1 OF 8 MODA HEALTH PLAN, INC.: MODA HEALTH BE TRANQUIL (GOLD) COVERAGE PERIOD: 01/01/2016 – 12/31/2016 SUMMARY OF BENEFITS AND COVERAGE: WHAT THIS PLAN COVERS & WHAT IT COSTS COVERAGE FOR: INDIVIDUAL AND FAMILY | PLAN TYPE: PPO QUESTIONS: CALL 1-855-522-9807 OR VISIT US AT WWW.MODAHEALTH.COM. IF YOU AREN’T CLEAR ABOUT ANY OF THE UNDERLINED TERMS USED IN THIS FORM, SEE THE GLOSSARY.

Moda Health Plan, Inc.: Moda Health Be Tranquil (Gold)

Tranquil Family Home Plan Plan - 1 of 8 Moda Health Plan, Inc.: Moda Health Be Tranquil (Gold) Coverage Period: 01/01/2016 – 12/31/2016 Summary of Benefits and Coverage: What this Plan Covers & What it Costs Coverage for: Individual and Family | Plan Type: PPO Questions: Call 1-855-522-9807 or visit us at www.modahealth.com. If you aren’t clear about any of the underlined terms used in this form, see the Glossary.. File Shared by on .



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