Moda Health. Healthcare from your head to your toes. Delta Dental | Moda Health

PPO Plan

Area 1 (Portland)

Prevailing Benefits
Age Insured
Only		 Insured &
Spouse		 Insured & Spouse & Child (ren) Insured & Child (ren)

Monthly rates effective June 1, 2012
Monthly family rates are based on the age of primary applicant
Under 25 $337 $708 $995 $583
25 - 29 $379 $796 $1,118 $656
30 - 34 $379 $796 $1,119 $656
35 - 39 $400 $841 $1,181 $693
40 - 44 $443 $931 $1,308 $767
45 - 49 $524 $1,101 $1,547 $907
50 - 54 $608 $1,276 $1,793 $1,052
55 - 59 $647 $1,359 $1,909 $1,120
60 - 64 $667 $1,400 $1,967 $1,154
65 and older $671 $1,409 $1,980 $1,161
Low Cost Benefits
Age Insured
Only		 Insured &
Spouse		 Insured & Spouse & Child (ren) Insured & Child (ren)

Monthly rates effective June 1, 2012
Monthly family rates are based on the age of primary applicant
Under 25 $252 $528 $742 $435
25 - 29 $283 $594 $834 $489
30 - 34 $283 $594 $834 $489
35 - 39 $299 $627 $881 $517
40 - 44 $331 $694 $975 $572
45 - 49 $391 $821 $1,153 $676
50 - 54 $453 $952 $1,337 $784
55 - 59 $483 $1,014 $1,424 $835
60 - 64 $497 $1,044 $1,467 $860
65 and older $501 $1,051 $1,477 $866

Area 2 (Eugene)

Prevailing Benefits
Age Insured
Only		 Insured &
Spouse		 Insured & Spouse & Child (ren) Insured & Child (ren)

Monthly rates effective June 1, 2012
Monthly family rates are based on the age of primary applicant
Under 25 $329 $690 $969 $569
25 - 29 $369 $776 $1,090 $639
30 - 34 $370 $776 $1,090 $639
35 - 39 $390 $819 $1,151 $675
40 - 44 $432 $907 $1,274 $747
45 - 49 $511 $1,073 $1,507 $884
50 - 54 $592 $1,244 $1,747 $1,025
55 - 59 $631 $1,324 $1,860 $1,091
60 - 64 $650 $1,364 $1,917 $1,124
65 and older $654 $1,373 $1,929 $1,131
Low Cost Benefits
Age Insured
Only		 Insured &
Spouse		 Insured & Spouse & Child (ren) Insured & Child (ren)

Monthly rates effective June 1, 2012
Monthly family rates are based on the age of primary applicant
Under 25 $245 $515 $723 $424
25 - 29 $275 $579 $813 $477
30 - 34 $276 $579 $813 $477
35 - 39 $291 $611 $858 $503
40 - 44 $322 $677 $950 $557
45 - 49 $381 $800 $1,124 $659
50 - 54 $442 $928 $1,303 $764
55 - 59 $470 $988 $1,387 $814
60 - 64 $485 $1,018 $1,429 $838
65 and older $488 $1,024 $1,439 $844

Area 3 (Salem)

Prevailing Benefits
Age Insured
Only		 Insured &
Spouse		 Insured & Spouse & Child (ren) Insured & Child (ren)

Monthly rates effective June 1, 2012
Monthly family rates are based on the age of primary applicant
Under 25 $314 $659 $925 $543
25 - 29 $353 $740 $1,040 $610
30 - 34 $353 $741 $1,040 $610
35 - 39 $372 $782 $1,099 $644
40 - 44 $412 $866 $1,216 $713
45 - 49 $488 $1,024 $1,438 $843
50 - 54 $565 $1,187 $1,668 $978
55 - 59 $602 $1,264 $1,776 $1,041
60 - 64 $620 $1,302 $1,829 $1,073
65 and older $624 $1,311 $1,841 $1,080
Low Cost Benefits
Age Insured
Only		 Insured &
Spouse		 Insured & Spouse & Child (ren) Insured & Child (ren)

Monthly rates effective June 1, 2012
Monthly family rates are based on the age of primary applicant
Under 25 $234 $491 $690 $405
25 - 29 $263 $552 $776 $455
30 - 34 $263 $552 $776 $455
35 - 39 $278 $583 $819 $480
40 - 44 $307 $646 $907 $532
45 - 49 $364 $764 $1,073 $629
50 - 54 $422 $885 $1,244 $729
55 - 59 $449 $943 $1,324 $777
60 - 64 $462 $971 $1,364 $800
65 and older $465 $978 $1,373 $805

Area 4 (Bend/Klamath Falls)

Prevailing Benefits
Age Insured
Only		 Insured &
Spouse		 Insured & Spouse & Child (ren) Insured & Child (ren)

Monthly rates effective June 1, 2012
Monthly family rates are based on the age of primary applicant
Under 25 $351 $737 $1,035 $607
25 - 29 $394 $828 $1,163 $682
30 - 34 $394 $828 $1,164 $682
35 - 39 $416 $874 $1,228 $720
40 - 44 $461 $968 $1,360 $798
45 - 49 $545 $1,145 $1,608 $943
50 - 54 $632 $1,328 $1,865 $1,094
55 - 59 $673 $1,413 $1,986 $1,164
60 - 64 $693 $1,456 $2,046 $1,200
65 and older $698 $1,466 $2,059 $1,207
Low Cost Benefits
Age Insured
Only		 Insured &
Spouse		 Insured & Spouse & Child (ren) Insured & Child (ren)

Monthly rates effective June 1, 2012
Monthly family rates are based on the age of primary applicant
Under 25 $262 $549 $772 $453
25 - 29 $294 $617 $867 $509
30 - 34 $294 $618 $868 $509
35 - 39 $311 $652 $916 $537
40 - 44 $344 $722 $1,014 $595
45 - 49 $407 $854 $1,200 $703
50 - 54 $471 $990 $1,391 $816
55 - 59 $502 $1,054 $1,481 $868
60 - 64 $517 $1,086 $1,526 $895
65 and older $521 $1,093 $1,536 $901

Area 5 (Coastal Areas)

Prevailing Benefits
Age Insured
Only		 Insured &
Spouse		 Insured & Spouse & Child (ren) Insured & Child (ren)

Monthly rates effective June 1, 2012
Monthly family rates are based on the age of primary applicant
Under 25 $327 $687 $965 $566
25 - 29 $368 $772 $1,085 $636
30 - 34 $368 $773 $1,085 $636
35 - 39 $388 $816 $1,146 $672
40 - 44 $430 $903 $1,269 $744
45 - 49 $509 $1,068 $1,500 $880
50 - 54 $590 $1,238 $1,739 $1,020
55 - 59 $628 $1,318 $1,852 $1,086
60 - 64 $647 $1,358 $1,908 $1,119
65 and older $651 $1,367 $1,920 $1,126
Low Cost Benefits
Age Insured
Only		 Insured &
Spouse		 Insured & Spouse & Child (ren) Insured & Child (ren)

Monthly rates effective June 1, 2012
Monthly family rates are based on the age of primary applicant
Under 25 $244 $512 $720 $422
25 - 29 $274 $576 $809 $474
30 - 34 $274 $576 $809 $475
35 - 39 $290 $608 $855 $501
40 - 44 $321 $673 $946 $555
45 - 49 $379 $796 $1,119 $656
50 - 54 $440 $923 $1,297 $761
55 - 59 $468 $983 $1,381 $810
60 - 64 $482 $1,013 $1,423 $834
65 and older $486 $1,020 $1,432 $840

Area 6 (Eastern Oregon)

Prevailing Benefits
Age Insured
Only		 Insured &
Spouse		 Insured & Spouse & Child (ren) Insured & Child (ren)

Monthly rates effective June 1, 2012
Monthly family rates are based on the age of primary applicant
Under 25 $341 $715 $1,005 $589
25 - 29 $383 $804 $1,129 $662
30 - 34 $383 $804 $1,130 $663
35 - 39 $404 $849 $1,193 $700
40 - 44 $448 $940 $1,321 $775
45 - 49 $530 $1,112 $1,562 $916
50 - 54 $614 $1,289 $1,811 $1,062
55 - 59 $654 $1,373 $1,928 $1,131
60 - 64 $673 $1,414 $1,987 $1,165
65 and older $678 $1,423 $2,000 $1,173
Low Cost Benefits
Age Insured
Only		 Insured &
Spouse		 Insured & Spouse & Child (ren) Insured & Child (ren)

Monthly rates effective June 1, 2012
Monthly family rates are based on the age of primary applicant
Under 25 $254 $533 $749 $439
25 - 29 $286 $600 $842 $494
30 - 34 $286 $600 $843 $494
35 - 39 $302 $633 $890 $522
40 - 44 $334 $701 $985 $578
45 - 49 $395 $829 $1,165 $683
50 - 54 $458 $961 $1,351 $792
55 - 59 $487 $1,024 $1,438 $843
60 - 64 $502 $1,055 $1,482 $869
65 and older $506 $1,062 $1,491 $875

Area 7 (Medford)

Prevailing Benefits
Age Insured
Only		 Insured &
Spouse		 Insured & Spouse & Child (ren) Insured & Child (ren)

Monthly rates effective June 1, 2012
Monthly family rates are based on the age of primary applicant
Under 25 $357 $751 $1,055 $618
25 - 29 $402 $844 $1,185 $695
30 - 34 $402 $844 $1,186 $695
35 - 39 $424 $891 $1,252 $734
40 - 44 $470 $987 $1,386 $813
45 - 49 $556 $1,167 $1,639 $961
50 - 54 $644 $1,353 $1,901 $1,115
55 - 59 $686 $1,441 $2,024 $1,187
60 - 64 $707 $1,484 $2,085 $1,223
65 and older $711 $1,494 $2,099 $1,231
Low Cost Benefits
Age Insured
Only		 Insured &
Spouse		 Insured & Spouse & Child (ren) Insured & Child (ren)

Monthly rates effective June 1, 2012
Monthly family rates are based on the age of primary applicant
Under 25 $267 $560 $786 $461
25 - 29 $300 $629 $884 $518
30 - 34 $300 $630 $884 $519
35 - 39 $317 $665 $934 $548
40 - 44 $350 $736 $1,034 $606
45 - 49 $414 $870 $1,223 $717
50 - 54 $481 $1,009 $1,418 $831
55 - 59 $512 $1,074 $1,509 $885
60 - 64 $527 $1,107 $1,555 $912
65 and older $531 $1,114 $1,565 $918

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Hello.

We have exciting news to share. ODS is changing its name to Moda Health.

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