Your Medical Benefits
OAP HDHPQ Plan - HDHPQ OAP Mid
Benefit Summary
Group # 00634554
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.
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Plan Documents
| In-Network | Out-of-Network | |
|---|---|---|
| Plan Name | OAP HDHPQ Plan - HDHPQ OAP Mid | |
| Plan Coinsurance | Plan pays 100% | Plan pays 70% |
| Individual Deductible | Individual - Employee Only: $3,400 Individual - within a Family: $3,400 | Individual - Employee Only: $6,000 Individual - within a Family: $6,000 |
| Family Deductible | Family Maximum: $8,400 | Family Maximum: $18,000 |
| Individual Out-of-Pocket | Individual - Employee Only: $3,400 Individual - within a Family: $3,400 | Individual - Employee Only: $6,000 Individual - within a Family: $6,000 |
| Family Out-of-Pocket | Family Maximum: $8,400 | Family Maximum: $18,000 |
| Primary Care Office Visit | Plan pays 100% | Plan pays 70% |
| Specialist Care Office Visit | Plan pays 100% | Plan pays 70% |
| Emergency Room | Plan pays 100% | |
| Urgent Care | Plan pays 100% | Plan pays 100% |
| Outpatient Radiology | Plan pays 100% | Plan pays 70% |
| Independent Laboratory | Plan pays 100% | Plan pays 70% |
| Outpatient Physical, Speech, Hearing, and Occupational Therapy | Plan pays 100% | Plan pays 70% |
| Pharmacy Formulary | Advantage | |
| Retail Pharmacy Customer Share | Retail: You pay 0% Your plan pays 100% | Retail: You pay 0% Your plan pays 100% |
| Home Delivery Pharmacy Customer Share | Home Delivery: You pay 0% Your plan pays 100% | Home Delivery: Same as Retail Out-of-Network |
All plans have exclusions and limitations. For a summary of these exclusions and limitations, view the Summary of Benefits and Coverage.
Benefit Summary
Group # 00634554
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 | OAP HDHPQ Plan - HDHPQ OAP Mid | |
| Plan Coinsurance | Plan pays 100% | Plan pays 70% |
| Individual Deductible | Individual - Employee Only: $3,400 Individual - within a Family: $3,400 | Individual - Employee Only: $6,000 Individual - within a Family: $6,000 |
| Family Deductible | Family Maximum: $8,400 | Family Maximum: $18,000 |
| Individual Out-of-Pocket | Individual - Employee Only: $3,400 Individual - within a Family: $3,400 | Individual - Employee Only: $6,000 Individual - within a Family: $6,000 |
| Family Out-of-Pocket | Family Maximum: $8,400 | Family Maximum: $18,000 |
| Primary Care Office Visit | Plan pays 100% | Plan pays 70% |
| Specialist Care Office Visit | Plan pays 100% | Plan pays 70% |
| Emergency Room | Plan pays 100% | |
| Urgent Care | Plan pays 100% | Plan pays 100% |
| Outpatient Radiology | Plan pays 100% | Plan pays 70% |
| Independent Laboratory | Plan pays 100% | Plan pays 70% |
| Outpatient Physical, Speech, Hearing, and Occupational Therapy | Plan pays 100% | Plan pays 70% |
| Pharmacy Formulary | Advantage | |
| Retail Pharmacy Customer Share | Retail: You pay 0% Your plan pays 100% | Retail: You pay 0% Your plan pays 100% |
| Home Delivery Pharmacy Customer Share | Home Delivery: You pay 0% Your plan pays 100% | Home Delivery: Same as Retail Out-of-Network |
All plans have exclusions and limitations. For a summary of these exclusions and limitations, view the Summary of Benefits and Coverage.