Moda Select Bronze 8700 ($0 Virtual Care $2 Rx Value Tier)

17933TX0010006
Expanded Bronze
EPO

Moda Select Bronze 8700 ($0 Virtual Care $2 Rx Value Tier) is an Expanded Bronze EPO plan by Moda Health, Inc..

IMPORTANT: You are viewing the 2023 version of Moda Select Bronze 8700 ($0 Virtual Care $2 Rx Value Tier) 17933TX0010006. You can enroll in this plan during open enrollment 2023, which started November 1st and ends January 15th, 2023, in most states.

Locations

Moda Select Bronze 8700 ($0 Virtual Care $2 Rx Value Tier) is offered in the following counties.

Plan Overview

This is a plan overview for 2023 version of Moda Select Bronze 8700 ($0 Virtual Care $2 Rx Value Tier) 17933TX0010006.
Insurer: Moda Health, Inc.
Network Type: EPO
Metal Type: Expanded Bronze
HSA Eligible?: No
Plan ID: 17933TX0010006

Cost-Sharing Overview

Moda Select Bronze 8700 ($0 Virtual Care $2 Rx Value Tier) offers the following cost-sharing.

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 Select Bronze 8700 ($0 Virtual Care $2 Rx Value Tier)?

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 Select Bronze 8700 ($0 Virtual Care $2 Rx Value Tier) 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 Select Bronze 8700 ($0 Virtual Care $2 Rx Value Tier) covers when you are out of the service area or out of the country.

Out of Country Coverage: No
Out of Country Coverage Description: Emergency only
Out of Service Area Coverage: Yes
Out of Service Area Coverage Description: Emergency care covered, Out of Area children covered who are enrolled under QMCSO
National Network: No

Additional Benefits and Cost-Sharing

Moda Select Bronze 8700 ($0 Virtual Care $2 Rx Value Tier) includes the following benefits at the cost sharing rates listed below.

Free Preventive Services

There is no copayment or coinsurance for any of the following Moda Select Bronze 8700 ($0 Virtual Care $2 Rx Value Tier) 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.

Additional Resources

Below are additional resources for Moda Select Bronze 8700 ($0 Virtual Care $2 Rx Value Tier) 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 Select Bronze 8700 ($0 Virtual Care $2 Rx Value Tier)?

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

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