August/September 2011 

ODS helps individual members stay healthy with new pets    


At ODS, it is our goal to partner with our members in health. Scientific studies have shown that owning a pet is one of the best things people can do to improve their health.


ODS and the Oregon Humane Society have joined forces to bring our individual medical members the opportunity to improve their health and add a new pet to their family.


Individual members will receive a mailing from ODS that includes a coupon for $25 toward the adoption of a lifelong, loving companion from the Oregon Humane Society. In addition to a great new pal, the member and new pet will also receive a welcome home kit from ODS that includes helpful information about owning a pet and a toy.


The Affordable Care Act wants to reward your wellness!  


The Patient Protection and Affordable Care Act (PPACA) allows small business to apply for grants to fund workplace wellness programs. The government allocated $200 million for these grants from 2011 through 2015. While the government has yet to publish grant guidelines, we want you to be aware of the ODS programs that may help your clients meet grant requirements.



Programs must have:

ODS programs/

services that fulfill requirement:


What your workplace can do:

Health awareness initiatives (health education, preventive screenings and health risk assessments)


  • Health education materials (e.g., flyers, payroll stuffers and brochures)
  • Preventive screenings (included in standard health benefits)
  • Online personal health assessment for members 18+


  • Maintain a health library for employees to access



Efforts to maximize employee engagement


  • ODS health coaching provides incentives for participants to engage with a coach in self-care and personal health improvement


  • Create incentives (gift cards, money or prizes) for participation in health activities


Initiatives to change unhealthy behaviors and lifestyle choices (counseling, seminars, online programs and self-help materials)


  • Dedicated 1:1 health coaching
  • ODS eDoc & Nurse Advice Line for all fully-insured groups
  • myODS online health library
  • Healthy Living campaign to increase physical activity


  • Sponsor lunches on health topics
  • Promote employee assistance program (EAP) benefits
  • Provide Nurse Advice Line program (groups of 51+)
  • Provide telephonic health coaching benefits


Supportive environment efforts (workplace policies to encourage healthy lifestyles, healthy eating, increased physical activity and improved mental health)


  • ODS Well@Work Toolkit provides consulting to promote health, weight loss and nutrition
  • ODS services and programs are consistent with evidence-based research and best practices



  • Mandate a smoke-free workplace
  • Promote an alcohol/drug-free environment
  • Require seatbelt use
  • Formulate safety/emergency procedures for disasters
  • Include healthy options in vending machines
  • Encourage use of stairs
  • Support walking meetings
  • Provide services/classes to promote stress relief (yoga, meditation and/or massage)
  • Provide an employee fitness center
  • Encourage bike or walk to work programs



The PPACA also states employers must follow additional guidelines (to be developed) by the secretary of Health and Human Services. To be eligible for the grant, employers must have 100 or fewer employees and cannot have a comprehensive wellness program in place as of March 23, 2010. To receive grants, your clients must submit an application, including a proposal for a comprehensive workplace wellness program that meets the criteria. The legislation does not specify the amount of the grant per employer or employee, or make any requirement for employers to provide matching funds.  


PCOS- A common cause of infertility


Five to 7 million women in the U.S. have polycystic ovary syndrome (PCOS). This is about one in 15 women. Some women have PCOS and don't know it, in part because:

  • There is no single test to diagnosis PCOS.
  • Women who have PCOS don't all have the same symptoms.
  • Other conditions can also cause PCOS-like symptoms.

PCOS is a common cause of infertility. Without treatment, women with PCOS often cannot get pregnant.

What exactly is PCOS?

PCOS is a condition in which certain sex hormones are not in balance. This may cause a woman to experience changes in her menstrual cycle, skin and ovaries.

Symptoms of PCOS

Women with PCOS might have:

  • Irregular or absent menstrual periods
  • Infertility
  • Excessive growth of facial or body hair
  • Male-pattern hair loss
  • A tendency to be overweight or obese (>35-inch waist)
  • Acne on the face, chest or back
  • Skin tags in the armpits or neck
  • Darkening or thickening of skin around the neck, groin or underarms
  • High triglycerides and low HDL cholesterol blood levels
  • High blood pressure

Importance of PCOS diagnosis

Sometimes doctors treat the symptoms of PCOS (infertility, acne or excess body or facial hair) without determining the cause. A missed diagnosis may leave a woman with PCOS at higher risk of developing complications, including:

  • Endometrial cancer
  • Type 2 diabetes
  • Cardiovascular disease
  • Cerebrovascular disease

Finally, it's helpful to know that there is a genetic component to PCOS. Sisters and daughters of women with PCOS are at risk of having it, too, making diagnosis even more essential.


Article from Quest Diagnostics


ODS Well@Work makes your client's workplace healthier    


For all your workplace wellness needs, the ODS Worksite Wellness Consulting Team is here to help. Support from the team is built into the services you already receive from your most valuable healthcare partner - ODS.  


We're here to help you meet your client's organization health goals. They decide how we get involved with their wellness programs - hands on or off, it's their choice. The ODS Worksite Wellness Consulting Team can tailor our services to their unique needs and provide advice and resources to help client's implement their vision.


This group, along with your ODS Account Services team, can work with your client to:

  • Assess client's organization current level of wellness, including physical surroundings, policies and leading health-risk drivers.
  • Identify potential plan design opportunities, wellness gaps and effective strategies.
  • Work with clients to set measurable goals for improving employee health.
  • Partner with clients to create a detailed wellness plan that addresses their priorities.

We offer the ODS Well@Work Toolkit for groups who want to chart their own wellness journey.

For more about how ODS Well@Work can help your clients, or to schedule a wellness planning meeting, contact your ODS Account Services representative today.

Join us for our Producer Road Show


We're coming to you in October! Your invitation to the Fall 2011 Producer Road Show will arrive in a few weeks. Please check the dates we will be in your area. We look forward to seeing you. 



Not all plans have access to all resources or tools referenced in this newsletter. Please refer to your Member Handbook, or call your ODS Sales and Account Services Representative for plan-specific information.

Volume 2, Issue 4   

In this issue:
ODS partners with Oregon Humane Society
Two bills signed by governor
ODS Well@Work
Fall Road Show


Two Health Care Reform bills signed by governor


Governor John Kitzhaber recently signed Senate Bill 99 and Senate Bill 91, which will shape Oregon's health insurance market beginning in 2014.


SB 99: Creating the    Oregon Health Insurance Exchange Corporation

The Oregon Health   Insurance Exchange Corporation will provide access to individuals   seeking non-group    coverage (on a guaranteed issue basis) and employers with no more than 50 employees, beginning        Jan. 1, 2014. On Jan. 1, 2016, employers with 51 to 100 employees will also be eligible.

  • The Exchange         will be a public corporation    governed by a        board of directors consisting of nine members.
  • The directors of the    Oregon Health Authority and Department of   Consumer and Business Services will serve as ex officio members.     
  • No more than two  members may be affiliated with the healthcare sector (insurers, third- party administrators, producers, providers, trade or professional associations).
  • At least two members must be consumers, including one individual and one small employer purchasing coverage through the Exchange.

All members must be  

U.S. citizens and Oregon residents and have demonstrated  

professional and  

community leadership  

skills and experience.

Oregon will maintain dual individual and small group markets. Qualified health plans will be available through the Exchange  

while the traditional marketplace will continue

as an option for  

individuals and small  

groups. Health insurer participation in the  

Exchange is voluntary,  

but if an insurer uses the Exchange, it must offer  

the same products outside the Exchange as within,  

and at the same price.   


The insurer must also maintain common risk  

pools for individual and

small group products, respectively.


Individuals seeking  

premium tax credits and reduced cost-sharing

based on household  

income, and employers who want to receive small employer health insurance credits must purchase coverage through the Exchange.


Any insurer licensed by the state of Oregon and meeting applicable federal requirements for participation may offer products in the Exchange. The Exchange, however,  

will adopt uniform requirements that all qualified health plans must meet, and may limit the number of plans available  

as long as the limit applies uniformly to all insurers.


While the planning, development and implementation of  

Oregon's Exchange will commence in earnest, the actual operation of the Exchange is conditioned  

upon legislative approval  

of a formal business plan submitted by the Exchange Board no later than  

February 2012. In addition, the Exchange is required  

to report regularly to  

interim legislative committees on the implementation of the information technology

system that will support Exchange operations.


On June 23, Governor Kitzhaber named Howard "Rocky" King the interim director of the Oregon  

Health Insurance Exchange Corporation. Rocky served for more than 20 years  

as the administrator of the Office of Private Health Partnerships and the  

Oregon Medical Insurance Pool; both programs work closely with Oregon health insurers to improve access to health insurance coverage through various premium subsidy mechanisms.


The following activities  

are anticipated over the next 90 days:

  • The initial management team    of the Exchange      will be assembled. 
  • The governor will  solicit nominations for the Exchange Board,  with names forwarded for Senate      confirmation in late September.  
  • A federal establishment  
    grant will be approved with funding for about one year.
  • Federal policy guidance on several key operational  issues will be published.

A PDF of SB 99 is  

available at: SB99  


SB 91: Bronze and silver plans in reformed market

This legislation requires  

all health insurers  

operating in Oregon to offer bronze and silver health benefit plans approved by  

the Department of  

Consumer and Business Services in both the individual and small group markets, either through

the Oregon Health Insurance Exchange or outside the Exchange.

  • Bronze plans are  actuarially    equivalent to 60 percent of the full actuarial value of    the essential     benefit package as defined by the federal Affordable Care Act.
  • Silver plans are equivalent to 70 percent of the full actuarial value.

The purpose of this legislation is to assure the most level playing field possible between the Exchange and the outside market. Requiring all  

carriers to offer  

benchmark bronze and  

silver plans will help consumers compare  

insurers operating inside

and outside the Exchange.  In addition, it provides the Oregon Insurance Division with a tool for reviewing  

the appropriateness of an insurer's rating  

methodology across its product portfolio.


A PDF of SB 91 is  

available at: SB91 


If you have questions  

about SB 99 or SB 91,  

contact Barney Speight at ODS at

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