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Beneficial Rx (PPO)

The Beneficial Rx plan is best for those looking for a higher level of benefits and a lower total out-of pocket cost. The Beneficial Rx plan includes services that can be accessed before the deductible, including preventive care, pharmacy services, limited doctor’s office or urgent care center visits, and alternative care.

Benefit Summary
Plan yearThe 12-month period commencing on the effective date and each 12-month period thereafter. deductible options $1,000 / $2,500 / $5,000
  Member Responsibility
In Network Out of Network
Out-of-pocketA specified amount of applicable claims expenses in a plan year that must be met before benefits are paid in full. Once the member has met his or her out-ofpocket maximum, the plan begins covering eligible expenses at 100 percent. The out-of-pocket maximum starts over every plan year. maximum, per person (after deductible) $3,000 $6,000
Preventive Care
Annual women's exam — pap, pelvic, breast $15 co-payThe insured patient's share of the total medical bill, usually expressed as a specific dollar amount paid for a given service, product or treatment. For example, the patient might pay $20 for each doctor's office visit. The patient is usually responsible for payment at the time of the treatment or service.* 40%
Women's routine mammogram $15 co-pay* 40%
Well-baby care $15 co-pay* Not covered
Routine physical exams $15 co-pay* Not covered
Immunizations $0 co-pay* Not covered

*DeductibleThe portion of an individual's applicable healthcare expenses that must be paid by the member in a given year before the insurance plan will start paying for treatment. waived.

**Beneficial plans pay first three office visits with a co-payment, which may be used for either office visits or urgent care for illness and injury. Alternative care includes an additional three visits with a co-payment. Thereafter, the deductible and co-insuranceThe percentage of allowable charges for which the patient is responsible. apply for additional office visits and alternative care.

This is a benefit summary only. For a complete description of benefits, refer to your Policy. Effective July 1, 2007 through June 30, 2008
Professional Services
Office visits First 3 at $15** 40%
Alternative Care ($1000 Annual Benefit Maximum):
Chiropractic, Naturopathic and Acupuncture		 First 3 at $15** 40%
Maternity
All pre/post office visits and doctor delivery; hospital charges 20% 40%
Hospital Services
Inpatient and outpatient surgery; room, ancillary and
physician charges; skilled nursing facility care		 20% 40%
Emergency Services
Urgent care First 3 at $15** 40%
Emergency room (deductible applies) 20% after
$100 co-pay
Ambulance 20%
Other Facilities and Services
Lab and X-ray services; rehabilitation services; medical supplies and devices; in-hospital care; home healthcare 20% 40%
Prescription services $15 generics or 50% brand*; $5,000 annual maximum benefit

Lifetime maximum

 $2,000,000 ($250,000 out-of-network)
Value-Added Services

When you join ODS, you get health plans enhanced by a wide variety of helpful value-added services. Medical members have access to:

  • myODS, a personalized website allowing you to manage your own plan.
  • eDocAmerica a secure account for emailing health questions and concerns directly to a physician.
  • Registered Nurse Advice Line, a toll free number providing access to a nurse's advice 24 hours a day.

In addition to these tools, you'll discover benefit plans that are actually easy to understand. And teams of ODS Health Professionals dedicated to your healthy, happy life.

All of our health plans include access to the largest directly contracted PPO medical provider network in Oregon. With more than 11,000 providers in the ODS Network participating across all specialties — including primary care, surgery, radiology, anesthesiology, vision, chiropractic, naturopathic and acupuncture — your service needs have been anticipated.