Individual and family plan FAQs
- Who is eligible to apply for ODS individual medical and dental plans?
- Do you offer a dental plan?
- What payment methods do you offer?
- Can my employer sponsor my individual coverage?
- When do your rates change?
- Is there a waiting period for pre-existing conditions?
- Can I switch to a different plan at any time?
Who is eligible to apply for ODS individual medical and dental plans?
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 or registered partner, according to the Oregon Family Fairness Act, and any children younger than age 26. Individuals must be younger than age 65 and not eligible for Medicare.
Do you offer a dental plan?
We offer two individual dental options. To be eligible to enroll in these two dental plans at these rates, you need to enroll when you first apply for an ODS individual medical plan.
If you waived dental coverage for any dependent child who was under age 3 when you first enrolled yourself and dependents in this dental plan, you will have an open enrollment period to enroll the child on your dental plan upon the child’s third birthday with written request to ODS that is received within 31 days of the birthday.
What payment methods do you offer?
Payment can be made via monthly electronic deduction from your checking account, free of charge, or you can elect to receive monthly or quarterly billing for an additional $5 administrative fee per billed statement.
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 using a personal check. ODS does not accept employer checks for individual plans.
When do your rates change?
ODS renews all individual plans on Nov. 1 each year and makes any necessary benefit and rate adjustments. Rates also change when the primary applicant moves into the next age category; new rates are effective the following month.
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 in the ODS plan, or if it ended within 63 days of the effective date of coverage with ODS. 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.
Pre-existing conditions do not apply to children under the age of 19. Applicants under the age of 19 can not be denied coverage based on their health status.
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. If you are declined for the new plan, your current coverage and plan will not be affected.
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