Moda Pioneer Alaska Standard Bronze
77963AK0040001
Bronze
PPO
Moda Pioneer Alaska Standard Bronze is a Bronze PPO plan by Moda Assurance Company.
IMPORTANT: You are viewing the 2023 version of Moda Pioneer Alaska Standard Bronze 77963AK0040001. You can enroll in this plan if you qualify for special enrollment until the end of 2023.
Locations
Moda Pioneer Alaska Standard Bronze is offered in the following counties.
Plan Overview
This is a plan overview for 2023 version of Moda Pioneer Alaska Standard Bronze 77963AK0040001.
| Insurer: | Moda Assurance Company |
| Network Type: | PPO |
| Metal Type: | Bronze |
| HSA Eligible?: | No |
| Plan ID: | 77963AK0040001 |
Cost-Sharing Overview
Moda Pioneer Alaska Standard Bronze offers the following cost-sharing.
Cost-Sharing
Out-of-Network Cost-Sharing
Cost-Sharing Examples
Cost-Sharing
Cost-sharing for Moda Pioneer Alaska Standard Bronze includes your out-of-pocket maximum, your annual deductible, and coinsurance under this plan.
| Cost Sharing Type | Individual | Family |
|---|---|---|
| Out-of-Pocket Maximum: | $9,100.00 | $9100 per person | $18200 per group |
| Deductible: | $9,100.00 | $9100 per person | $18200 per group |
| Coinsurance: | 0.00% | |
Out-of-Network Cost-Sharing
Some plans have different cost-sharing out-of-network. The out-of-network cost-sharing for Moda Pioneer Alaska Standard Bronze will be shown below if applicable.
| Cost Sharing Type | Individual | Family |
|---|---|---|
| Out-of-Network Maximum: | $27,300.00 | $27300 per person | $54600 per group |
| Out-of-Network Deductible: | $27,300.00 | $27300 per person | $54600 per group |
Cost-Sharing Examples
The cost-sharing for the sample Summary of Benefits & Coverage (SBC) scenarios of having a baby, having diabetes, and having a simple fracture.
| Deductible: | $9,100.00 |
| Copayment: | $0.00 |
| Coinsurance: | $0.00 |
| Limit: | $50.00 |
| Deductible: | $5,400.00 |
| Copayment: | $0.00 |
| Coinsurance: | $0.00 |
| Limit: | $20.00 |
| Deductible: | $2,800.00 |
| Copayment: | $0.00 |
| Coinsurance: | $0.00 |
| Limit: | $0.00 |
Notes:
- Some plans have separate cost-sharing for medical and drugs, while other plans offer combined cost-sharing. The cost-sharing amounts above are combined medical and drug costs unless otherwise noted.
- You are viewing the standard version of this plan. Your costs may be lower depending on your income. Use the “get a quote” button below to see your estimated premium and out-of-pocket costs after assistance.
Ready to sign up for Moda Pioneer Alaska Standard Bronze?
Click or call to enroll online, get a quote, or find out if you qualify for assistance.
Get Help from a licensed agent. 1-877-668-0904
Plan Features
Moda Pioneer Alaska Standard Bronze offers the following features and referral requirements.
| Wellness Program: | No |
| Disease Program: | |
| Notice Pregnancy: | No |
| Referral Specialist: | No |
| Specialist Requiring Referral: | |
| Plan Exclusions: | |
| Child Only Option?: | Allows Adult and Child-Only |
Network Details
The following network details will help you understand what Moda Pioneer Alaska Standard Bronze covers when you are out of the service area or out of the country.
| Out of Country Coverage: | No |
| Out of Country Coverage Description: | |
| Out of Service Area Coverage: | Yes |
| Out of Service Area Coverage Description: | Out of Network |
| National Network: | Yes |
Additional Benefits and Cost-Sharing
Moda Pioneer Alaska Standard Bronze includes the following benefits at the cost sharing rates listed below.
| Service | In-Network Copay / Coinsurance | Out-of-Network Copay / Coinsurance | Limits and Explanation |
|---|---|---|---|
| Primary Care Visit to Treat an Injury or Illness Covered | No Charge after deductible | – – | |
| Specialist Visit Covered | No Charge after deductible | – – | |
| Other Practitioner Office Visit (Nurse, Physician Assistant) Covered | No Charge after deductible | – – Covered only when the provider is licensed to practice where the care is provided, is providing a service within the scope of that license, is providing a service or supply for which benefits are specified in this plan, and when benefits would be payable if the services were provided by a physician. | |
| Outpatient Facility Fee (e.g., Ambulatory Surgery Center) Covered | No Charge after deductible | – – | |
| Outpatient Surgery Physician/Surgical Services Covered | No Charge after deductible | – – | |
| Hospice Services Covered | No Charge after deductible | – – Inpatient hospice care up to a maximum of 10 days. Respite care, up to a maximum of 240 hours, to relieve anyone who lives with and cares for the terminally ill member. | |
| Routine Dental Services (Adult) | – – | ||
| Infertility Treatment | – – | ||
| Long-Term/Custodial Nursing Home Care | – – | ||
| Private-Duty Nursing | – – | ||
| Routine Eye Exam (Adult) Covered | 50.00% | 1 Exam(s) per Year – – 1 exam per year | |
| Urgent Care Centers or Facilities Covered | No Charge after deductible | – – | |
| Home Health Care Services Covered | No Charge after deductible | 130 Visit(s) per Year – – 130 visits per year applies to home visits of a home health care provider or one or more: registered nurse; a licensed practical nurse; a licensed physical therapist or occupational therapist; a certified respiratory therapist; a speech therapist certified by the American Speech, Language, and Hearing Association; a licensed social worker. | |
| Emergency Room Services Covered | No Charge after deductible | – – | |
| Emergency Transportation/Ambulance Covered | No Charge after deductible | – – Air and Ground transpiration benefit is limited to medical emergency. Ambulance services is separate benefit. | |
| Inpatient Hospital Services (e.g., Hospital Stay) Covered | No Charge after deductible | – – | |
| Inpatient Physician and Surgical Services Covered | No Charge after deductible | – – | |
| Bariatric Surgery | – – | ||
| Cosmetic Surgery | – – | ||
| Skilled Nursing Facility Covered | No Charge after deductible | 60 Days per Year – – | |
| Prenatal and Postnatal Care Covered | No Charge after deductible | – – | |
| Delivery and All Inpatient Services for Maternity Care Covered | No Charge after deductible | – – | |
| Mental/Behavioral Health Outpatient Services Covered | No Charge after deductible | – Biofeedback is limited to the treatment of migraine headaches. – | |
| Mental/Behavioral Health Inpatient Services Covered | No Charge after deductible | – – | |
| Substance Abuse Disorder Outpatient Services Covered | No Charge after deductible | – – | |
| Substance Abuse Disorder Inpatient Services Covered | No Charge after deductible | – – | |
| Generic Drugs Covered | No Charge after deductible | – – Up to 90-day supply for retail and mail order (one copay for each 30 day supply); up to 30 day supply per prescription for specialty pharmacy. | |
| Preferred Brand Drugs Covered | No Charge after deductible | – – Up to 90-day supply for retail and mail order (one copay for each 30 day supply); up to 30 day supply per prescription for specialty pharmacy. | |
| Non-Preferred Brand Drugs Covered | No Charge after deductible | – – Up to 90-day supply for retail and mail order (one copay for each 30 day supply); up to 30 day supply per prescription for specialty pharmacy. | |
| Specialty Drugs Covered | 100.00% | – – Up to 90-day supply for retail and mail order (one copay for each 30 day supply); up to 30 day supply per prescription for specialty pharmacy. | |
| Outpatient Rehabilitation Services Covered | No Charge after deductible | 45 Visit(s) per Year – – Outpatient rehabilitation/habilitation includes physical, speech and occupational therapy and cardiac and pulmonary rehabilitation combined, and is subject to an annual visit limit. There is no annual limit for care for autism spectrum disorders provided. Limits apply separately to rehabilitative and habilitative services. Services to treat intractable or chronic pain are subject to the annual limit. Benefits are not provided for both chronic pain care and neurodevelopmental therapy for the same condition. | |
| Habilitation Services Covered | No Charge after deductible | 45 Visit(s) per Year – – Outpatient rehabilitation/habilitation includes physical, speech and occupational therapy and cardiac and pulmonary rehabilitation combined, and is subject to an annual visit limit. There is no annual limit for care for autism spectrum disorders provided. Limits apply separately to rehabilitative and habilitative services. Services to treat intractable or chronic pain are subject to the annual limit. Benefits are not provided for both chronic pain care and neurodevelopmental therapy for the same condition. | |
| Chiropractic Care Covered | No Charge after deductible | 24 Visit(s) per Year – – | |
| Durable Medical Equipment Covered | No Charge after deductible | – – Orthotics or orthopedic shoes are covered when medically necessary. | |
| Hearing Aids Covered | 20.00% | 3000 Dollars per 3 Years – – | |
| Imaging (CT/PET Scans, MRIs) Covered | No Charge after deductible | – – | |
| Preventive Care/Screening/Immunization Covered | No Charge after deductible | – – Well Baby Exams covered for the first 24 months of life; 3 exams age 2-4; one exam per year age 5+; Newborn Hearing Screening within 30 days of birth. Additional tests up to age 24 months; Routine Vision Screening age 3-5. | |
| Routine Foot Care Covered | No Charge after deductible | – – Covered if required for the member?s medical condition. | |
| Acupuncture Covered | No Charge after deductible | 24 Visit(s) per Year – – Services must be medically necessary to relieve pain, induce surgical anesthesia, or to treat a covered illness, injury or condition. | |
| Weight Loss Programs | – – | ||
| Routine Eye Exam for Children Covered | 50.00% | 1 Exam(s) per Year – – | |
| Eye Glasses for Children Covered | 50.00% | 1 Item(s) per Year – – | |
| Dental Check-Up for Children Covered | No Charge after deductible | 1 Exam(s) per 6 Months – – | |
| Rehabilitative Speech Therapy Covered | No Charge after deductible | 45 Visit(s) per Year – – Outpatient rehabilitation/habilitation includes physical, speech and occupational therapy and cardiac and pulmonary rehabilitation combined, and is subject to an annual visit limit. There is no annual limit for care for autism spectrum disorders provided. Limits apply separately to rehabilitative and habilitative services. Services to treat intractable or chronic pain are subject to the annual limit. Benefits are not provided for both chronic pain care and neurodevelopmental therapy for the same condition. | |
| Rehabilitative Occupational and Rehabilitative Physical Therapy Covered | No Charge after deductible | 45 Visit(s) per Year – – Outpatient rehabilitation/habilitation includes physical, speech and occupational therapy and cardiac and pulmonary rehabilitation combined, and is subject to an annual visit limit. There is no annual limit for care for autism spectrum disorders provided. Limits apply separately to rehabilitative and habilitative services. Services to treat intractable or chronic pain are subject to the annual limit. Benefits are not provided for both chronic pain care and neurodevelopmental therapy for the same condition. | |
| Well Baby Visits and Care Covered | No Charge after deductible | – – Well Baby Exams covered for the first 24 months of life; 3 exams age 2-4; one exam per year age 5+; Newborn Hearing Screening within 30 days of birth. Additional tests up to age 24 months; Routine Vision Screening age 3-5. | |
| Laboratory Outpatient and Professional Services Covered | No Charge after deductible | – – | |
| X-rays and Diagnostic Imaging Covered | No Charge after deductible | – – | |
| Basic Dental Care – Child Covered | No Charge after deductible | – – Frequency limits apply to some services. | |
| Orthodontia – Child Covered | No Charge after deductible | – – Medically necessary repair of disabling malocclusion or cleft palate and severe craniofacial defects impacting function of speech, swallowing and chewing. | |
| Major Dental Care – Child Covered | No Charge after deductible | – – Frequency limits apply to some services. | |
| Basic Dental Care – Adult | – – | ||
| Orthodontia – Adult | – – | ||
| Major Dental Care – Adult | – – | ||
| Abortion for Which Public Funding is Prohibited Covered | No Charge after deductible | – – | |
| Transplant Covered | – – | ||
| Accidental Dental Covered | No Charge after deductible | – – Services must begin within 12 months of the date of injury; diagnosis made within 6 months of date of injury. | |
| Dialysis Covered | No Charge after deductible | – – | |
| Allergy Testing Covered | No Charge after deductible | – – | |
| Chemotherapy Covered | No Charge after deductible | – – | |
| Radiation Covered | No Charge after deductible | – – | |
| Diabetes Education Covered | No Charge after deductible | – – | |
| Prosthetic Devices Covered | No Charge after deductible | – – Benefit limited to initial purchase of prosthetic; does not cover replacement unless the existing device can?t be repaired, or replacement is prescribed by a physician because of a change in your physical condition. | |
| Infusion Therapy Covered | No Charge after deductible | – – | |
| Treatment for Temporomandibular Joint Disorders | – – | ||
| Nutritional Counseling Covered | No Charge after deductible | – – | |
| Reconstructive Surgery Covered | No Charge after deductible | – – Breast reconstruction allowed. | |
| Gender Affirming Care Covered | No Charge after deductible | – – Information about gender affirming care can be found in the policy. | |
| Primary Care Visit to Treat an Injury or Illness Covered | No Charge after deductible | No Charge after deductible | |
| Specialist Visit Covered | No Charge after deductible | No Charge after deductible | |
| Other Practitioner Office Visit (Nurse, Physician Assistant) Covered | No Charge after deductible | No Charge after deductible | Covered only when the provider is licensed to practice where the care is provided, is providing a service within the scope of that license, is providing a service or supply for which benefits are specified in this plan, and when benefits would be payable if the services were provided by a physician. |
| Outpatient Facility Fee (e.g., Ambulatory Surgery Center) Covered | No Charge after deductible | No Charge after deductible | |
| Outpatient Surgery Physician/Surgical Services Covered | No Charge after deductible | No Charge after deductible | |
| Hospice Services Covered | No Charge after deductible | No Charge after deductible | Inpatient hospice care up to a maximum of 10 days. Respite care, up to a maximum of 240 hours, to relieve anyone who lives with and cares for the terminally ill member. |
| Routine Dental Services (Adult) | |||
| Infertility Treatment | |||
| Long-Term/Custodial Nursing Home Care | |||
| Private-Duty Nursing | |||
| Routine Eye Exam (Adult) Covered | $10.00 | 50.00% | 1 Exam(s) per Year 1 exam per year |
| Urgent Care Centers or Facilities Covered | No Charge after deductible | No Charge after deductible | |
| Home Health Care Services Covered | No Charge after deductible | No Charge after deductible | 130 Visit(s) per Year 130 visits per year applies to home visits of a home health care provider or one or more: registered nurse; a licensed practical nurse; a licensed physical therapist or occupational therapist; a certified respiratory therapist; a speech therapist certified by the American Speech, Language, and Hearing Association; a licensed social worker. |
| Emergency Room Services Covered | No Charge after deductible | No Charge after deductible | |
| Emergency Transportation/Ambulance Covered | No Charge after deductible | No Charge after deductible | Air and Ground transpiration benefit is limited to medical emergency. Ambulance services is separate benefit. |
| Inpatient Hospital Services (e.g., Hospital Stay) Covered | No Charge after deductible | No Charge after deductible | |
| Inpatient Physician and Surgical Services Covered | No Charge after deductible | No Charge after deductible | |
| Bariatric Surgery | |||
| Cosmetic Surgery | |||
| Skilled Nursing Facility Covered | No Charge after deductible | No Charge after deductible | 60 Days per Year |
| Prenatal and Postnatal Care Covered | No Charge after deductible | No Charge after deductible | |
| Delivery and All Inpatient Services for Maternity Care Covered | No Charge after deductible | No Charge after deductible | |
| Mental/Behavioral Health Outpatient Services Covered | No Charge after deductible | No Charge after deductible | Biofeedback is limited to the treatment of migraine headaches. |
| Mental/Behavioral Health Inpatient Services Covered | No Charge after deductible | No Charge after deductible | |
| Substance Abuse Disorder Outpatient Services Covered | No Charge after deductible | No Charge after deductible | |
| Substance Abuse Disorder Inpatient Services Covered | No Charge after deductible | No Charge after deductible | |
| Generic Drugs Covered | No Charge after deductible | No Charge after deductible | Up to 90-day supply for retail and mail order (one copay for each 30 day supply); up to 30 day supply per prescription for specialty pharmacy. |
| Preferred Brand Drugs Covered | No Charge after deductible | No Charge after deductible | Up to 90-day supply for retail and mail order (one copay for each 30 day supply); up to 30 day supply per prescription for specialty pharmacy. |
| Non-Preferred Brand Drugs Covered | No Charge after deductible | No Charge after deductible | Up to 90-day supply for retail and mail order (one copay for each 30 day supply); up to 30 day supply per prescription for specialty pharmacy. |
| Specialty Drugs Covered | No Charge after deductible | 100.00% | Up to 90-day supply for retail and mail order (one copay for each 30 day supply); up to 30 day supply per prescription for specialty pharmacy. |
| Outpatient Rehabilitation Services Covered | No Charge after deductible | No Charge after deductible | 45 Visit(s) per Year Outpatient rehabilitation/habilitation includes physical, speech and occupational therapy and cardiac and pulmonary rehabilitation combined, and is subject to an annual visit limit. There is no annual limit for care for autism spectrum disorders provided. Limits apply separately to rehabilitative and habilitative services. Services to treat intractable or chronic pain are subject to the annual limit. Benefits are not provided for both chronic pain care and neurodevelopmental therapy for the same condition. |
| Habilitation Services Covered | No Charge after deductible | No Charge after deductible | 45 Visit(s) per Year Outpatient rehabilitation/habilitation includes physical, speech and occupational therapy and cardiac and pulmonary rehabilitation combined, and is subject to an annual visit limit. There is no annual limit for care for autism spectrum disorders provided. Limits apply separately to rehabilitative and habilitative services. Services to treat intractable or chronic pain are subject to the annual limit. Benefits are not provided for both chronic pain care and neurodevelopmental therapy for the same condition. |
| Chiropractic Care Covered | No Charge after deductible | No Charge after deductible | 24 Visit(s) per Year |
| Durable Medical Equipment Covered | No Charge after deductible | No Charge after deductible | Orthotics or orthopedic shoes are covered when medically necessary. |
| Hearing Aids Covered | 20.00% | 20.00% | 3000 Dollars per 3 Years |
| Imaging (CT/PET Scans, MRIs) Covered | No Charge after deductible | No Charge after deductible | |
| Preventive Care/Screening/Immunization Covered | No Charge | No Charge after deductible | Well Baby Exams covered for the first 24 months of life; 3 exams age 2-4; one exam per year age 5+; Newborn Hearing Screening within 30 days of birth. Additional tests up to age 24 months; Routine Vision Screening age 3-5. |
| Routine Foot Care Covered | No Charge after deductible | No Charge after deductible | Covered if required for the member?s medical condition. |
| Acupuncture Covered | No Charge after deductible | No Charge after deductible | 24 Visit(s) per Year Services must be medically necessary to relieve pain, induce surgical anesthesia, or to treat a covered illness, injury or condition. |
| Weight Loss Programs | |||
| Routine Eye Exam for Children Covered | No Charge | 50.00% | 1 Exam(s) per Year |
| Eye Glasses for Children Covered | No Charge | 50.00% | 1 Item(s) per Year |
| Dental Check-Up for Children Covered | No Charge | No Charge after deductible | 1 Exam(s) per 6 Months |
| Rehabilitative Speech Therapy Covered | No Charge after deductible | No Charge after deductible | 45 Visit(s) per Year Outpatient rehabilitation/habilitation includes physical, speech and occupational therapy and cardiac and pulmonary rehabilitation combined, and is subject to an annual visit limit. There is no annual limit for care for autism spectrum disorders provided. Limits apply separately to rehabilitative and habilitative services. Services to treat intractable or chronic pain are subject to the annual limit. Benefits are not provided for both chronic pain care and neurodevelopmental therapy for the same condition. |
| Rehabilitative Occupational and Rehabilitative Physical Therapy Covered | No Charge after deductible | No Charge after deductible | 45 Visit(s) per Year Outpatient rehabilitation/habilitation includes physical, speech and occupational therapy and cardiac and pulmonary rehabilitation combined, and is subject to an annual visit limit. There is no annual limit for care for autism spectrum disorders provided. Limits apply separately to rehabilitative and habilitative services. Services to treat intractable or chronic pain are subject to the annual limit. Benefits are not provided for both chronic pain care and neurodevelopmental therapy for the same condition. |
| Well Baby Visits and Care Covered | No Charge | No Charge after deductible | Well Baby Exams covered for the first 24 months of life; 3 exams age 2-4; one exam per year age 5+; Newborn Hearing Screening within 30 days of birth. Additional tests up to age 24 months; Routine Vision Screening age 3-5. |
| Laboratory Outpatient and Professional Services Covered | No Charge after deductible | No Charge after deductible | |
| X-rays and Diagnostic Imaging Covered | No Charge after deductible | No Charge after deductible | |
| Basic Dental Care – Child Covered | No Charge after deductible | No Charge after deductible | Frequency limits apply to some services. |
| Orthodontia – Child Covered | No Charge after deductible | No Charge after deductible | Medically necessary repair of disabling malocclusion or cleft palate and severe craniofacial defects impacting function of speech, swallowing and chewing. |
| Major Dental Care – Child Covered | No Charge after deductible | No Charge after deductible | Frequency limits apply to some services. |
| Basic Dental Care – Adult | |||
| Orthodontia – Adult | |||
| Major Dental Care – Adult | |||
| Abortion for Which Public Funding is Prohibited Covered | No Charge after deductible | No Charge after deductible | |
| Transplant Covered | No Charge after deductible | ||
| Accidental Dental Covered | No Charge after deductible | No Charge after deductible | Services must begin within 12 months of the date of injury; diagnosis made within 6 months of date of injury. |
| Dialysis Covered | No Charge after deductible | No Charge after deductible | |
| Allergy Testing Covered | No Charge after deductible | No Charge after deductible | |
| Chemotherapy Covered | No Charge after deductible | No Charge after deductible | |
| Radiation Covered | No Charge after deductible | No Charge after deductible | |
| Diabetes Education Covered | No Charge after deductible | No Charge after deductible | |
| Prosthetic Devices Covered | No Charge after deductible | No Charge after deductible | Benefit limited to initial purchase of prosthetic; does not cover replacement unless the existing device can?t be repaired, or replacement is prescribed by a physician because of a change in your physical condition. |
| Infusion Therapy Covered | No Charge after deductible | No Charge after deductible | |
| Treatment for Temporomandibular Joint Disorders | |||
| Nutritional Counseling Covered | No Charge after deductible | No Charge after deductible | |
| Reconstructive Surgery Covered | No Charge after deductible | No Charge after deductible | Breast reconstruction allowed. |
| Gender Affirming Care Covered | No Charge after deductible | No Charge after deductible | Information about gender affirming care can be found in the policy. |
Free Preventive Services
There is no copayment or coinsurance for any of the following Moda Pioneer Alaska Standard Bronze preventive services. This is true even if you haven’t met your yearly deductible.
Please note, these services are free only when delivered by a doctor or other provider in your plan’s network.
Preventive Care Benefits for All Adults
Preventive Care Benefits for Women
Preventive Care Benefits for Children
Preventive Care Benefits for All Adults
Preventive care benefits for adults
- Abdominal aortic aneurysm one-time screening for men of specified ages who have ever smoked
- Alcohol misuse screening and counseling
- Aspirin use to prevent cardiovascular disease and colorectal cancer for adults 50 to 59 years with a high cardiovascular risk
- Blood pressure screening
- Cholesterol screening for adults of certain ages or at higher risk
- Colorectal cancer screening for adults 45 to 75
- Depression screening
- Diabetes (Type 2) screening for adults 40 to 70 years who are overweight or obese
- Diet counseling for adults at higher risk for chronic disease
- Falls prevention (with exercise or physical therapy and vitamin D use) for adults 65 years and over, living in a community setting
- Hepatitis B screening for people at high risk, including people from countries with 2% or more Hepatitis B prevalence, and U.S.-born people not vaccinated as infants and with at least one parent born in a region with 8% or more Hepatitis B prevalence.
- Hepatitis C screening for adults age 18 to 79 years
- HIV screening for everyone age 15 to 65, and other ages at increased risk
- PrEP (pre-exposure prophylaxis) HIV prevention medication for HIV-negative adults at high risk for getting HIV through sex or injection drug use
- Immunizations for adults — doses, recommended ages, and recommended populations vary:
- Chickenpox (Varicella)
- Diphtheria
- Flu (influenza)
- Hepatitis A
- Hepatitis B
- Human Papillomavirus (HPV)
- Measles
- Meningococcal
- Mumps
- Whooping Cough (Pertussis)
- Pneumococcal
- Rubella
- Shingles
- Tetanus
- Lung cancer screening for adults 50 to 80 at high risk for lung cancer because they’re heavy smokers or have quit in the past 15 years
- Obesity screening and counseling
- Sexually transmitted infection (STI) prevention counseling for adults at higher risk
- Statin preventive medication for adults 40 to 75 at high risk
- Syphilis screening for adults at higher risk
- Tobacco use screening for all adults and cessation interventions for tobacco users
- Tuberculosis screening for certain adults without symptoms at high risk
Preventive Care Benefits for Women
Services for pregnant women or women who may become pregnant
- Breastfeeding support and counseling from trained providers, and access to breastfeeding supplies, for pregnant and nursing women
- Birth control: Food and Drug Administration-approved contraceptive methods, sterilization procedures, and patient education and counseling, as prescribed by a health care provider for women with reproductive capacity (not including abortifacient drugs). This does not apply to health plans sponsored by certain exempt “religious employers.”
- Folic acid supplements for women who may become pregnant
- Gestational diabetes screening for women 24 weeks pregnant (or later) and those at high risk of developing gestational diabetes
- Gonorrhea screening for all women at higher risk
- Hepatitis B screening for pregnant women at their first prenatal visit
- Maternal depression screening for mothers at well-baby visits
- Preeclampsia prevention and screening for pregnant women with high blood pressure
- Rh incompatibility screening for all pregnant women and follow-up testing for women at higher risk
- Syphilis screening
- Expanded tobacco intervention and counseling for pregnant tobacco users
- Urinary tract or other infection screening
Other covered preventive services for women
- Bone density screening for all women over age 65 or women age 64 and younger that have gone through menopause
- Breast cancer genetic test counseling (BRCA) for women at higher risk
- Breast cancer mammography screenings
- Every 2 years for women 50 and over
- As recommended by a provider for women 40 to 49 or women at higher risk for breast cancer
- Breast cancer chemoprevention counseling for women at higher risk
- Cervical cancer screening
- Pap test (also called a Pap smear) for women age 21 to 65
- Chlamydia infection screening for younger women and other women at higher risk
- Diabetes screening for women with a history of gestational diabetes who aren’t currently pregnant and who haven’t been diagnosed with type 2 diabetes before
- Domestic and interpersonal violence screening and counseling for all women
- Gonorrhea screening for all women at higher risk
- HIV screening and counseling for everyone age 15 to 65, and other ages at increased risk
- PrEP (pre-exposure prophylaxis) HIV prevention medication for HIV-negative women at high risk for getting HIV through sex or injection drug use
- Sexually transmitted infections counseling for sexually active women
- Tobacco use screening and interventions
- Urinary incontinence screening for women yearly
- Well-woman visits to get recommended services for all women
Preventive Care Benefits for Children
Coverage for children’s preventive health services
- Alcohol, tobacco, and drug use assessments for adolescents
- Autism screening for children at 18 and 24 months
- Behavioral assessments for children: Age 0 to 17 years
- Bilirubin concentration screening for newborns
- Blood pressure screening for children: Age 0 to 17
- Blood screening for newborns
- Depression screening for adolescents beginning routinely at age 12
- Developmental screening for children under age 3
- Dyslipidemia screening for all children once between 9 and 11 years and once between 17 and 21 years, and for children at higher risk of lipid disorders
- Fluoride supplements for children without fluoride in their water source
- Fluoride varnish for all infants and children as soon as teeth are present
- Gonorrhea preventive medication for the eyes of all newborns
- Hearing screening for all newborns; and regular screenings for children and adolescents as recommended by their provider
- Height, weight and body mass index (BMI) measurements taken regularly for all children
- Hematocrit or hemoglobin screening for all children
- Hemoglobinopathies or sickle cell screening for newborns
- Hepatitis B screening for adolescents at higher risk
- HIV screening for adolescents at higher risk
- Hypothyroidism screening for newborns
- PrEP (pre-exposure prophylaxis) HIV prevention medication for HIV-negative adolescents at high risk for getting HIV through sex or injection drug use
Immunizations for children from birth to age 18 — doses, recommended ages, and recommended populations vary:
- Chickenpox (Varicella)
- Diphtheria, tetanus, and pertussis (DTaP)
- Haemophilus influenza type b
- Hepatitis A
- Hepatitis B
- Human Papillomavirus (HPV)
- Inactivated Poliovirus
- Influenza (flu shot)
- Measles
- Meningococcal
- Mumps
- Pneumococcal
- Rubella
- Rotavirus
Lead screening for children at risk of exposure
Obesity screening and counseling
- Oral health risk assessment for young children from 6 months to 6 years
- Phenylketonuria (PKU) screening for newborns
- Sexually transmitted infection (STI) prevention counseling and screening for adolescents at higher risk
- Tuberculin testing for children at higher risk of tuberculosis: Age 0 -17
- Vision screening for all children
- Well-baby and well-child visits
Additional Resources
Below are additional resources for Moda Pioneer Alaska Standard Bronze including the Summary of Benefits & Coverage (SBC), plan brochure, formulary link, and a link to the website to pay your monthly premium after you enroll.
| Summary of Benefits: | Summary of Benefits Link |
| Plan Brochure: | Plan Brochure Link |
| Formulary: | Formulary Link |
| Premium Payment Website: | Premium Payment Link |
Ready to sign up for Moda Pioneer Alaska Standard Bronze?
Click or call to enroll online, get a quote, or find out if you qualify for assistance.
Get Help from a licensed agent. 1-877-668-0904