Your Medical Benefits
OAP HDHPQ Plan - HDHPQ OAP
Benefit Summary
Group # 00657005
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 | |
| Plan Coinsurance | Plan pays 70% | Plan pays 50% |
| Individual Deductible | Individual - Employee Only: $6,500 Individual - within a Family: $6,500 | Individual - Employee Only: $10,000 Individual - within a Family: $10,000 |
| Family Deductible | Family Maximum: $13,000 | Family Maximum: $20,000 |
| Individual Out-of-Pocket | Individual - Employee Only: $8,050 Individual - within a Family: $8,050 | Individual - Employee Only: $20,000 Individual - within a Family: $20,000 |
| Family Out-of-Pocket | Family Maximum: $16,100 | Family Maximum: $40,000 |
| Primary Care Office Visit | Plan pays 70% | Plan pays 50% |
| Specialist Care Office Visit | Plan pays 70% | Plan pays 50% |
| Emergency Room | Plan pays 70% | |
| Urgent Care | Plan pays 70% | Plan pays 50% |
| Outpatient Radiology | Plan pays 70% | Plan pays 50% |
| Independent Laboratory | Plan pays 70% | Plan pays 50% |
| Outpatient Physical, Speech, Hearing, and Occupational Therapy | Plan pays 70% | Plan pays 50% |
| Pharmacy Formulary | Advantage | |
| Retail Pharmacy Customer Share | Retail (per 30-day supply): Generic: You pay $10 Preferred Brand: You pay $35 Non-Preferred Brand: You pay $70 | Not Covered for all benefits |
| Home Delivery Pharmacy Customer Share | Retail and Home Delivery (per 90-day supply): Generic: You pay $25 Preferred Brand: You pay $88 Non-Preferred Brand: You pay $175 | Not Covered for all benefits |
All plans have exclusions and limitations. For a summary of these exclusions and limitations, view the Summary of Benefits and Coverage.
Benefit Summary
Group # 00657005
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 | |
| Plan Coinsurance | Plan pays 70% | Plan pays 50% |
| Individual Deductible | Individual - Employee Only: $6,500 Individual - within a Family: $6,500 | Individual - Employee Only: $10,000 Individual - within a Family: $10,000 |
| Family Deductible | Family Maximum: $13,000 | Family Maximum: $20,000 |
| Individual Out-of-Pocket | Individual - Employee Only: $8,050 Individual - within a Family: $8,050 | Individual - Employee Only: $20,000 Individual - within a Family: $20,000 |
| Family Out-of-Pocket | Family Maximum: $16,100 | Family Maximum: $40,000 |
| Primary Care Office Visit | Plan pays 70% | Plan pays 50% |
| Specialist Care Office Visit | Plan pays 70% | Plan pays 50% |
| Emergency Room | Plan pays 70% | |
| Urgent Care | Plan pays 70% | Plan pays 50% |
| Outpatient Radiology | Plan pays 70% | Plan pays 50% |
| Independent Laboratory | Plan pays 70% | Plan pays 50% |
| Outpatient Physical, Speech, Hearing, and Occupational Therapy | Plan pays 70% | Plan pays 50% |
| Pharmacy Formulary | Advantage | |
| Retail Pharmacy Customer Share | Retail (per 30-day supply): Generic: You pay $10 Preferred Brand: You pay $35 Non-Preferred Brand: You pay $70 | Not Covered for all benefits |
| Home Delivery Pharmacy Customer Share | Retail and Home Delivery (per 90-day supply): Generic: You pay $25 Preferred Brand: You pay $88 Non-Preferred Brand: You pay $175 | Not Covered for all benefits |
All plans have exclusions and limitations. For a summary of these exclusions and limitations, view the Summary of Benefits and Coverage.