.
Successfully diagnose problems.
Achieve the patient outcomes.
Receive the highest patient satisfaction rates.

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Garner will reimburse members for using high-quality providers*

If you are on High-Deductible Health Plan (Medical Plans 6 and 7), you must meet the IRS minimum annual deductible of $1,650 for a self-only plan and $3,300 for a family plan before you can use the Garner incentive.

Office Visits
Imaging
Lab Work
Procedures
Prescriptions

$700 �for Individuals

$1,400�for Families

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Flexible Spending Accounts (FSAs) & �Health Reimbursement Accounts (HRAs)

You cannot get reimbursed by both Garner and your FSA or HRA for the same visit. That’s called “double-dipping,” which violates IRS rules and could result in tax penalties.

You don’t have to use Garner. You can use your FSA or HRA. But if you use Garner to see a Top Provider, they’ll automatically reimburse you up to your yearly limit.

Once Garner has reimbursed you up to the yearly limit ($700 individuals, $1,400 family), you can start using your FSA, HRA, or HSA for future visits with any provider, including Garner Top Providers.

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Health Savings Accounts (HSAs)

If you have an HSA, you cannot be reimbursed by both Garner and your HSA for the same visit. That’s considered “double-dipping,” which violates IRS rules and could result in tax penalties.

For those on Medical Plan 6 and 7, Garner will start reimbursing you after you meet the IRS minimum deductible ($1,650 individuals, $3,330 family). They’ll track your spending and automatically start reimbursing you once you qualify — as long as you see a Garner Top Provider. You can use your HSA any time before Garner starts to reimburse you.

You can also use your HSA after Garner has reimbursed you up to your yearly limit.

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Garner reimbursement example�Single Coverage / High Utilizer / Full-time Employee

Type of Care	Total Cost	2024-25 Moda Plan 1 (CCM)	Notes	2025-26 Moda Plan 1 (CCM)	Notes
6 Specialist Visits ($300 each)	$1,800	$240	($40 copay X 6) Deductible waived	$270	$45 copay x 6 Deductible waived
4 PCP Office Visits ($225)	$900	$80	( $20 copay X 4) Deductible waived	$100	$25 copay x 4 Deductible waived
5 Labs and X-rays	$1,600	$640	$1600-$400 (deductible) = $1200 x 20% coinsurance	$880	$1600-$700 (deductible) = �$900 x 20% coinsurance
MRI	$2,200	$520	($100 copay + 20% coinsurance)	$520	($100 copay + 20% coinsurance)
2-Day Hospital Stay	$6,000	$1,200	20% coinsurance	$1,200	20% coinsurance
Prescription: �12 preferred brand at $100/mo�2 generic prescriptions	$1,248	$170	$100 x 25% coinsurance ; $12 copay for generic x 2 ; minus $154 (hit OOPM)	$320	$100 x 25% coinsurance ;�$12 copay for generic x 2
Total Medical Out-of-Pocket	$13,748
Employee Medical Out-of-Pocket		$2,850	Out-of-pocket met	$3,294	Out-of-pocket
Garner Incentive Reimbursement		N/A		$700
Total Employee Medical Out-of-Pocket Spend	$700	$2,850		$2,594
Garner Incentive Balance		N/A		$0

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How to use Garner

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Creating a Garner Account

To register, you will need to provide the following:

Email Address
Employer Name

You will need to type or select ‘OEBB’ as your employer's name

Name

Please enter your first and last name as it appears on your Moda ID card

Phone Number
Date of Birth (DOB)
The subscriber E number (This is your subscriber ID on your Moda ID card)

For new members, you will need enter your OEBB E number.�If you do not know your E number, you can reach out to your employer or OEBB.

You can create your account during open enrollment.

Meaning you can start searching for providers at this time. These searches will count toward any services you incur after 10/1/2025.

REMEMBER

You must create your Garner account and find a Top Provider before your appointment to get reimbursed.

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PCP 360 Exception

Search for your existing PCP 360* primary care provider or pediatrician, or any existing OB/GYN, gerontologist, or mental health provider.

To add a current primary care provider:

Search by doctor name�
Click “Request”�
Confirm the provider is added to your Approved Providers list

Specialists do not qualify under this policy.

Doctors must have in-network status and must be added to your account before the date of service.

*Teladoc does not qualify for the PCP 360 exception.

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Find Garner Top Providers

You can find nearby providers based on symptoms, name, or the type of care needed.

Providers with a �Top Provider badge �are eligible for reimbursement. �Viewing Top provider badge will automatically add them to the member’s approved providers list.

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Garner Concierge: Live chat for support

Garner’s Concierge team is here to help you with:

Understanding the benefit
Explain the reimbursement process
Find Top Providers

You can reach the concierge team:

Through the app or web page – visit https://app.getgarner.com to learn more.
Email: concierge@getgarner.com
Phone: (458) 488-4828

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Member dashboard (Effective 10/1/25)

Members will be able to access Garner through the member dashboard with Single Sign On.

Members can also download the app on their phone and access Garner directly.

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Network Overview

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Network – Connexus

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Members who live inside the service area

Starting 10/1/25, members who live in Oregon, SW Washington and Idaho now have access to the National Aetna PPO® network for care beyond urgent and emergent care .

Starting 10/1/25, the Connexus network now covers the entire state of Idaho. This change means OEBB members in Idaho will no longer have access to First Health providers.

You will also now have access to Moda’s national network, Aetna PPO® when outside of the service area.

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Members who live outside the service area

To receive care when living outside of the Connexus service area:

Any member who lives outside of the service area will need to update their address in myOEBB to get the correct network.

Dependents who live part-time outside the service area (e.g., college students) can still choose a PCP 360 for the better benefits. They’ll see their PCP 360 when they’re home and use the Aetna PPO® Network when away, except members in Alaska.

If you live in Alaska, you’ll use the First Health Network.

Members who live full-time outside the Connexus service area can get coordinated care through Teladoc’s Primary Care Program.

You must choose Teladoc as your PCP 360 for primary care to get the better benefits.

Members can also get reimbursed outside of the service area when using Garner’s Top Providers. To see if your provider is a Garner Top Provider, visit https://app.getgarner.com.

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Behavioral �Health 360

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Behavioral Health 360 experience

Our Behavioral Health Champions and Self-Guided Assessment offer two ways to help members find care they need to feel their best. Our Behavioral Health Champions can help members with:

Find a local mental health professional that’s right �for you

Get the care �and support �you need �quickly �and easily

Verify provider availability to make it easy for you to book appointments

They’ll also follow up with you to make sure you have what you need and are getting care that works for you.

Call a Behavioral Health Champion at 833-212-5027 �or email them at bhchampions@modahealth.com

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Behavioral Health 360

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Behavioral Health 360

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2023 Producer Roadshow | Alaska

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Behavioral Health 360 vendors

Spring Health provides counseling, psychiatry, �and more via phone, tablet or computer.

Video modeling and skill development for �children with autism & developmental disorder.

Hazelden Betty Ford offers resources� and care for substance use disorder.

Meru Health provides effective treatment �for stress and depression via your smart phone.

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Health Navigators

When a you call the Moda Health OEBB member phone number, you are connected with a �Moda 360 Health Navigator.
They can help members with:

Assistance with appointment scheduling
Connecting members with care programs
Assistance with prior authorizations
Selecting a PCP 360
Claims and provider billing support
Closing gaps in care

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Dental

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There are NO changes to the benefits or plans.
The Exclusive PPO plans do not include out-of-network benefit coverages

If you are enrolled in an Exclusive PPO plan you must �see a Delta Dental PPO provider, or Specialist in order to receive benefits

OEBB members have the Preventive First benefit. �This means preventive services do not accrue towards the annual benefit maximum, leaving additional dollars to use for basic and major services.

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Member cost

Group premium

Member cost

Group premium

Delta Dental plan options – No changes

Plan options	Plan 1	Plan 5	Plan 6
Network	Delta Dental Premier
Deductible	$50	$50	$50
Benefit maximum	$2,200	$1,700	$1,200
In-network, members pay
Preventive/diagnostic	30% - 0%	30% - 0%	0%
Restorative	30% - 0%	30% - 0%	20%
Major restorative - crowns/onlays	30% - 0%	30%	50%
Prosthodontic -implants	30% - 0%	50%	50%
Orthodontic (lifetime maximum - $1,800)	20%	20%	N/A
Occlusal guards (night guards* and athletic mouth guards)	50%	50%	50%
Nitrous oxide	50%	50%	50%

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Health through Oral Wellness® (HtOW)

All OEBB members have access to the HtOW program

Patient-centered wellness program that helps members maintain better oral health through a risk assessment, education and additional evidence-based preventive care.
Providers participating in the program use an oral health assessment to find out the member’s risk of tooth decay, gum disease and oral cancer.

Members may qualify for the following services �depending on their risk score:

Additional cleanings
Fluoride treatment
Sealants
Periodontal maintenance
Nutritional counseling

For more details on HtOW – please see our website: �deltadentalor.com/oralwellness/members/

To see which providers are participating in HtOW, members can look for a green badge shown in Find Care

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Find Care – Delta Dental’s online provider directory

Search for providers in your network

Click on Find Care on the Moda/OEBB homepage

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Vision

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Vision plan options – No changes

Vision plan options	Opal
Benefit maximum	$600
	What members pay
Eye examinations Frequency: Once per plan year	0%
Lenses Frequency: Contacts or one pair of lenses per plan year	0%
Frames Frequency: One pair per plan year for members under age 17; �One pair per every two plan years for members age 17 and older	0%

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Vision – Key things to remember

You may see any licensed ophthalmologist, optometrist �or optician

To receive a discounted rate, �make sure you see a Moda Health contracted provider.

Benefits run on a plan year basis �from Oct. 1 through Sept. 30

The Annual Maximum benefit include vision exam and hardware

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Find Care – Moda Health’s online provider directory

Search for providers in your network

Click on Find Care on the Moda/OEBB homepage

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Available Monday through Friday from 7:30 a.m. to 5:30 p.m. Pacific time.

Or email Moda Health at OEBBquestions@modahealth.com.

You can also chat with the Moda 360 Health Navigator team instantly through your Member Dashboard.

Medical/Vision

866-923-0409

Pharmacy

866-923-0411

Health Navigators

Dental

866-923-0410

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Thank you

© 2024 Moda Health Plan, Inc. All rights reserved. �This information is proprietary and may not be reproduced in whole or in part without the prior written consent of an authorized representative of Moda Health.