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Employers
- Provider Search
- ODS Plans
- Employer Online Services
- Value-Added Services
- Third Party Administration
- Group Administrator Guide (PDF)
- Samples & Forms
- Need Help?
- Medical
- 503-243-3962 or
877-605-3229 - Dental
- 503-265-5680 or
877-277-7280 - Employer Online Services
- 503-265-5691 or
877-277-7075
Commercial Preferred Provider Organization
NCQA is committed to providing healthcare quality information through the web and the media to help consumers, employers and others make more informed healthcare choices.
ODS Preferred Provider (PPO)
A PPO, or Preferred Provider Organization, contracts with physicians and hospitals to secure preferred rates for you and your covered family members. You can decide to visit a PPO provider any time medical care is needed. Should you choose a non-PPO provider, a lower level of benefit may apply. When you choose a PPO provider, you will receive quality medical care and the highest level of benefits. ODS contracts with several PPO networks to provide more physician choices and geographic coverage.
Value-Added Services
OUR PROVIDER NETWORK
All of our health plans include access to the largest directly contracted PPO network in Oregon, the ODS Plus Network.
PERSONALIZED MEMBER WEBSITE
ODS members can access all insurance-related information at one convenient online location with myODS,which provides access to member handbooks, claims status and history, detailed benefit information, health tools and more.
These additional services are provided to ODS medical plans at no additional cost.
YOUR PARTNER IN HEALTH
Through our medical management and health coaching programs, clinical professionals will work with you to help you manage your health. With their help, you’ll identify, plan and achieve the goals that are essential in helping you feel your best.
FREE ONLINE HEALTH ADVICE 24/7
A variety of helpful tools, both online and via the phone, are available around the clock to help you improve your health, including:
- E-mail answers from physicians, psychologists, dentists, pharmacists, dietitians and fitness experts
- Phone advice from a registered nurse
- Online tools to track healthy living habits
- Web-based health and symptom evaluator
- Medication-specific pricing information
- Health assessments
- Online medical library
- Health news articles, forums and more
Third Party Administration
Additionally, the following services are provided through our subsidiary, BenefitHelp Solutions.
- Groups 2-99: Premium Contribution Plan (PC-EZ)
- Groups 20-99: COBRA Administration
Frequently Asked Questions About Preferred Provider (PPO) Plans:
- How will I benefit from using the PPO physicians and hospitals?
- How do I use the PPO when I need healthcare?
- Do all family members have to choose the same PPO provider?
- What if my family physician is not in this directory?
- What should I do in a medical emergency?
- How are my claims handled?
- What happens if my benefit plan does not cover a service which I have received from a preferred provider?
- How do I find out what my benefits will be when using PPO physicians and hospitals?
How will I benefit from using the PPO physicians and hospitals?
You will benefit for the following reasons:
- You will be receiving quality healthcare from some of the area's most respected private practice physicians and hospitals.
- Your health insurance will offer the highest level of benefits when you use PPO physicians and hospitals.
- You will save money through lower out-of-pocket expenses. Remember, participating preferred providers (physicians and hospitals) agree to accept preferred rates for services provided to ODS members like you.
- There is no additional paperwork. PPO physicians and hospitals bill ODS for you.
- Your PPO provider will assist with preauthorization requirements.
How do I use the PPO when I need healthcare?
Follow the directions below:
- Select your physician or hospital from the correct PPO network in our directory.
- Identify yourself as a "PPO member" when you make your appointment (be sure to give your group and ID numbers).
- Show your ID card when you arrive.
- Savings are automatic, and the physician or hospital bills ODS directly.
Do all family members have to choose the same PPO provider?
No. Each family member may choose his or her own provider. However, the use of a PPO provider (whether the same as yours or not) results in higher benefits.
What if my family physician is not in this directory?
You may decide to visit a non-PPO physician, however any allowable services will be paid at lower benefit levels than if you visited a PPO physician.
What should I do in a medical emergency?
In the event of an emergency you are covered worldwide 24 hours a day. Emergency medical condition means a medical condition that manifests itself by symptoms of sufficient severity that a prudent layperson possessing an average knowledge of health and medicine would reasonably expect that failure to receive immediate medical attention would place the health of a person, or a fetus in the case of a pregnant woman, in serious jeopardy.* In such a case you should proceed to the closest medical facility for care. In the case where a non-participating facility or provider is used for follow up care to a medical emergency, lower out-of-network benefits will apply.
How are my claims handled?
If you use a PPO provider, they will bill ODS directly.
What happens if my benefit plan does not cover a service which I have received from a preferred provider?
For services not covered by your health benefit plan, you will be responsible for paying the provider's fee.
How do I find out what my benefits will be when using PPO physicians and hospitals?
Please refer to your member handbook or contact Customer Service.
*This is our standard contract wording, your plan may be different so please reference your member handbook for what applies to your plan.