Your Medical Benefits
OAP HDHPQ Plan - HDHPQ OAPIN Base
Benefit Summary
Group # 00650877
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 | OAP HDHPQ Plan - HDHPQ OAPIN Base | |
| Plan Coinsurance | Plan pays 70% | Not Covered for all benefits |
| Individual Deductible | Individual - Employee Only: $7,000 Individual - within a Family: $7,000 | Not Covered for all benefits |
| Family Deductible | Family Maximum: $14,000 | Not Covered for all benefits |
| Individual Out-of-Pocket | Individual - Employee Only: $8,500 Individual - within a Family: $8,500 | Not Covered for all benefits |
| Family Out-of-Pocket | Family Maximum: $17,000 | Not Covered for all benefits |
| Primary Care Office Visit | Plan pays 70% | Not Covered for all benefits |
| Specialist Care Office Visit | Plan pays 70% | Not Covered for all benefits |
| Emergency Room | Plan pays 70% | |
| Urgent Care | Plan pays 70% | Not Covered for all benefits |
| Outpatient Radiology | Plan pays 70% | Not Covered for all benefits |
| Independent Laboratory | Plan pays 70% | Not Covered for all benefits |
| Outpatient Physical, Speech, Hearing, and Occupational Therapy | Plan pays 70% | Not Covered for all benefits |
| Pharmacy Formulary | Advantage | |
| Retail Pharmacy Customer Share | Retail (per 30-day supply): Generic: You pay $30 Preferred Brand: You pay $80 Non-Preferred Brand: You pay $160 Specialty: You pay 30% up to a maximum of $200 Retail (per 90-day supply): Generic: You pay $90 Preferred Brand: You pay $240 Non-Preferred Brand: You pay $480 | Retail: You pay 10% Your plan pays 90% |
| Home Delivery Pharmacy Customer Share | Home Delivery (per 90-day supply): Generic: You pay $90 Preferred Brand: You pay $240 Non-Preferred Brand: You pay $480 Specialty: You pay 30% up to a maximum of $480 | 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 # 00650877
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 OAPIN Base | |
| Plan Coinsurance | Plan pays 70% | Not Covered for all benefits |
| Individual Deductible | Individual - Employee Only: $7,000 Individual - within a Family: $7,000 | Not Covered for all benefits |
| Family Deductible | Family Maximum: $14,000 | Not Covered for all benefits |
| Individual Out-of-Pocket | Individual - Employee Only: $8,500 Individual - within a Family: $8,500 | Not Covered for all benefits |
| Family Out-of-Pocket | Family Maximum: $17,000 | Not Covered for all benefits |
| Primary Care Office Visit | Plan pays 70% | Not Covered for all benefits |
| Specialist Care Office Visit | Plan pays 70% | Not Covered for all benefits |
| Emergency Room | Plan pays 70% | |
| Urgent Care | Plan pays 70% | Not Covered for all benefits |
| Outpatient Radiology | Plan pays 70% | Not Covered for all benefits |
| Independent Laboratory | Plan pays 70% | Not Covered for all benefits |
| Outpatient Physical, Speech, Hearing, and Occupational Therapy | Plan pays 70% | Not Covered for all benefits |
| Pharmacy Formulary | Advantage | |
| Retail Pharmacy Customer Share | Retail (per 30-day supply): Generic: You pay $30 Preferred Brand: You pay $80 Non-Preferred Brand: You pay $160 Specialty: You pay 30% up to a maximum of $200 Retail (per 90-day supply): Generic: You pay $90 Preferred Brand: You pay $240 Non-Preferred Brand: You pay $480 | Retail: You pay 10% Your plan pays 90% |
| Home Delivery Pharmacy Customer Share | Home Delivery (per 90-day supply): Generic: You pay $90 Preferred Brand: You pay $240 Non-Preferred Brand: You pay $480 Specialty: You pay 30% up to a maximum of $480 | 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.