Español

Beneficial Value (PPO)

The Beneficial Value plan is suited to individuals shopping for a lower premium cost. The Beneficial Value plan offers catastrophic coverage and also waives the deductible for preventive care and the first three office and alternative care visits per plan year.

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 / $7,500
  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) $5,000 $10,000
Preventive Care
Annual women's exam — pap, pelvic, breast $25 co-pay* 50%
Women's routine mammogram $25 co-pay* 50%
Well-baby care $25 co-pay* Not covered
Routine physical exams $25 co-pay* Not covered
Immunizations $0 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.* 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.

***Can purchase prescription rider separately; benefit is $15 generic or 50% brand, $2,000 maximum benefit; deductible waived. View Rx Rider rates.

This is a benefit summary only. For a complete description of benefits, refer to your Policy. Effective December 1, 2009 through October 31, 2010
Professional Services
Office visits First 3 at $25** 50%
Alternative Care ($1000 Annual Benefit Maximum):
Chiropractic, Naturopathic and Acupuncture		 First 3 at $25** 50%
Maternity
All pre/post office visits and doctor delivery; hospital charges 30% 50%
Hospital Services
Inpatient and outpatient surgery; room, ancillary and
physician charges; skilled nursing facility care		 30% 50%
Emergency Services
Urgent care First 3 at $25** 50%
Emergency room (deductible applies) 30% after
$100 co-pay
Ambulance 30%
Other Facilities and Services
Lab and X-ray services; rehabilitation services; medical supplies and devices; in-hospital care; home healthcare 30% 50%
Prescription services optional***

Lifetime maximum

 $2,000,000 ($250,000 out-of-network)
Accident benefit Deductible waived for treatment completed within 90 days of accident. $10,000 per person per year maximum
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.
  • WorldDoc, a personalized website allowing you to improve your health and reduce your healthcare costs..
  • 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.
  • PersonalHealth Rx, online access to detailed claims history, benefit information and tax reports.
  • Free & Clear, a tobacco reduction program.

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.