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ODS Health Plans of
Oregon
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ODS Health Home | Index | Dental
Rates | Premier Benefits |
Preferred PPO Benefits |
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Delta Dental Premier Rates
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Individual |
Individual &
Spouse |
Individual & Child (ren) |
Individual & Spouse & Child (ren) |
| 0 - 19 |
$38.00 |
$77.00 |
$75.00 |
$111.00 |
| 20 - 24 |
$40.00 |
$81.00 |
$81.00 |
$118.00 |
| 25 - 29 |
$40.00 |
$81.00 |
$81.00 |
$118.00 |
| 30 - 34 |
$40.00 |
$81.00 |
$81.00 |
$118.00 |
| 35 - 39 |
$49.00 |
$97.00 |
$97.00 |
$150.00 |
| 40 - 44 |
$49.00 |
$97.00 |
$97.00 |
$150.00 |
| 45 - 49 |
$51.00 |
$102.00 |
$102.00 |
$152.00 |
| 50 - 54 |
$51.00 |
$102.00 |
$102.00 |
$152.00 |
| 55 - 59 |
$51.00 |
$102.00 |
$102.00 |
$152.00 |
| 60 - 64 |
$51.00 |
$102.00 |
$102.00 |
$152.00 |
Delta Dental PPO Rates
| |
Individual |
Individual &
Spouse |
Individual & Child (ren) |
Individual & Spouse & Child (ren) |
| 0 - 19 |
$34.00 |
$71.00 |
$68.00 |
$107.00 |
| 20 - 24 |
$38.00 |
$77.00 |
$75.00 |
$113.00 |
| 25 - 29 |
$38.00 |
$77.00 |
$75.00 |
$113.00 |
| 30 - 34 |
$38.00 |
$77.00 |
$75.00 |
$113.00 |
| 35 - 39 |
$43.00 |
$86.00 |
$85.00 |
$127.00 |
| 40 - 44 |
$43.00 |
$86.00 |
$85.00 |
$127.00 |
| 45 - 49 |
$48.00 |
$93.00 |
$92.00 |
$139.00 |
| 50 - 54 |
$48.00 |
$93.00 |
$92.00 |
$139.00 |
| 55 - 59 |
$48.00 |
$93.00 |
$92.00 |
$139.00 |
| 60 - 64 |
$48.00 |
$93.00 |
$92.00 |
$139.00 |
Monthly rates effective December, 2009 - October 31, 2010
Monthly family rates are based on the age of primary applicant
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