Networks protect members, near and far
All of Moda Health's medical plans come with a medical network of licensed health professionals, clinics, pharmacies, labs and hospitals. These providers offer quality care and services to Moda Health members at an agreed-upon cost.
For dental networks, please visit DeltaDentalOR.com for more information.
In-network care offers better value
Members get a better benefit and can save money by seeing in-network providers. These providers offer quality care and services to our members at an agreed-upon cost.
Care from out-of-network providers may also be subject to "balance billing" - the difference between what the plan allows or reimburses and the providers' billed charges. In-network providers don't do this.
Is a provider in-network?
Members should use our provider search tool, Find Care, to see which network(s) our contracted providers are in.
Medical networks in Oregon
Here are the medical provider networks for our Oregon small and large group members. Members save money by seeing in-network providers. Check medical plan summaries to see which medical network each small group plan includes.
Connexus Network
When your employees want our broadest selection of providers across Oregon, Connexus Network has them covered. Your employees located anywhere in Oregon can choose a plan with this network. Members can see in-network providers in all counties in Oregon and some areas in Washington and Idaho.
Moda Select
New for 2022, we are introducing the Moda Select Network. In partnership with OSHU Health, we have created a network that brings the best combination of care, value and health. OHSU Health is committed not only to being the state's leader in quality, providers, innovations and treatments, but also in the ability to deliver greater value for Oregonians.
Serving Clackamas, Multnomah and Washington counties in the greater Portland tri-county metro area, Moda Select Network helps employees residing in these counties manage their health in close partnership with their primary care provider (PCP) and the rest of their care team. The result is a personalized experience that gives members access to high-quality, coordinated care and value at affordable costs.
In addition to OHSU, Moda Select gives members access to a community of quality providers, including OHSU Hillsboro Medical Center and Adventist Health Portland.
Networks outside of Oregon
Aetna® PPO Network through Aetna Signature Administrators® (ASA)
When members are on the road, care is never far behind. When traveling outside the network service area, members can receive emergency or urgent care through the comprehensive ASA PPO Network. With one national network, it's easy for members to find an in-network provider when traveling.
Members with individual and employer-sponsored plans in Oregon have access to a network of quality healthcare providers and hospitals nationwide, including:
- Over 1.5 million participating physicians and ancillary providers
- More than 6,000 hospitals
- Presence in all 50 states
To search for participating providers in the ASA PPO Network, visit aetna.com/asa to access the online provider directory.
Questions?
We're here to help. Contact our Sales and Account Services team for friendly support.
Networks protect members, near and far
All of Moda Health's plans come with a provider network. Each medical network is a group of licensed health professionals, clinics, pharmacies, labs and hospitals located. These providers offer quality care and services to Moda Health members at an agreed-upon cost.
For dental networks, please visit DeltaDentalAK.com for more information.
In-network care offers better value
It's important to remember that members may pay more for services from out of-network providers than from in-network providers. Out-of-network providers may balance bill members the difference between the maximum plan allowance and their billed charges when permitted by law.
Is a provider in-network?
Members should use our provider search tool, Find Care, to see which network(s) our contracted providers are in.
Medical networks in Alaska
Choose one in-state network to offer employees - either Endeavor Select or Pioneer.
Endeavor Select
This Alaska network covers participating physicians, clinics and ancillary providers throughout the state. It includes Alaska Regional Hospital as the preferred provider of acute care services in the Anchorage area. Members can see First Choice PPO panel providers in Alaska for in-network care.
Pioneer Network
For residents in the Municipality of Anchorage, Fairbanks North Star, Haines, Kenai Peninsula, Ketchikan Gateway, Mat-Su, Petersburg and Municipality of Skagway boroughs, City and Borough of Juneau, City and Borough of Sitka, SEARHC, Hoonah-Angoon Census Area and Prince of Wales-Hyder Census Area)
The Pioneer Network was developed to provide cost-effective, coordinated care. Pioneer offers three benefit levels (tiers) of healthcare:
- Tier One. Includes Central Peninsula Hospital, Alaska Regional Hospital, PeaceHealth Ketchikan Medical Center, Bartlett Regional Hospital, Mat-Su Regional Medical Center, South Peninsula Hospital, Fairbanks Memorial Hospital, SEARHC and other Tier One contracted providers.
- Tier Two. It includes the First Choice Network in Alaska.
- Tier Three. All other Alaska providers not in Tier One or Tier Two.
Members can use any professional provider or hospital. However, Tier Three providers can balance bill when permitted by law. Members receive the best benefit by using Tier One providers.
Networks outside Alaska
Aetna® PPO Network through Aetna Signature Administrators® (ASA)
When members are on the road, care is never far behind. When traveling outside the network service area, members can receive emergency or urgent care through the comprehensive ASA PPO Network. With one national network, it's easy for members to find an in-network provider when traveling.
Members with individual and employer-sponsored plans in Alaska have access to a network of quality healthcare providers and hospitals nationwide, including:
- Over 1.5 million participating physicians and ancillary providers
- More than 6,000 hospitals
- Presence in all 50 states
To search for participating providers in the ASA PPO Network, visit Find Care or aetna.com/asa to access the online provider directory.
Questions?
We're here to help. Contact our Sales & Account Service team for friendly support.
Networks protect members, near and far
Each Moda Health medical plan and Delta Dental Plan of Oregon plan comes with a provider network. Each medical network is a group of licensed health professionals, clinics, pharmacies, labs and hospitals located in a certain area. These providers offer quality care and services to Moda Health members at an agreed-upon cost. Each dental network includes network dentists who accept the Delta Dental contracted fee so there will be no additional balance billing.
View our networks:
In-network care offers better value
Members get a better benefit and can save money by seeing in-network providers. These providers offer quality care and services to our members at an agreed-upon cost.
Care from out-of-network providers may also be subject to "balance billing" ‐ the difference between what the plan allows or reimburses and the providers' billed charges. In-network providers don't do this.
Is a provider in-network?
Members can find out by visiting modahealth.com and using Find Care. They choose a network and look for a doctor, dentist or facility nearby.
Questions?
We're here to help. Contact our Sales and Account Services team for friendly support.
2019 medical networks
Here are the 2019 medical provider networks for our Oregon small and large group members. Members save money by seeing in-network providers. Check medical plan summaries to see which medical network each small group plan includes.
Connexus Network
Our traditional PPO plans give members access to the Connexus Network, one of the largest PPO medical networks in Oregon. Members will enjoy access to more than 80 hospitals and 26,000 providers in Oregon, Washington and Idaho. In-network and out-of-network benefits are available, and no primary care selection is required. PPO plans may be the best option for members looking for statewide coverage.
Coordinated Care Model (CCM) plans
Our CCM plans, powered by the Synergy and Summit networks, offer patient-centered care with a team-based approach. The plans connect a primary care provider with the rest of a member's care team (other providers, specialists, etc.) to bring members the best treatments, facilitated through a Medical Home. By choosing a CCM plan, members will enjoy a team-based approach to healthcare, and a dedicated Medical Home that coordinates care across the healthcare system for better health outcomes. The CCM plan is the best option for members looking for partners to help them on their healthcare journey. This is also the ideal option for members who are managing an existing condition because of its laser focus on wellness, prevention and improving their quality of life.
Synergy Network
Groups located in western Oregon can choose a plan with this network. Members living or working in these areas can access care through the nearby Medical Home they select.
Hospitals and health systems affiliated with the Synergy Network include:
- Adventist Health
- Asante
- Bay Area Hospital
- Columbia Memorial Hospital
- Legacy Health
- Mercy Medical Center
- Mid-Columbia Medical Center
- Oregon Health Science University (OHSU)
- PeaceHealth
- Salem Clinic
- Salem Health
- Samaritan Health Services
- Santiam Hospital
- Sky Lakes Medical Center
- St. Charles Health System
- Tillamook Regional Medical Center
- Tuality Healthcare (OHSU partner)
- Willamette Valley Medical Center
Synergy Network covers these counties:
Benton, Clackamas, Clatsop, Columbia, Coos, Crook, Curry, Deschutes, Douglas, Hood River, Jackson, Jefferson, Josephine, Klamath, Lane, Lincoln, Linn, Marion, Multnomah, Polk, Tillamook, Wasco, Washington and Yamhill.
Summit Network
Groups located in eastern Oregon can choose a plan with this network. Members living or working in this area can access care through the nearby medical home they select.
Hospitals and health systems affiliated with the Summit Network include:
- Blue Mountain Hospital
- Good Shepard Health Care System
- Grande Ronde Hospital
- Harney District Hospital
- Pioneer Memorial Hospital - Heppner
- Saint Alphonsus Medical Center ‐ Baker City, Boise, Nampa and Ontario
- St. Anthony Hospital
- St. Luke's Regional Medical Center
- Wallowa Memorial Hospital
Summit Network covers these counties:
Baker, Gilliam, Grant, Harney, Lake, Malheur, Morrow, Sherman, Umatilla, Union, Wallowa and Wheeler.
Medical homes make care personal
Members can find out more information about Medical Homes by visiting modahealth.com/medicalhome.
Networks outside of Oregon
Members living in states outside of Oregon can receive in-network care through the following networks.
First Choice Health Network
Members living in most counties in Washington can receive in-network care through First Choice Health Network. It includes thousands of doctors, hospitals and other medical providers across many specialties.
Private HealthCare Systems (PHCS) Network
Members living outside of Oregon or Washington in the U.S. can see providers in the PHCS Network for in-network care. It is the largest PPO medical network nationwide, with thousands of doctors and clinics, and hundreds of hospitals, to choose from.
Travel network - First Health Network
When members hit the road, care is never far away. While traveling outside the network service areas, members can receive emergency or urgent care through the First Health Network which is paid at the in-network amount. Traveling for the purpose of seeking care does not qualify for the travel network benefit. Outside the U.S., members may access any provider for emergency care at the in-network cost-sharing amount. This care is subject to balance billing. Other care received outside the U.S. is not covered.
Questions?
We're here to help. Contact our Sales and Account Services team for friendly support.
2019 dental networks
Each Delta Dental of Oregon plan comes with a Delta Dental network. It includes thousands of dentists across the state, and the country.
Depending on the plan type, members access dentists in the Delta Dental Premier or PPO network. Members save money by seeing participating, in-network dentists.
Here are the 2019 dental provider networks for our Oregon small and large group members. Check dental plan summaries to see which dental network each small group plan includes.
Delta Dental Premier® Network
This is the largest dental network in Oregon and across the country. It includes more than 2,400 providers in Oregon and over 155,000 Delta Dental Premier dentists nationwide.
Delta Dental PPO NetworkSM
This is one of the largest preferred provider organization (PPO) dental networks in Oregon and across the country. It includes more than 1,300 participating providers in Oregon and offers access to over 110,000 Delta Dental PPO dentists nationwide.
Questions?
We're here to help. Contact our Sales and Account Services team for friendly support.
Networks protect members, near and far
Health happens, whether employees are at home or on the road, so we've made it easy for them to find in-network coverage.
Each Moda Health medical plan and Delta Dental of Alaska plan comes with a provider network. Each medical network is a group of licensed health professionals, clinics, pharmacies, labs and hospitals located in a certain area. These providers offer quality care and services to Moda Health members at an agreed-upon cost. Each dental network includes network dentists who accept the Delta Dental contracted fee so there will be no additional balance billing.
View our networks:
In- and out-of-network care
It's important to remember that members may pay more for services from out of-network providers than from in-network providers. Out-of-network providers may balance bill members the difference between the maximum plan allowance and their billed charges.
2019 provider networks
Choose one in-state network to offer employees ‐ either Endeavor Providence, Endeavor Select or Pioneer.
Endeavor Providence
This Alaska network covers participating physicians, clinics and ancillary providers throughout the state. It includes Providence Alaska Medical Center as the preferred provider of acute care services in the Anchorage area. Members can see First Choice PPO panel providers in Alaska for in-network care.
Endeavor Select
This Alaska network covers participating physicians, clinics and ancillary providers throughout the state, with the exception of the Kenai Peninsula Borough. It includes Alaska Regional Hospital as the preferred provider of acute care services in the Anchorage area. Members can see First Choice PPO panel providers in Alaska for in-network care.
PHCS Network outside Alaska
For members who choose the Endeavor Providence or Endeavor Select networks, their network outside of Alaska is the PHCS Network.
For care outside Alaska, these members can see providers in the PHCS Network for in-network care. It is the largest PPO medical network nationwide, with thousands of doctors and clinics, and hundreds of hospitals to choose from. PHCS Network gives members plenty of choice and lower out-of-pocket costs.
Pioneer Network (NEW option for residents in the Kenai Peninsula Borough)
The Pioneer Network was developed to provide cost-effective, coordinated care for residents of the Kenai Peninsula Borough. Pioneer offers three benefit levels (tiers) of healthcare:
- Tier One ‐ For Kenai Peninsula Borough residents seeking coordinated care in the community.
- Tier Two ‐ For Alaskans seeking care outside of the Kenai Peninsula Borough. It includes First Choice Network in Alaska and Alaska Regional Hospital.
- Tier Three ‐ All other Alaska providers not in Tier One or Tier Two.
Members can use any professional provider or hospital. However, Tier Three providers can balance bill. Members receive the best benefit by using Tier One providers.
First Health Network outside Alaska
For members who choose the Pioneer network, their network outside of Alaska is the First Health Network. Services received outside Alaska are covered at the Tier One benefit level for urgent and emergency care through providers in the First Health Network.
Is a provider in-network?
Members can find out by visiting modahealth.com and using Find Care. They choose a network and look for a doctor, dentist or facility nearby.
2019 dental networks
Each Delta Dental of Alaska plan comes with a Delta Dental network. It includes thousands of dentists across the state, and the country.
Depending on the plan type, members access dentists in the Delta Dental Premier or PPO network. Members save money by seeing participating, in-network dentists.
Here are the 2019 dental provider networks for our Alaska small group members. Check dental plan summaries to see which dental network each plan includes.
Delta Dental Premier® Network
This is the largest dental network in Alaska and nationally. It includes more than 440 providers in Alaska and over 155,000 Delta Dental Premier Dentists nationwide, serving 50 states, the District of Columbia, Puerto Rico, Guam, the Northern Mariana Islands and the Virgin Islands.
Delta Dental PPO Networksm
The preferred provider option (PPO) dental network in Anchorage, Mat-Su Valley and Fairbanks North Star includes over 190 participating providers and offers access to over 110,000 Delta Dental PPO Dentists nationwide.
Questions?
We're here to help. Contact our Sales and Account Services team for friendly support.
Hello.
We have exciting news to share. ODS is changing its name to Moda Health.
Moda comes from the latin term "modus" and means "a way". We picked it because that's what we are here to do: help our communities find a way to better health.
Together, we can be more, be better.
Please select the state you live in, or the state where your employer is headquartered, so we can tailor your experience:
Hello.
Please select the state you live in, or the state where your employer is headquartered, so we can tailor your experience:
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