Your Medical Benefits
Open Access Plus - HDHPQ OAP
Benefit Summary
Group # 00637515
Open Access Plus (OAP) gives you access to thousands of providers, doctors, hospitals and specialists– plus programs and services to support your whole-health needs.
A HDHP, or High Deductible Health Plan, can be combined with a tax-advantaged saving account allowing you to pay for certain medical expenses with money free from federal taxes. Until you reach your deductible, you must pay for most of your health care expenses out-of-pocket.
Note: The Plan deductible always applies before any benefit copay/deductible or coinsurance.
Find a Provider
Plan Documents
| In-Network | Out-of-Network | |
|---|---|---|
| Plan Name | Open Access Plus - HDHPQ OAP | |
| Plan Coinsurance | Plan pays 80% | Plan pays 60% |
| Individual Deductible | Individual - Employee Only: $1,700 Individual - within a Family: $3,400 | Individual - Employee Only: $3,400 Individual - within a Family: $6,600 |
| Family Deductible | Family Maximum: $3,400 | Family Maximum: $6,800 |
| Individual Out-of-Pocket | Individual - Employee Only: $3,000 Individual - within a Family: $3,400 | Individual - Employee Only: $9,000 Individual - within a Family: $9,000 |
| Family Out-of-Pocket | Family Maximum: $6,000 | Family Maximum: $18,000 |
| Primary Care Office Visit | Plan pays 80% | Plan pays 60% |
| Specialist Care Office Visit | Plan pays 80% | Plan pays 60% |
| Emergency Room | Plan pays 80% | |
| Urgent Care | Plan pays 80% | Plan pays 60% |
| Outpatient Radiology | Plan pays 80% | Plan pays 60% |
| Independent Laboratory | Plan pays 80% | Plan pays 60% |
| Outpatient Physical, Speech, Hearing, and Occupational Therapy | Plan pays 80% | Plan pays 60% |
| Pharmacy Formulary | Performance | |
| Retail Pharmacy Customer Share | Retail (per 30-day supply): Generic: You pay $15 Preferred Brand: You pay $40 Non-Preferred Brand: You pay $60 | Retail: You pay 40% Your plan pays 60% |
| Home Delivery Pharmacy Customer Share | Retail and Home Delivery (per 30-day supply): Specialty: You pay 30% up to a maximum of $250 Retail and Home Delivery (per 90-day supply): Generic: You pay $38 Preferred Brand: You pay $120 Non-Preferred Brand: You pay $180 | Home Delivery: Not Covered |
All plans have exclusions and limitations. For a summary of these exclusions and limitations, view the Summary of Benefits and Coverage.
Benefit Summary
Group # 00637515
Open Access Plus (OAP) gives you access to thousands of providers, doctors, hospitals and specialists– plus programs and services to support your whole-health needs.
A HDHP, or High Deductible Health Plan, can be combined with a tax-advantaged saving account allowing you to pay for certain medical expenses with money free from federal taxes. Until you reach your deductible, you must pay for most of your health care expenses out-of-pocket.
Note: The Plan deductible always applies before any benefit copay/deductible or coinsurance.
| In-Network | Out-of-Network | |
|---|---|---|
| Plan Name | Open Access Plus - HDHPQ OAP | |
| Plan Coinsurance | Plan pays 80% | Plan pays 60% |
| Individual Deductible | Individual - Employee Only: $1,700 Individual - within a Family: $3,400 | Individual - Employee Only: $3,400 Individual - within a Family: $6,600 |
| Family Deductible | Family Maximum: $3,400 | Family Maximum: $6,800 |
| Individual Out-of-Pocket | Individual - Employee Only: $3,000 Individual - within a Family: $3,400 | Individual - Employee Only: $9,000 Individual - within a Family: $9,000 |
| Family Out-of-Pocket | Family Maximum: $6,000 | Family Maximum: $18,000 |
| Primary Care Office Visit | Plan pays 80% | Plan pays 60% |
| Specialist Care Office Visit | Plan pays 80% | Plan pays 60% |
| Emergency Room | Plan pays 80% | |
| Urgent Care | Plan pays 80% | Plan pays 60% |
| Outpatient Radiology | Plan pays 80% | Plan pays 60% |
| Independent Laboratory | Plan pays 80% | Plan pays 60% |
| Outpatient Physical, Speech, Hearing, and Occupational Therapy | Plan pays 80% | Plan pays 60% |
| Pharmacy Formulary | Performance | |
| Retail Pharmacy Customer Share | Retail (per 30-day supply): Generic: You pay $15 Preferred Brand: You pay $40 Non-Preferred Brand: You pay $60 | Retail: You pay 40% Your plan pays 60% |
| Home Delivery Pharmacy Customer Share | Retail and Home Delivery (per 30-day supply): Specialty: You pay 30% up to a maximum of $250 Retail and Home Delivery (per 90-day supply): Generic: You pay $38 Preferred Brand: You pay $120 Non-Preferred Brand: You pay $180 | Home Delivery: Not Covered |
All plans have exclusions and limitations. For a summary of these exclusions and limitations, view the Summary of Benefits and Coverage.