Beneficial Medical Benefits

When you join ODS, you get health plans enhanced by a wide variety of helpful value added services. Members have access to:

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. We're looking forward to helping you out.

Maximums / Deductibles
**Combined in- and out-of-network deductibles, separate out-of-pocket maximums.
1Fixed dollar co-pays and disallowed charges do not apply to the annual deductible or to the out-of-pocket maximum. Expenses applied toward the annual deductible do not apply to the out-of-pocket maximum.
  In Network
(You Pay)		 Out of Network
(You Pay)1
Annual deductibleThe portion of an individual’s applicable healthcare expenses that must be paid by the member in a given year before the insurance plan will start paying for treatment. $1,000 / $2,500 individual
$3,000 family**1		 $1,000 / $2,500 individual
$7,500 family**1
Annual out-of-pocket maximumA specified amount of applicable claims expenses in a plan year that must be met before benefits are paid in full. Once the member has met his or her out-of-pocket maximum, the plan begins covering eligible expenses at 100 percent. The out-of-pocket maximum starts over every plan year. In network: $3,000 individual**1
Out of Network: No Maximum**
Maximum lifetime benefit $2,000,000 ($250,000 can be accessed out of network)
Covered Services
Services In Network
after deductible, you pay		 Out of Network
after deductible, you pay
Preventive Care ($350 plan yearThe 12-month period commencing on the effective date and each 12-month period thereafter. maximum)
Well Baby Care No co-pay* No co-pay*
Routine Physicals $20 co-payThe insured patient’s share of the total medical bill, usually expressed as a specific dollar amount paid for a given service, product or treatment. For example, the patient might pay 0 for each doctor’s office visit. The patient is usually responsible for payment at the time of the treatment or service.*1 50%
Immunizations No co-pay* 50%

1Fixed dollar co-pays and disallowed charges do not apply to the annual deductible or to the out-of-pocket maximum. Expenses applied toward the annual deductible do not apply to the out-of-pocket maximum.
2Covers visits except for services for TMJ, occupational therapy, speech therapy, family planning and biofeedback.
* Deductible waived.
** Beneficial plan pays first three office visits with a $20 co-payment, which may be used for either illness or injury visits. Subsequent office visits, you pay 20% after deductible.

This is a benefit summary only. For a complete description of benefits, refer to your Policy.
Professional Services
Routine women’s exams (including pap test, pelvic exam and breast exam) $20 co-pay*1 50%
Routine prostate rectal exam $20 co-pay*1 50%
Office and Home Visits $20 co-pay**2 / 20% 50%
Urgent Care Visits 20% after $50 co-pay 50% after $50 co-pay
Surgery 20% 50%
Acupuncture, chiropractic and naturopathic ($1,000 plan year maximum) 20% 50%
Maternity ($5000 plan yearThe 12-month period commencing on the effective date and each 12-month period thereafter. maximum)
Practitioner services 20% 50%
Hospital stay 20% 50%
Hospital Services
Inpatient care 20% 50%
Skilled nursing facility care 20% 50%
Outpatient Services
Outpatient Hospital/Facility 20% 50%
Diagnostic X-Ray and Lab 20% 50%
Specified imaging (MRI, CT, CAT, PET scans) 20% 50%
Emergency Room Visits 20% after
$100 co-pay		 50% after
$100 co-pay
Other Covered Services
Physical Therapy 20% 50%
Allergy Injections 20% 50%
Ambulance Service 20%
Durable Medical Equipment 20% 50%
Home Health, Hospice, and Respite Care 20% 50%
Accident Benefit Deductible waived for treatment completed within 90 days of accident
Prescription Drug (Show your ODS Alaska ID card to access discounts at participating pharmacies) 20%
$10,000 annual maximum

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