ODS Health Plans of Oregon

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EVIDENCE-BASED DENTAL PLAN DESIGNS

We know that good overall health depends on good oral health. Dental benefits give additional protection to your total health, which is why ODS offers evidence-based dental programs to enhance your medical coverage.

Oral health research has shown a strong link between oral health and overall health. ODS believes when you see your dentist regularly and maintain a healthy mouth, you can help keep the rest of your body healthy, too. Through our Oral Health,Total Health program, ODS offers additional preventive benefits to diabetics and pregnant women in their third trimester. ODS also provides other evidence-based dental benefits, including routine oral cancer exams and coverage for ViziLite Plus with TBlue and brush biopsy, two non-surgical screenings designed to aid in the early detection of abnormal cells in the mouth.

DELTA DENTAL PREMIER

This popular, traditional fee-for-service product offers members access to the largest dental network available in Oregon and across the nation. Members can save money by seeking care from participating Delta Dental Premier providers.

• Indemnity plan—any licensed dentist is eligible
• Deductible applies to all services
• Delta Dental Premier network includes more than nine out of 10 practicing dentists in Oregon
• More than 2,000 participating providers

DELTA DENTAL PPO

Like the Delta Dental Premier plan, this preferred provider option offers access to the largest PPO network in Oregon and across the country.

• PPO plan—better benefits using PPO network dentists
• Deductible waived for Class I services rendered by a participating PPO dentist
• Largest PPO dental network in the state
• More than 600 participating providers

Eligibility Requirements

In order to be eligible for any ODS individual medical and/or dental plan, you 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 you, your legal spouse or registered partner pursuant to the Oregon Family Fairness Act and any unmarried children younger than age 23. Individuals must be younger than age 65 and not eligible for Medicare.

How do I enroll?

You can enroll by completing the Electronic Application.

Highlights of the plans

• Freedom to choose any licensed dentist
• No waiting periods for Class 1and Class 2 services
• 12 month waiting period for Class 3 services
• Filed-fee savings from participating dentists
• Increasing maximums
• Pre-determination of benefits if requested in a pre-treatment plan
• Prompt and accurate claims payment
• Superior customer service
• No claim forms

Dental Limitations & Exclusions

• Examination and bitewing X-rays are limited to once every sixmonths.
• Full mouth X-rays are limited to once every three years.
• Prophylaxis (cleaning) is limited to once every sixmonths.
• Fluoride application is limited to once every six months.
• Surgical placement or removal of implants is not covered.
• Orthodontic services are not covered.
• Services for cosmetic reasons are not covered.

Refer to your policy for a complete listing of limitations and exclusions. This is a benefit summary only. For a complete description of benefits, refer to your policy.