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For more than 50 years Oregonians have counted on ODS for their healthcare needs. We are pleased to welcome OEBB members to the ODS family.
When you choose ODS, you get more than just healthcare coverage. Our in-house experts ensure that our evidence-based programs focus on prevention. We offer integrated care coordination, disease management, health promotion and online tools that help you get the most out of your dental benefits.
With ODS, you also gain access to myODS, your personalized member Web site that contains valuable online services that help you manage your health.
We are committed to serving our members with the highest level of integrity and expertise. Visit your OEBB/ODS Web site at www.odscompanies.com/oebb to learn more about our plans, our networks and our commitment to you.
Benefit Handbooks
To view the benefit handbooks, click here: Handbook
Frequently Asked Questions
To view some of ODS' most Frequently Asked Questions, click here: FAQ
To view Direct Member Reimbursement FAQ, click here: DMR FAQ
Preferred Drug List
To view ODS' Preferred Drug List, click here: Preferred Drug List
Specialty Medications
To view some frequently asked questions about specialty medications, click here: Specialty Medications FAQ
To view the complete list of specialty medications covered by ODS, click here: Covered Specialty Medications
Transition of Care Form
To download the Transition of Care form, click here: Transition of Care
If you are new to ODS and you are in active treatment with an out-of-network provider, you may be eligible for a Transition of Care.
Transition of Care occurs when a member’s health plan changes during the course of certain medical treatments, and as a result the medically necessary services become out of network. It may necessary to continue with the provider at the higher benefit level for a period of time to complete the course of treatment.
Some examples of medically necessary services that may qualify for Transition of Care at the higher benefit level include:
- Later stages of pregnancy
- Active chemotherapy
- Medically necessary surgery, previously scheduled
To request a case review, please fill out the transition of care form, and ask your provider to send clinical notes for review by our medical consultant.
Or, call ODS Customer Service at (503) 265-2909, or toll free at (866) 923-0409, to assist you in filling out and submitting the form.
Protected Health Information Authorization Form
To download a copy of the form allowing members to authorize the disclosure of protected, personal health information to another person, click this link: Protected Health Information Authorization Form
How will ODS handle students/dependents living out of the service area?
If a student/dependent lives outside of the ODS Plus Network service area, the employee must notify the ODS customer service department, as OEBB will not be indicating this information on the weekly electronic file to ODS. If ODS receives information of a student/dependent living outside of the service area, we will allow as follows:
Coverage Outside the Service Area for Dependent Children When an insured dependent child under age 19 (26 if a full-time student at an accredited college, university, or vocational school) resides outside the service area, ODS will extend Plan benefits for treatment of an illness or injury, preventive healthcare (including routine physicals and immunizations) and maternity services, as if the care were rendered by in network physicians or providers. Out-of-area dependents must access benefits within a 30-mile radius of the dependent’s child’s residence in order for the benefit level to apply. Fees charged by out-of-area physicians and providers of care will be reimbursed at the maximum plan allowance for those services.
Link to Frequently Asked Questions: http://www.odscompanies.com/pdfs/oebb/oebb_ods_qa.pdf
Maximum Plan Allowance (MPA) is the maximum amount that ODS will reimburse physicians and providers. For an in-network physician/provider, the maximum amount is the amount the provider has agreed to accept for a particular service.
For a service by an out-of-network physician/provider, ODS will process charges for those services as follows: maximum amount is the lesser of the amount payable under any supplemental provider fee arrangements we may have in place and the seventy-fifth (75th) percentile of fees commonly charged for a given procedure in a given area, based on a national database.
If a dollar value is not available in the national database, ODS will consider 75% of the billed charge as the MPA. The remaining 25% over the MPA is the patient’s responsibility.
In certain instances, when a dollar value is not available in the database, the claim is reviewed by the ODS Medical Consultant, who determines a comparable code to the one billed. Once a comparable code is established, the claim is processed as described above.
In each of the above situations relating to an out-of-network physician/provider, any amount above the MPA is patient responsibility. Depending upon the plan provisions deductibles and co-payments may apply.
Maximum Plan Allowance for prescription benefits is the maximum amount which ODS will reimburse for medications. For an in-network pharmacy, the maximum amount is the contracted fee. For out-of-network pharmacies, the maximum amount is no more than the prevailing pharmacy network fee based on Average Wholesale Price (AWP) determined by First Data Bank minus a percentage discount. AWP is a figure that is reported by commercial publishers of drug pricing data, based on wholesale pricing information provided to them by drug manufacturers. Reimbursement for medications dispensed by physicians and providers other than retail pharmacies, mail-order pharmacies, and specialty pharmacies will be subject to benefit provisions of the Plan and paid based on the lesser of contracted rates, AWP or billed charges.
Link to Member Handbooks: http://odscompanies.com/oebb/handbook.shtml
WellPartner
To visit the WellPartner Web site, click this link: www.wellpartner.com
To view information about the mail-order pharmacy process, click here: http://odscompanies.com/oebb/mailorder.shtml
To view or download the mail-order pharmacy form, click here: http://odscompanies.com/pdfs/oebb_wellpartner_mailorder.pdf
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