Individual medical plans
Individual
Each individual has unique healthcare needs. That’s why ODS offers a variety of individual medical plans. All of our plan designs give members the freedom to see any licensed provider they choose, but with a better benefit if members use a preferred provider from our statewide network. Members also get benefits beyond coverage, with online health tools, health coaching, 24/7 advice and more.
Members get more from ODS
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 and includes:
- 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 plan can access additional health tools including a web-based health and symptom evaluator, an online medical library and much 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.
- Individual medical plan members can save on brand-name and generic prescription drugs using our pharmacy discount card.
Medical plan options
ODS offers a variety of individual plans. Coverage varies from plan to plan, so look for the features that best fit the individual member’s healthcare preferences.
Apply online or download a paper application for individual insurance.
Click on a deductible amount to see the benefit summary for that plan.
| Rates Maximizer (PPO) |
| The Maximizer plan is ideal for individuals who want broad coverage for a range of services, including pharmacy benefits. |
| Deductible optionsThe 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. |
Office visit |
Pharmacy |
$1,000
$2,500
$5,000 |
First 6 at $20 |
$2 value tier, $15 generics, 50% brand |
| Rates Beneficial Rx (PPO) |
| The Beneficial Rx plan is best for those looking for a higher level of benefits and a lower total out-of-pocket costA 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.. |
| Deductible optionsThe 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. |
Office visit |
Pharmacy |
$1,000
$2,500
$5,000 |
First 3 at $15 |
$2 value tier, $15 generics, 50% brand |
| Rates Beneficial Value (PPO) |
| The Beneficial Value plan is suited to individuals shopping for a lower premium cost. |
| Deductible optionsThe 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. |
Office visit |
Pharmacy |
$1,000
$2,500
$5,000
$7,500 |
First 3 at $25 |
Optional1 |
| 1If selected, prescription rider provides $2 value tier, $15 generics, 50% brand name. View Rx rider rates |
| Rates Health Savings Account (HSA) 3000 |
| HSA plans offer lower insurance premiums through a high 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. health plan coupled with a bank account in which you accumulate tax-advantaged savings through your contributions to pay for qualified medical expenses until your deductible is met. More about HSAs |
| Deductible optionsThe 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. |
Office visit |
Pharmacy |
$3,000 (individual)
$6,000 (family) |
0% |
0% |
| Rates Health Savings Account (HSA) Value |
| HSA plans offer lower insurance premiums through a high 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. health plan coupled with a bank account in which you accumulate tax-advantaged savings through your contributions to pay for qualified medical expenses until your deductible is met. More about HSAs |
| Deductible optionsThe 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. |
Office visit |
Pharmacy |
$2,800 (individual)
$5,600 (family) |
50% |
50% |
Enrollment for applicants under age 19
Beginning August 1, 2011, ODS will resume accepting applications for children under age 19 each month. The first effective date for these applications will be September 1, 2011.
