ODS OEBB member flu vaccines
Information about flu vaccines
Influenza vaccines are covered under OEBB’s preventive care benefit at 100 percent when you visit a contracted provider. Individual and family deductibles are waived for this preventative service.
OEBB members have access to flu vaccines through any of the following options:
- Preferred providers. Use the ODS Provider Search to find the provider nearest you.
- Participating Oregon Prescription Drug Plan (OPDP) network pharmacies.
- Flu shot clinics, student health clinics, county health clinics, etc.
Reimbursement to providers will be based on:
- Preferred providers contracted reimbursement fees
- Contracted fees for pharmacies participating in the OPDP network
- Immunizations billed by licensed flu shot clinic providers or student and county health clinics will be reimbursed at the in-network benefit level. The payment allowance will be based on the maximum plan allowable (MPA) for the geographic area.
Benefits will be based on policy provisions and covered immunizations will be limited to those that are considered the "standard of care" by the local medical community. Government agencies or medical associations such as the American Medical Association and Oregon Medical Association will set these standards for the state as a whole.
Flu vaccine billing process
- If a member goes to an ODS preferred provider for a flu vaccine, the provider will submit a bill to ODS for reimbursement. This means no out-of-pocket expenses for the member.
- OEBB members accessing immunizations and vaccines at a contracted OPDP network pharmacy can have their claims processed for covered benefits at the point of service by simply supplying their insurance information to the pharmacy. This means no out-of-pocket expenses for the member.
- In some cases, members may need to pay for the immunization and bill ODS directly for reimbursement. Please note, members must submit a receipt for the vaccine to the address below to be eligible for reimbursement.
Group billing for immunizations
Flu shot clinic providers can submit for reimbursement by using the attached group billing roster. The itemized billing statement must be legible and include all data elements requested on the form. Reimbursement will be based on eligibility for members on the date of service
Please submit claims to:
ODS Health Plans
Attn: Director Medical Claims
PO BOX 40384
Portland, OR 97240-0384
For any questions, please call:
503-265-2909 or toll-free 866-923-0409