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Q&A: Out-of-Area Services

Q: How do students/dependents living out of the service area access services?

A:  If you have a dependent planning to live outside the service area, make sure to update their address by using your MyOEBB account or by contacting your employer’s human resources or payroll department. Effective the first of the month following the request or address update, the dependent’s plan will be updated to allow out-of-area care at the in-network benefit level according to the terms outlined in your member handbook. You can also contact Moda Health at 866-923-0409 to have the plan updated, but you will still need to update the dependent’s address in MyOEBB.

Dependents living and accessing care outside the service area do not need to select a Medical Home; however, if out-of-area dependents plan to access primary care while visiting home within the service area, they should select a Medical Home to use while in the service area in order to receive the in-network benefit level.

Q: What are my benefits when traveling?

A:  Members have access to the Moda Health travel network. The travel network allows medical plan members to receive emergency and nonemergency care outside of their primary service area while traveling. Eligible members need to seek care from a First Health Network provider to receive in-network benefits.

Dependents living outside of the primary network area can also use the Moda Health travel network to receive care at an in-network benefit level. More information about setting up dependents in “out-of-area” status can be found on the eligibility FAQ.

The Moda Health travel network is not an alternative primary network. Members must seek in-network services whenever possible, and preauthorization is required for in-patient services.

If a member is traveling out of the service area and seeks care from an out-of-network physician or provider, the benefit will be paid at the out-of-network benefit level. Out-of-network benefits are subject to the maximum plan allowable.

Q: What if I am out of the service area and have a medical emergency?

A: If a member is out of the service area and has a medical emergency, the member should go to the nearest emergency room or urgent care facility. Benefits will be paid at the in-network benefit level, subject to the maximum plan allowable for urgent and emergency services.

Q: I’m going to be traveling to a remote location where I won’t have access to a pharmacy or mail delivery.  Is it possible to stock up on my prescriptions before I leave?

A: In rare circumstances like this, Moda may approve an “override” allowing your pharmacist to dispense more than the standard maximum amount of your medication.  Depending on the details of the situation, you may be asked to pay the full cost of some or all of the medication up front, then submit the receipts for reimbursement after Moda is able to verify your insurance was still in place at the time a refill would have normally occurred.  Whatever the circumstances, Moda can usually work something out to ensure you have the medication you need when you need it.  Initiate the process as far in advance as possible by calling Moda Pharmacy Customer Service at (866) 923-0411.