Group medical plans
With ODS medical plans, your clients get more than just coverage. They get a partner in health. ODS medical plans support the member’s whole health with programs that connect members with helpful information, walk them through serious health conditions, help them set goals and even provide one-on-one health coaching.
Healthcare that goes beyond coverage
At no additional cost, ODS medical plan members benefit from the following services:
- Members get access to the largest directly contracted PPO network in Oregon, the ODS Plus Network.
- myODS, our personalized member website, offers all insurance-related information at one convenient online location. Members can access their Member Handbooks, claims status and history, detailed benefit information, health tools and more.
- ODS Well™ helps members take charge of their own well-being. ODS Well tools include:
- Our one-on-one health coaching program — clinical professionals work with members to identify, plan and achieve health goals.
- Personal health assessments and participation incentives.
- Free health advice, 24/7, both online and by phone. Help includes e-mail answers from clinical professionals and a nurse advice line.
- Members with a pharmacy benefit can access additional health tools such as, a web-based health and symptom evaluator, an online medical library and more.
- ODS care coordination and case management programs help members through a serious injury or illness, while working directly with facilities and providers to coordinate care.
Medical plan options
ODS offers a variety of medical plans, along with prescription and vision riders. Other plan options are available for larger groups. ODS also offers Administrative Services Only (ASO) plans.
Medical plans effective July 1, 2011
| In plan benefits | Out of plan benefits | ||||||||
|---|---|---|---|---|---|---|---|---|---|
* Plan eligible for FHIAP ** Deductible Waived Purchasing an Rx rider with a PPO or Beneficial medical plan is optional. However, an Rx rider cannot be purchased with an HSA plan. HSA plans continue to include a major medical Rx benefit. |
|||||||||
| Plan | Ded | Office visit |
coins. | OOP | Ded | coins. | OOP | ||
| Beneficial plans | |||||||||
| BEN2500_11A1 | $2,500 | $25** | 70% | $5,000 | $2,500 | 50% | $15,000 | ||
| BEN3500_11A1 | $3,500 | $25** | 70% | $5,000 | $3,500 | 50% | $15,000 | ||
| BEN5000_11A1 | $5,000 | $25** | 70% | $5,000 | $5,000 | 50% | $15,000 | ||
| BEN7500_11A1 | $7,500 | $25** | 70% | $5,000 | $7,500 | 50% | $15,000 | ||
| PPO plans | |||||||||
| PPO500_11B1 | $500 | $20** | 80% | $2,500 | $500 | 50% | $7,500 | ||
| PPO500_11E1 | $500 | $30** | 80% | $3,500 | $500 | 50% | $10,500 | ||
| PPO750_11B1 | $750 | $25** | 80% | $3,000 | $750 | 50% | $9,000 | ||
| PPO750_11E1 | $750 | $30** | 80% | $4,000 | $750 | 50% | $12,000 | ||
| PPO1000_11B1 | $1,000 | $25** | 80% | $3,000 | $1,000 | 50% | $9,000 | ||
| PPO1000_11E1 | $1,000 | $30** | 80% | $4,000 | $1,000 | 50% | $12,000 | ||
| PPO1500_11A1 | $1,500 | $25** | 80% | $3,000 | $1,500 | 50% | $9,000 | ||
| PPO1500_11B1 | $1,500 | $25** | 75% | $3,500 | $1,500 | 50% | $10,500 | ||
| PPO1500_11E1 | $1,500 | $30** | 70% | $4,500 | $1,500 | 50% | $13,500 | ||
| PPO2000_11A1 | $2,000 | $25** | 80% | $3,000 | $2,000 | 50% | $9,000 | ||
| PPO2000_11B1 | $2,000 | $25** | 75% | $3,500 | $2,000 | 50% | $10,500 | ||
| PPO2000_11E1 | $2,000 | $30** | 70% | $4,500 | $2,000 | 50% | $13,500 | ||
| PPO2500_11A1 | $2,500 | $25** | 80% | $3,000 | $2,500 | 50% | $9,000 | ||
| PPO3000_11A1 | $3,000 | $25** | 80% | $3,000 | $3,000 | 50% | $9,000 | ||
| PPO4000_11A1 | $4,000 | $25** | 80% | $3,000 | $4,000 | 50% | $9,000 | ||
| PPO1000_11B1_EvBid | $1,000 | $25** | 80-70% | $3,000 | $3,000 | 60-50% | No Max | ||
| PPO1500_11B1_EvBid | $1,500 | $25** | 80-70% | $3,000 | $4,500 | 60-50% | No Max | ||
| PPO2000_11B1_EvBid | $2,000 | $25** | 80-70% | $3,000 | $6,000 | 60-50% | No Max | ||
| HSA PPO plans | |||||||||
| HSA1200_11A1 | $1,200 | 80% | $3,800 | $1,200 | 50% | $7,600 | |||
| HSA2000_11A1 | $2,000 | 80% | $3,000 | $2,000 | 50% | $6,000 | |||
| HSA2800_11A1 | $2,800 | 50% | $2,200 | $2,800 | 50% | $4,400 | |||
| HSA4000_11A1 | $4,000 | 50% | $1,000 | $4,000 | 50% | $2,000 | |||
| Indemnity plan | |||||||||
| Basic Oregon plan1 | 50% | 50% | $3,750 | $0 | 50% | $3,750 | |||
| Dual Option 1 | |||||||||
| PPO1000_11B1 | $1,000 | $25** | 80% | $3,000 | $1,000 | 50% | $9,000 | ||
| HSA2000_11A1 | $2,000 | 80% | $3,000 | $2,000 | 50% | $6,000 | |||
| Dual Option 2 | |||||||||
| PPO1500_11B1 | $1,500 | $25** | 75% | $3,500 | $1,500 | 50% | $10,500 | ||
| HSA2800_11A1 | $2,800 | 50% | $2,200 | $2,800 | 50% | $4,400 | |||
| Riders are only available to PPO plans. If you chose one of the ODS Dual Option plans, the riders you select below will be available to the PPO plan but not the HSA plan. |
| Standard Rx: $15/50% whichever greater copay, 3x Mail Order copay |
| Rx: 40% copay; Mail Order: 40% copay |
| Rx: $2/$10/$40/$60; 3x Mail Order copay |
| Rx: $2/$10/$35/$50; 3x Mail Order copay |
| Rx: $2/$15/$45/$75; 3x Mail Order copay |
| 100% w/ $300 Max |
| 100% w/ $200 Max |
| 100% Eye Exam Only |
Third-party administration
With so many intricate policies, guidelines and regulations, benefits administration is best left to the experts. BenefitHelp Solutions, an ODS subsidiary, can answer your questions regarding the following and much more:
- FSA administration
- COBRA/continuation (included with fully insured medical groups with fewer than 100 covered employees)
- Premium administration (included with fully insured medical groups with fewer than 100 covered employees)
Log in to Benefit Tracker
Check benefits and eligibility
Log in to Benefit Tracker
Check benefits, eligibility, incentive and utilization
Shopping for health insurance?
Shopping for health insurance?
