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Individual Plan FAQs

All Member FAQs

How am I eligible to apply for ODS individual medical and dental plans?

In order to be eligible for any ODS individual medical and dental plan, you and any dependents applying for coverage must be an Oregon resident and live in Oregon at least six months out of the year. Eligible members include you, your legal spouse and any unmarried children younger than age 23. Individuals must be younger than age 65 and not eligible for Medicare.

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Do you offer a dental plan?

We offer two individual dental options. In order to be eligible to enroll in an individual dental plan, you need to enroll when you first apply for an ODS individual medical plan.

Once all underwriting requirements including complete application with future payment method selection, premium, and health history information are received (all dates of treatment, medications, and physicians during the past 5 years), your policy is effective the first of the month following ODS' Underwriting approval notice.

If a 15th effective date is resulting, we will bill for an additional two weeks premium to bring you to a first of the month cycle thereafter.

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What payment methods do you offer?

We offer monthly electronic deduction from your checking account, monthly billing statements with a $2 administrative fee and quarterly payments.

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Can my employer sponsor my individual coverage?

ODS Individual plans cannot be employersponsored plans. You will be responsible for directly paying ODS your monthly premium using a personal check. ODS does not accept employer checks for individual plans.

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When do your rates change?

ODS renews all individual plans on July 1 each year, including benefit and rate adjustments. Rates also change when the primary applicant moves into the next age band; new rates are effective the following month.

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Is there a waiting period for pre-existing conditions?

ODS does not pay toward a pre-existing condition, even if the pre-existing condition worsens or recurs during the first six months you or your dependent(s) are insured under the policy. However, creditable coverage can reduce the six-month period if an individual’s most recent period of creditable coverage is still in effect on the date of enrollment or ended within 63 days of the effective date of coverage. Creditable coverage followed by a significant break in coverage cannot be used to reduce the waiting period. Each day of creditable coverage will reduce the six-month period by one day.

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Is there a minimum age a child can enroll?

For a new applicant, the minimum primary applicant age is a newborn child who has been released from a doctor’s care. This usually occurs at the six-week postbirth checkup. To acquire coverage for a newborn, the signing parent or legal guardian must be at least 18 years of age. Your unmarried children are eligible until their 23rd birthday.

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Does ODS quote for multiple children on one application (with no adults)?

Yes. The oldest child will become the primary applicant and the other children will become the dependents. The applicable rate will be the Insured + Child(ren).

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Can I switch to a different plan at any time?

Yes, if you would like to switch to a plan with lower benefits, a written letter must be sent to ODS prior to the requested effective date for the change. The letter will need to include the plan you would like to switch to with a dated signature from the primary applicant. If you would like to switch to a plan with higher benefits, you will need to submit a new application. The application will be health underwritten and you could be approved or declined for the new plan.

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