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Plans & Networks

Group Plans

Individual Plans

Group Plans

Point of Service (POS)

Under a Point of Service plan, members can choose a Primary Care Physician (PCP) to help manage their healthcare. The PCP manages all of their healthcare including referrals to specialists and hospitals, and emergency care if they need it. At any time, day or night, 365 days a year, the PCP assumes the primary responsibility for medical care. Should the PCP be unavailable, he or she will arrange for another participating physician to assume responsibility for care. If a member is treated for medical services from a provider without having gone through a PCP, claims will be paid at the out of network benefit level and the patient's responsibility for the cost associated with those claims will be higher than if they had coordinated care through their PCP.

Network: Various networks - refer to patient ID card
PCP Selection Required: Yes

Preferred Provider Plan (PPO)

A PPO, or Preferred Provider Organization, contracts with physicians and hospitals to secure preferred rates for patients and their covered family members. Members can decide to visit a PPO provider any time medical care is needed. Should they choose a non-PPO provider, a lower level of benefit may apply. When a member chooses a PPO provider, they will receive the highest level of benefits. ODS contracts with several PPO networks to provide more physician choices and geographic coverage.

Annual deductible and coinsurance apply to this plan. Once the deductible is satisfied, ODS will pay a percentage of the covered expenses.

Network: Various networks - refer to patient ID card
PCP Selection Required: No

Individual Plans

Indemnity

This traditional plan allows members to visit any physician of their choice on a fee for service basis. Indemnity plans are offered with a variety of deductibles, coinsurance amounts, and in some cases, copayments for office visits.

Network: None
PCP Selection Required: No

OHP-Medical (Oregon Health Plan)

The Oregon Health Plan is a state medical assistance program for low-income individuals and families. Members enrolled in the ODS Oregon Health Plan must first qualify for medical assistance through the Department of Human Services (DHS).

OHP Medical is a managed care plan, which requires members to select a PCP. Specialist services require a referral from the PCP for some care. Services performed without a referral may be denied. Prior authorizations are required for most hospital stays, surgeries and procedures performed by a specialist. This plan is not typically subject to a deductible, coinsurance or co-payment.

Network: OHP Medical network
PCP Selection Required: Yes