Individual plan FAQs
Have a question about ODS individual medical and dental plans? Let us help. If you don’t see the answer to your question here, call our Individual Plans Department at 503-243-3973 or 877-277-7073.
- Who is eligible to apply for ODS individual medical and dental plans?
- Does ODS offer a dental plan?
- How can members pay their premiums?
- Can employers sponsor individual coverage?
- When do your rates change?
- Is there a waiting period for pre-existing conditions?
- How soon can a new mother apply for herself and her newborn?
- Can members 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, individuals and any dependents applying for coverage must be Oregon residents and live in Oregon at least six months out of the year. Eligible members include the subscriber, legal spouse or registered partner pursuant to the Oregon Family Fairness Act, and any unmarried children younger than age 26. Individuals must be younger than age 65 and not eligible for Medicare.
Does ODS offer a dental plan?
We offer two individual dental options. To be eligible for these dental plans at the listed rates, subscribers must enroll when they first apply for an ODS individual medical plan.
If a subscriber waived dental coverage for any dependent child who was under age 3 when the subscriber first enrolled themselves and their dependents in the dental plan, the subscriber will have a chance to enroll the child upon his or her third birthday by sending a written request to ODS within 31 days of the birthday.
How can members pay their premiums?
Members can pay via monthly electronic deduction from their checking account, free of charge, or they can elect to receive monthly or quarterly billing for an additional $5 administrative fee per billed statement.
Can employers sponsor individual coverage?
No. ODS individual plans cannot be employer-sponsored plans. Individual members will be responsible for directly paying ODS their 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, including benefit and rate adjustments. Rates also change when the primary applicant moves into the next age bracket; 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 of coverage 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 or if it 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 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 cannot be denied coverage based on their health status.
How soon can a new mother apply for herself and her newborn?
For new applicants age 19 and older, the mother must be released from a doctor’s care. This release normally occurs at the six-week, post-birth checkup. A breastfeeding mother who has not resumed menstruation since childbirth will need to provide evidence that she is not pregnant prior to issue of this policy.
Can members switch to a different plan at any time?
Yes. Members can 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 must include the plan the member would like to switch to, with a dated signature from the primary applicant. If a member wants to switch to a plan with higher benefits, the member must submit a new application. The application will go through Underwriting and could be approved or declined for the new plan.
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