Beginning Jan. 1, 2025, PeaceHealth will transition to a new medical and pharmacy plan provider — Moda Health.

This change is part of our commitment to caring for you — the people who carry out our Mission, every day. Providing you and your families with access to the resources you need to focus on your mental, physical, spiritual and financial health and well-being is what we call Nurture360. It's whole-person care, and it's part of who we are at PeaceHealth.

With this transition, you can expect:

1. A robust medical plan that aligns with our well-being philosophy, with a focus on choosing PeaceHealth and ZoomCare for care and offering innovative solutions that improve access and meet the unique needs of our caregivers.
2. An expansive and flexible pharmacy plan with enhanced benefits when using PeaceHealth pharmacies.
3. Highly customized network options to accommodate you and your family.
   • Moving to Tier III: Legacy Salmon Creek Medical Center (providers remain Tier II), McKenzie Surgery Center, McKenzie-Willamette Medical Center, and Option Care at Legacy Health
   • Family Care Network remains excluded from coverage
4. A robust support system to help you navigate the network.

Please go to the Medical Plans tab for additional details on the 2025 Medical Plans.

For changes to Medical premiums, please click on the Plan Rates tab.

We have developed a highly customized network with Moda, which is not their standard network structure.  It was designed to reflect PeaceHealth’s well-being philosophy, with a focus on offering innovative solutions that improve access and meet the unique needs of our caregivers. The providers in Tier I will be the same across all 3 medical plans.

Tier I (In-Network): PeaceHealth Network, includes:

• PeaceHealth facilities and employed professional providers
• ZoomCare
• The Clinically Integrated Network community providers*
• PeaceHealth Joint Ventures**
• Slocum professional providers (the surgery center is Tier II)
• Willamette Valley Cancer Institute: Oncology Associates of Oregon
• Seattle’s Children's Hospital (the providers are Tier II) - for caregivers residing in Alaska and NW Washington)

**PeaceHealth Joint Ventures include Fresenius Kidney Care Longview, LLC, Mt. Baker Imaging, LLC, RiverBend Ambulatory Surgery Center, Southwest Washington Regional Surgery Center, Oregon Imaging Centers and Emerging Health, LLC.

To search for a Tier I provider, visit modahealth.com/peacehealth > Explore Networks

Tier II (In-Network): You will be assigned to a home network based on where you reside (Oregon/SW Washington (Cowlitz and Clark Counties), NW Washington, Alaska or all others. The providers in Tier I will be the same across all 3 medical plans, but the Tier II providers will vary based on where you live.

Note: In 2025 the following providers will be in Tier III (Out-of-Network) and are covered at a different benefit level for the PPO and ABHP plans; there is NO coverage for them on the EPO (unless true emergency): Legacy Salmon Creek Medical Center (providers remain Tier II), McKenzie Surgery Center, McKenzie-Willamette Medical Center, and Option Care at Legacy Health. Family Care Network remains excluded from coverage. When searching the directory on the PeaceHealth/Moda site, these providers will be displayed.

Please visit the Moda Health tab for additional details.

To search for a Tier II provider, visit modahealth.com/peacehealth > Explore Networks

Tier III (Out-of-Network): Tier III providers are not contracted and are therefore considered out-of-network. That means contracts are not in place to keep costs low for you and protect you from balance billing, the amount a provider will charge you above what the plan pays.

• For the PPO and ABHP plans, a small amount of provider fees may be paid — and any balance left will be billed to you.
• If you choose the EPO plan, there will be no coverage for Tier III providers unless it is a true medical emergency.

Review the Transition of Care Checklist to help guide you through the big and little things to help you get ready.

If you’re in the middle of treatment, scheduled for a procedure in January, or you’re pregnant, and your providers will not be in-network in 2025, don’t worry, Moda can help. You may be eligible to have your claims paid at a higher benefit level for a specific amount of time to support your health. Fill out the Transition of Care Request Form to get started.