Prospective Member 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 and your legal spouse, any unmarried children younger than age 19 or as old as 23 if a full-time student. 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 plans. 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.

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What payment methods do you offer?

We offer monthly electronic deduction from your checking account, monthly billing statements and quarterly payments. If you choose the monthly electronic deduction, please include one check for the first month's premium amount and one voided check. If you choose the monthly billing statement option, please include a check for the first month's premium. You will receive a bill in the mail every month, which will include a $2 monthly billing fee in addition to your monthly premium. If you choose the quarterly payment option, please include a check with the first three months' premium. You will receive a bill in the mail every three months.

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Can my employer sponsor my individual coverage?

ODS Individual plans cannot be employer-sponsored plans. You will be responsible for directly paying ODS your monthly premium from a personal checking account or money order. ODS does not accept employer checks.

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Can you describe the application process?

You may apply online or submit an original application to ODS. Applications must be received by the 20th for the next month's effective date on the 1st. If a 15th effective date is requested, we must have your application by the 5th day of the requested month. Applications received after the cutoff date will be processed for the subsequent month's effective date. Each applicant is required to complete the Oregon Standard Health Statement included in the application. This section requires that all those applying include all medical symptoms, diagnosis, treatment or advice received within the past five years. This includes all doctor visits for an illness or injury as well as visits to specialists, hospitals, and emergency rooms, prescription drugs, etc. Once the application is complete and mailed to ODS, each applicant must pass Oregon Standard Health Underwriting. Each medical condition or treatment is evaluated according to established underwriting standards in order to determine whether you will be approved or declined for coverage. You will then be notified if you are approved or declined for coverage.

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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 sixmonth 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 exclusion period. Each day of creditable coverage will reduce the six-month period by one day.

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Do you have a plan that offers a youth rate?

Yes. All of our plans offer a youth rate.

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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 post-birth 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 19th birthday. A child is also eligible until his or her 23rd birthday, if enrolled as a full-time student at an accredited college, university or vocational school.

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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 premium will be the Insured + Child(ren) rate.

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Can I switch to a different plan at any time?

Yes. You may switch plans with ODS as follows:

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