Moda Plans

Detailed documents and plan information for Moda Medical and (Delta) Dental plans.

On this page

  1. Who Do I Contact?
  2. ArrayRx Pharmacy Information
  3. Other information
  4. 2025 Plan Documents (see end of page for 2024 documents)
  5. Moda Medical - Additional Documents
  6. Moda Delta Dental
  7. 2024 Plan Documents

Who Do I Contact?

www.modahealth.com

Moda Medical Customer Service: 888-445-7413

Moda Delta Dental Customer Service: 888-447-8194

VSP*(Vision) Customer Service: 800-877-7195 (Note: The Moda Major Medical plan does not include vision services)

ArrayRx Pharmacy Information

Customer Support: 

Information on Rx Tiers & Costs

You can find the tier of your current medications in the Preferred Drug List (PDL) (updated quarterly)

PDL TierModa PPO 400 Tier
Value & PreventativeValue
SelectTier 1
Generic SpecialtyTier 1
Preferred BrandsTier 2
High Cost GenericsTier 2
Preferred SpecialtyTier 2
Non-Preferred BrandsTier 3
Non-Preferred SpecialtyTier 3
EXC - Plan ExclusionNot Covered

Then, use the charts below to see your expected costs.

PPO 400 -Medication Tiers & Employee Costs

Retail 30 Day SupplyRetail 90 Day SupplyMail Order 90 Day Supply
Value Tier: ≤$4Value Tier: ≤$12Value Tier: ≤$8
Tier 1: 20%, max of $50Tier 1: 20%, max of $150Tier 1: 20%, max of $30
Tier 2: 20%, max of $50Tier 2: 20%, max of $150Tier 2: 20%, max of $125
Tier 3: 50%Tier 3: 50%Tier 3: 50%

Moda Major Medical - Medication Tiers & Employee Costs

Retail 30 Day SupplyRetail 90 Day SupplyMail Order 90 Day Supply
Value Tier: ≤$4Value Tier: ≤$12Value Tier: ≤$8
Tier 1: 30% after deductibleTier 1: 30% after deductibleTier 1: 30% after deductible
Tier 2: 30% after deductibleTier 2: 30% after deductibleTier 2: 30% after deductible
Tier 3: 30% after deductibleTier 3: 30% after deductibleTier 3: 30% after deductible

*Medication prices vary between pharmacies and can change at the same pharmacy location due to market demand and price fluctuations. See further prescription plan details on the Medical Plan Comparison.

Mail Order Pharmacies

Note: A Costco membership is not needed to use Costco mail order.

Other Documents:

Other information

Claims to submit? Send an itemized statement from your provider to multco@modahealth.com or submit through your member dashboard.

Moda Provider Search - You can search for Moda's providers as a guest by selecting the "Connexus" network. After your plan start date, you can also search by using your subscriber ID# or member dashboard.

Look below for your plan handbooks and program flyers. Additional Moda forms, e.g. reimbursement or release of information forms, are available on the Moda Forms page.

2025 Plan Documents (see end of page for 2024 documents)

When reviewing your plan information below, please be sure to choose the document that corresponds to the medical plan you are enrolled in (PPO 400 or Major Medical), as these documents are specific to the stated plan. (Not sure? View your current benefits on the Workday Benefits and Pay Hub).

If you would like a printed copy of any of these documents, or access in another language, contact the Benefits Office at 503-988-3477 or employee.benefits@multco.us.

Moda PPO 400 Plan

Moda Major Medical Plan

Note: The 2025 Moda Major Medical Plan is not Medicare Part D creditable prescription drug coverage but will be creditable in 2026. 

Delta Dental 50 Plan

Moda Medical - Additional Documents

VSP* (Vision) - Moda PPO 400 Plan Additional Documents

Moda Delta Dental

Choose your provider from the available networks:

  • Delta PPO Network dentists offer services with the lowest out-of-pocket costs.
  • Dentists on the Premier Network are also in-network providers, but services can be more costly.
  • Services provided by an out-of-network provider are subject to balance billing and therefore, most costly.

Moda Delta Dental - Additional Documents

2024 Plan Documents

Moda PPO 400 Plan

Moda Major Medical Plan

For Medicare Retirees

Delta Dental 50 Plan

Last reviewed September 17, 2025

Was this page helpful?

Select one