Open Enrollment: 2023 Plan Changes

Plan changes effective January 1, 2023 are provided below.

Medical Plans     ::     Dental Plans     ::     Vision Plan

Rate Changes:

Increased cost:

  • Providence Plans
  • MODA Health Plan
  • Kaiser Health Plans

Same cost:

  • Kaiser Dental

Decreased Cost:

  • Willamette Dental
  • Delta Dental
  • VSP

Medical Plans

Providence Choice

  • New manufacturer coupon prescription program — You may be able to pay less for high-cost specialty medications by using a manufacturer’s coupon. If your medication is eligible, you’ll be automatically enrolled in PHP’s SmartRx program. PHP will reach out to explain the program. They will also assist in enrolling or reenrolling for a manufacturer’s coupon.
  • New medically necessary breast reduction surgery benefit — PHP is adding coverage for women’s breast reduction surgery in cases where it’s medically necessary, such as to relieve back pain.
  • New diabetes prevention program — PHP will send eligible members an invitation to join Omada, a new interactive weekly lifestyle training program. When you join the program, you receive a wireless smart scale to monitor your progress. You can also partner with a trained health coach to increase physical activity, reduce stress, and lose weight. Or join a group of peers to share tips and get motivated.

Moda Synergy

  • New medically necessary breast reduction surgery benefit — Moda is adding coverage for women’s breast reduction surgery in cases where it is medically necessary, such as to relieve related back pain.
  • Change to diabetic testing supplies — Moda is changing how glucose monitors and supplies are covered under the plan beginning January 1: » These supplies will be covered only under the prescription drug benefit instead of the medical plan. » This means you will buy diabetic supplies directly from a participating retail or mailorder pharmacy. » There will be no change in your member cost share for these supplies. Glucose monitors and diabetic supplies will continue to be covered in full. » Note: If you had prior authorization under the medical plan, this authorization will automatically transfer to the prescription drug plan. You will still need to ask your provider to send a new prescription to be able to purchase your Continuous Glucose Monitor (GCM)from a network pharmacy
  • Diabetes prevention program — Members who have been identified as at high risk for developing Type 2 diabetes will receive an invitation from Moda Health to join Livongo. If you enroll, you will receive the following at no cost: » An advanced smart scale and app » Unlimited one-on-one expert coaching » Guidance on creating healthy habits that last » All-in-one weight, activity, and food tracking

    Kaiser Plans

  • No 2023 benefit changes. (Note: Medically necessary breast reduction surgery and a diabetes prevention program are already available through Kaiser Permanente.)

Dental Plans

MODA/Delta Dental

  • Enhanced orthodontia benefit — Delta Dental is increasing to $1,800 per person per lifetime. This increased coverage applies to the full-time PPO and Premier plans. If you’re currently in treatment, contact the Health Navigators at Delta Dental at 844-827-7100 for additional information on this enhanced benefit.

  • Kaiser Dental

  • No 2023 benefit changes

Vision Plans

VSP Basic

  • Enhanced frame allowance benefit — When you purchase glasses from Walmart or Sam’s Club, you will receive an increased frame allowance. The increased amount is $150 for the Base plan.

VSP Plus

  • Enhanced frame allowance benefit — When you purchase glasses from Walmart or Sam’s Club, you will receive an increased frame allowance. The increased amount is $225 for the Plus plan.
  • Lower copay for retinal screening — VSP is reducing the copay for retinal screenings on the Plus plan to $10.