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| ODS eDocAmerica E-mail Contest |
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ODS eDocAmerica Email Contest
November 15 - December 15
How to participate: Beginning November 15, 2009, email as many health and wellness related questions as possible to eDocAmerica. Participation in the contest is free, easy and all ODS members can take part! Ask any questions you may have relevant to your needs, concerns, interests and lifestyles. There are no limitations to email usage. To get started, members need to set up a myODS account if they haven’t already. Please see below for easy instructions on setting up or accessing your myODS account.
How to win: The 12 educational entities with the highest usage percentage of eDoc’s secure e-mail service will win wide-ranging prizes that encourage health and fitness. Prizes up to the winning value will be chosen by each educational entity based on their own wishes or needs.
Prizes: Each winning educational entity will win a gift credit to PowerSystems, a sports and fitness equipment store and will be able to select items to purchase.
First Prize - $300
Runner-up Prize - $200
Ten Finalist Prizes - $100 each
myODS account:
To create or log in to your myODS account visit www.odscompanies.com/oebb. If you don’t already have a myODS account, choose the “Need to Create an Account” link and be sure to have your ODS member ID card on hand. Follow the instructions to enter your personal information and create your account. From there, click on the eDocAmerica link in the “myHealth” portion of the page. Click on “Log In” and create a brief medical profile. From there, click on the appropriate icon and e-mail your questions to a doctor, psychologist, dentist, pharmacist, fitness expert or dietitian.
More about eDoc:
eDocAmerica offers the tools and information you need to take good care of yourself. The next time you have a worrisome but non-critical medical issue, e-mail a doctor at any time, day or night. The eDoc team of experts is ready 24/7 to serve you and your family whenever you need them. Ask board-certified physicians, psychologists, pharmacists, dentists, dietitians and personal trainers any questions, any time that is convenient for you.
We guarantee a physician will answer within 24 hours, but in most cases your personalized answer arrives within 2-4 hours! You don't have to wait for an office visit or in a waiting room, and you don't have to take time off work. With eDocAmerica there are no co-pays, no additional fees, and no hidden costs. And, with eDocAmerica, providers may actually help you avoid unnecessary physician office visits and other associated costs. All you have to do is enjoy the benefits!
CALL A REGISTERED NURSE FOR HELP*
Members can also call the 24-hour Registered Nurse Advice Line any time to get help with medical issues ranging from home-care remedies, to recommended emergency treatment. To access the advice line, call 866-321-7580.
* Only email submissions to eDoc will be used to determine usage participation – calls to the 24 hour nurse line will not be included in this contest.
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| About ODS |
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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 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.
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| Benefit Handbooks |
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To view the benefit handbooks, click here: Handbook
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| Frequently Asked Questions |
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To view some of ODS' most Frequently Asked Questions, click here: FAQ
To view Direct Member Reimbursement FAQ, click here: DMR FAQ
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| Transition of Care |
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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.
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| Protected Health Information Authorization Form |
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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
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| Students/Dependents Living Out of the Service Area |
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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
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| Maximum Plan Allowance |
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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.
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| Healthcare Cost Calculator |
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The ODS DentalOptimizer is a free online resource for ODS members, accessible on your myODS page. The tool was designed to help you get the most out of your plan benefits and explore healthcare resources. Since most dental treatments are planned in advance with your dentist, you can use the DentalOptimizer to helps estimate what the costs of your care might be, so you can budget your dental care. You can also use the DentalOptimizer to determine your risk level for cavities and use that assessment to learn about reducing your risks and reducing your costs in the future.
ODS also offers members the Treatment Cost Navigator (TCN), a medical treatment cost estimator. TCN will give you personalized cost information based on the information you choose, such as provider and treatment type, and also estimates amount covered by your plan. This can help you determine the fluctuations in costs for different treatments and different providers, and arms you with these estimates prior to calling the providers to learn more. You’ll also find easy-to-understand explanations of treatments, expected out-of-pocket costs, and details about how costs were determined.
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