OHP Client Benefits and Information
Starting January 1, 2014, most people will qualify for the Oregon Health Plan’s full benefit package called OHP Plus.
OHP Plus benefits include:
- Doctor visits
- Mental health care
- Addictions treatment
- Basic dental services: cleaning, fillings and extractions
- Hearing aids and hearing aid exams
- Medical equipment and supplies
- Medical transportation
- Physical therapy
- Occupational therapy
- Speech therapy
- Home health services
- Some vision services for eye health
Learn more about how to apply for the Oregon Health Plan today. View the benefit chart to compare benefits for different OHP programs. For information about specific services, contact your provider.
How does OHP determine what services are covered?
The Prioritized List of Health Services helps determine what the Oregon Health Plan covers. To find out if a specific procedure is covered according to the Prioritized List, contact your provider.
If you have questions about how to receive OHP services, refer to your OHP Client Handbook first, then contact your OHP medical, dental or mental health plan. If you are not in a plan or you still need help, then call OHP Client Services at 800-273-0557.
OHP Client Handbook (updated March 2014)
You can call OHP Client Services at 1-800-273-0557 to have a copy mailed to you.
OHP Client Toolkit
Read the toolkit
to learn what to expect as an OHP member about the topics listed below, including how to prevent bills, and work with your health plan. You can call OHP Client Services at 1-800-273-0557 to have a copy mailed to you.
- How to successfully access services (English)
- How providers request prior authorization (English)
- The Notice of Action letter (English)
- Appeal and hearing processes (English)
- Copayments (English)
- Paying for covered services (English)
- Paying for non-covered services (English)
- What to do if you get an unexpected bill (English)
- Rights and responsibilities (English)
- Common forms you may see and resources (English)
More information about your OHP benefits
This chart lists the benefits covered for each OHP benefit package. Your OHP coverage letter tells you the benefit package(s) for each person in your household. Learn more at these links:
- Dental benefits: Read our brochure in English or Spanish
- Pharmacy benefits: Your doctor will know what prescriptions are covered, and your pharmacy will know whether you will need to pay a copayment.
- Frequently Asked Questions
- Oregon Health Plan Care Coordination - If you are not enrolled in an OHP medical plan, you can call 1-800-562-4620 anytime you are sick, hurt or want to talk to a nurse. Additional programs are available for clients with more complex conditions.
- OHP Tobacco Cessation Services provided by OHP medical and dental plans.
- Oregon Tobacco Quit Line: Call 1-800-QUIT-NOW (Español: 1-877-2NO-FUME) for free and friendly help to quit smoking or chewing.
Do I need to pay for my OHP benefits?
|If your benefit package is:
||Then your costs are:|
|OHP Plus or OHP with Limited Drug
$0 to $3 copayments for some services (such as office visits and non-preferred prescriptions).
- For more information, see the frequently asked questions about copayments.
- Clients not in an OHP medical plan can enroll in OHP home-delivery pharmacy and pay no copayments for home-delivered drugs.
You may have to pay for services that are covered by OHP, if you:
- See a provider who isn't enrolled with OHP or your OHP health or dental plan. Not all providers, pharmacies or laboratories accept OHP. Ask your provider if they accept OHP before getting services.
- Don't tell your provider you have OHP.
You will have to pay for services you receive:
- When you are not eligible for OHP,
- During an appeal, grievance or hearing if the action is denied, or
- If you sign an agreement to pay and the service is not covered by OHP.
How can I get medical, dental or mental health care?
See if you are enrolled in a plan. Your coverage letter will list the plan name and phone number. If you are enrolled in an OHP health or dental plan, call your plan first. Also see our frequently asked questions about service delivery.
In a plan?
YES - Call your plan
|NO- Find a local provider who will accept OHP ("open card")|
Medical care - Doctor visits, tests and lab work; pharmacy, vision, family planning, hospital, chemical dependency services
Call your OHP Fully Capitated Health Plan or Coordinated Care Organization
Call providers in your area, or a local safety net clinic:
|Mental health care - Counseling, therapy, behavioral and psychiatric care
Call your OHP Mental Health Organization or Coordinated Care Organization
|Dental care - Dentist visits, dentures and other services
||Call your OHP Dental Care Organization or Coordinated Care Organization
Use the Insure Kids Now! Web site to find OHP dentists in your area. Select the "Oregon Health Plan - Fee-for-Service" benefit plan.
Go to the Oregon Dental Association Web site to find out about dental clinics and other resources.
What if I get a bill from my provider?
Do not pay it! If you get a bill that says you owe money, you should:
- Call your provider's office. Make sure they have billed OHP or your health plan using your Client ID number.
- If you still get a bill, call your health plan or OHP Client Services.
Learn more about what to do if you receive a bill for OHP services. Also read our frequently asked questions about what clients can do when they disagree with a plan or DMAP decision about paying for health care services.
Is there other help?
When you need help, contact your OHP health or dental plan first. If you are not in a plan or still need help after contacting your plan, call OHP Client Services at 1-800-273-0557.