Medical and Dental Plan Changes Effective April 1, 2008
Kaiser Medical |
ODS Medical |
Home health visits are covered up to 130 days per calendar year. |
Prescription drugs will be administered through the Oregon Prescription Drug Program (OPDP), a new state program (Click here for more info). |
The outpatient surgery cost share applies to all procedures performed in ambulatory surgery centers.
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The lifetime maximum benefit has increased from $1,000,000 to $2,000,000. |
| Physical, occupational and speech therapy are covered up to 20 visits per therapy per year. | Periodic health examinations will be covered as follows: One exam per person per calendar year for all ages 2 and above. |
Drugs used for the treatment of sexual dysfunction disorders are currently excluded from coverage. Effective April 1, 2008, drugs for prevention of sexual dysfunction disorders will also be excluded.
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Vision benefits are covered as follows: Exams and frames available every calendar year for those under age 17 and every 2 calendar years ages 17 and over. |
Prescription drugs cannot be provided through mail delivery to members who permanently reside outside Oregon and Washington. |
Limitations on Mental Health Care are revised as follows: Prior authorization after the 8th outpatient visit is no longer required. The Plan covers medically necessary outpatient services by a mental health provider.
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Limitations on Chemical Dependency Care are revised as follows: Prior authorization after the 1st outpatient visit is no longer required. The Plan covers medically necessary outpatient services by a chemical dependence provider. |
Coordination of Benefits provision changes as follows: (1) Credit savings is removed; (2) Order of COB determination is expanded to include unmarried parents; and (3) Definition of allowable expense is revised. |
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| Kaiser Permanente Dental Plan | ODS Dental Plan |
Speech aid prosthetic devices and follow-up modifications are excluded from coverage. |
Coverage for dental implant placement and removal once per lifetime per tooth space is added to the plan. |
Treatment to restore tooth structure lost due to attrition, erosion or abrasion is excluded. |
The name of the Healthy Mouth, Health Body program has changed to Oral Health, Total Health |
The dental annual maximum benefit has changed from $1,000 to $1,500. |
Diabetic members enrolled in the Oral Health, Total Health Program are eligible for two additional cleanings or periodontal maintenance per year (for a total of four cleanings or periodontal maintenance per year). Enrolled members must register for the program to be eligible for the increased benefit. |
The dental annual maximum benefit has changed from $1,000 to $1,500. |
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