Beneficial Rx (PPO)

The Beneficial Rx plan is best for those looking for a higher level of benefits and a lower total out-of pocket cost. The Beneficial Rx plan includes services that can be accessed before the deductible, including preventive care, pharmacy services, limited doctor’s office or urgent care center visits, and alternative care.

Benefit Summary

Plan year deductible options

$1,000 / $2,500 / $5,000

Member Responsibility

In Network

Out of Network

Out-of-pocket maximum, per person (after deductible)

$3,000

$6,000

Preventive Care

Annual women's exam — pap, pelvic, breast

$15 co-pay*

40%

Women's routine mammogram

$15 co-pay*

40%

Well-baby care

$15 co-pay*

Not covered

Routine physical exams

$15 co-pay*

Not covered

Immunizations

$0 co-pay*

Not covered

*Deductible waived.

**Beneficial plans pay first three office visits with a co-payment, which may be used for either office visits or urgent care for illness and injury. Alternative care includes an additional three visits with a co-payment. Thereafter, the deductible and co-insurance apply for additional office visits and alternative care.

Professional Services
Office visits	First 3 at $15**	40%
Alternative Care ($1000 Annual Benefit Maximum): Chiropractic, Naturopathic and Acupuncture	First 3 at $15**	40%
Maternity
All pre/post office visits and doctor delivery; hospital charges	20%	40%
Hospital Services
Inpatient and outpatient surgery; room, ancillary and physician charges; skilled nursing facility care	20%	40%
Emergency Services
Urgent care	First 3 at $15**	40%
Emergency room (deductible applies)	20% after $100 co-pay
Ambulance	20%
Other Facilities and Services
Lab and X-ray services; rehabilitation services; medical supplies and devices; in-hospital care; home healthcare	20%	40%
Prescription services	$15 generics or 50% brand*; $5,000 annual maximum benefit
Lifetime maximum	$2,000,000 ($250,000 out-of-network)
Value Added Services
When you join ODS, you get health plans enhanced by a wide variety of helpful value added services. Medical members have access to: myODS, a personalized website allowing you to manage your own plan. eDocAmerica a secure account for emailing health questions and concerns directly to a physician. Registered Nurse Advice Line, a toll free number providing access to a nurse's advice 24 hours a day. In addition to these tools, you'll discover benefit plans that are actually easy to understand. And teams of ODS Health Professionals dedicated to your healthy, happy life.

This is a benefit summary only. For a complete description of benefits, refer to your Policy. Effective July 1, 2007 through June 30, 2008

Beneficial Rx Rates

Beneficial Rx - $1,000 Deductible
Age	Insured Only	Insured & Spouse	Insured & Spouse & Child (ren)	Insured & Child (ren)
Monthly rates effective July 1, 2007 through June 30, 2008 Monthly family rates are based on the age of primary applicant
0 - 19	$85	$170	$236	$147
20 - 24	125	248	345	214
25 - 29	136	287	405	251
30 - 34	158	336	463	289
35 - 39	172	364	482	310
40 - 44	213	424	565	352
45 - 49	253	502	616	362
50 - 54	299	594	711	410
55 - 59	354	703	821	460
60 - 64	413	825	884	496

Beneficial Rx - $2,500 Deductible
Age	Insured Only	Insured & Spouse	Insured & Spouse & Child (ren)	Insured & Child (ren)
Monthly rates effective July 1, 2007 through June 30, 2008 Monthly family rates are based on the age of primary applicant
0 - 19	$71	$140	$195	$121
20 - 24	103	204	285	177
25 - 29	112	237	334	208
30 - 34	130	277	382	239
35 - 39	142	301	398	256
40 - 44	176	350	467	291
45 - 49	209	414	509	299
50 - 54	247	490	588	338
55 - 59	292	581	678	380
60 - 64	341	681	730	409

Beneficial Rx - $5,000 Deductible
Age	Insured Only	Insured & Spouse	Insured & Spouse & Child (ren)	Insured & Child (ren)
Monthly rates effective July 1, 2007 through June 30, 2008 Monthly family rates are based on the age of primary applicant
0 - 19	$56	$111	$155	$96
20 - 24	81	162	226	140
25 - 29	89	188	265	164
30 - 34	103	219	303	189
35 - 39	113	238	315	203
40 - 44	139	277	370	230
45 - 49	165	328	403	237
50 - 54	195	388	465	268
55 - 59	231	460	537	301
60 - 64	270	539	578	324

Privacy Statement- This request will be absolutely confidential. The information will not be sold, given away or used for any other purpose but to mail or email requested information.

Information Request Form

This is not an application for insurance. In the state of Oregon, Individual Health Insurance plans must be approved in the underwriting stage of the insurance application. This might take a few weeks to complete. Please leave your name address and questions and any information that you would like.

Beneficial Rx (PPO)

Beneficial Rx Rates

Information Request Form

Send mail to frs@xprt.net with questions or comments about this web site. Copyright © 1999 INDEPENDENT HEALTH INSURANCE AGENTS

Send mail to frs@xprt.net with questions or comments about this web site.
Copyright © 1999 INDEPENDENT HEALTH INSURANCE AGENTS