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Oregon Medical Insurance > ODS Health Plans of Oregon > Beneficial Rx Benefits


 
Beneficial Rx (PPO)
Plan year deductible
(family deductible is 3x the individual)
$1,000 / $2,500 / $5,000
Out-of-Pocket Maximum, Per Member
(after deductible)
$3,000
$6,000
Plan Year Essential Benefit Maximum
$2,000,000
Preventive Care
Member Responsibility
The deductible is waived for in-network preventive care.
In Network Provider
Out of Network Provider
Annual women’s exam -Pap, pelvic, breast $0* 40%
Women's routine mammogram $0* 40%
Well-baby care $0* Not covered
Routine Physical Exams $0* Not covered
Immunizations $0* Not covered
Professional Services
Office Visits
First three at $15*
40%
Alternative care ($1,000 per plan year limit)
Chiropractic, naturopathic and acupuncture
First three at $15*
40%
Facility and Ancillary Services
Hospital - Inpatient and outpatient surgery; room, ancillary and physician charges; skilled nursing facility care
20%
40%
Maternity - All pre/post office visits and doctor delivery; hospital charges
20%
40%
Mental health - Inpatient, outpatient, residential
(see limitations and exclusions)
20%
40%
Alcohol / Mental Health Treatment
Inpatient, outpatient, residential combined
20%
40%
Lab and X-ray services; rehabilitation services; medical supplies and devices; in-hospital care; home healthcare
20%
40%
Vision
(see limitations and exclusions)		 20%* Not covered
Emergency Services
Urgent care First three at $15* 40%
Emergency room (deductible applies)
20% after $100 copay
Ambulance ($5,000 per plan year limit)
20%
Other Benefits
Prescription services
$2 value tier, $15 generics or 50% brand*
Accident benefit
Deductible waived for treatment completed within 90 days of accident.
*Deductible waived

** Deductible waived for first six medical home, office or urgent care visits per plan year. First six in-network visits do not include home or office visits for mental health, alcohol treatment, family planning or biofeedback. Subsequent visits are subject to the deductible and co-insurance.
Note: This is a benefit summary only. For a complete description of benefits, refer to your Policy.

 

 
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