Your Medical Benefits
Open Access Plus - HDHPQ OAP
Benefit Summary
Group # 3346200
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% |
| Plan Deductible (Individual) | Individual - Employee Only: $3,000 Individual - within a Family: $3,400 | Individual - Employee Only: $5,000 Individual - within a Family: $6,800 |
| Plan Deductible (Family) | Family Maximum: $6,000 | Family Maximum: $10,000 |
| Plan Out-of-Pocket (Individual) | Individual - Employee Only: $4,500 Individual - within a Family: $4,500 | Individual - Employee Only: $8,000 Individual - within a Family: $8,000 |
| Plan Out-of-Pocket (Family) | Family Maximum: $8,000 | Family Maximum: $14,500 |
| Primary Care Physician Office Visit | $30 copay, and plan pays 100% | Plan pays 60% |
| Specialist Care Physician Office Visit | $50 copay, and plan pays 100% | Plan pays 60% |
| Emergency Room | Plan pays 80% | |
| Urgent Care | $25 copay, and plan pays 100% | Plan pays 60% |
| Outpatient Radiology | Plan pays 80% | Plan pays 60% |
| Independent Laboratory | Plan pays 80% | Plan pays 60% |
| Formulary Type | Standard | |
| Retail Pharmacy | Retail (per 30-day supply): Generic: You pay $25 Preferred Brand: You pay $40 Non-Preferred Brand: You pay $60 | Not Covered for all benefits |
| Home Delivery Pharmacy | Retail and Home Delivery (per 30-day supply): Specialty: You pay $100 Retail and Home Delivery (per 90-day supply): Generic: You pay $50 Preferred Brand: You pay $80 Non-Preferred Brand: You pay $120 | Not Covered for all benefits |
| Outpatient Therapy and Chiropractic Services | Covered same as Physician Services - Office Visit | Covered same as Physician Services - Office Visit |
All plans have exclusions and limitations. For a summary of these exclusions and limitations, view the Summary of Benefits and Coverage.
Benefit Summary
Group # 3346200
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% |
| Plan Deductible (Individual) | Individual - Employee Only: $3,000 Individual - within a Family: $3,400 | Individual - Employee Only: $5,000 Individual - within a Family: $6,800 |
| Plan Deductible (Family) | Family Maximum: $6,000 | Family Maximum: $10,000 |
| Plan Out-of-Pocket (Individual) | Individual - Employee Only: $4,500 Individual - within a Family: $4,500 | Individual - Employee Only: $8,000 Individual - within a Family: $8,000 |
| Plan Out-of-Pocket (Family) | Family Maximum: $8,000 | Family Maximum: $14,500 |
| Primary Care Physician Office Visit | $30 copay, and plan pays 100% | Plan pays 60% |
| Specialist Care Physician Office Visit | $50 copay, and plan pays 100% | Plan pays 60% |
| Emergency Room | Plan pays 80% | |
| Urgent Care | $25 copay, and plan pays 100% | Plan pays 60% |
| Outpatient Radiology | Plan pays 80% | Plan pays 60% |
| Independent Laboratory | Plan pays 80% | Plan pays 60% |
| Formulary Type | Standard | |
| Retail Pharmacy | Retail (per 30-day supply): Generic: You pay $25 Preferred Brand: You pay $40 Non-Preferred Brand: You pay $60 | Not Covered for all benefits |
| Home Delivery Pharmacy | Retail and Home Delivery (per 30-day supply): Specialty: You pay $100 Retail and Home Delivery (per 90-day supply): Generic: You pay $50 Preferred Brand: You pay $80 Non-Preferred Brand: You pay $120 | Not Covered for all benefits |
| Outpatient Therapy and Chiropractic Services | Covered same as Physician Services - Office Visit | Covered same as Physician Services - Office Visit |
All plans have exclusions and limitations. For a summary of these exclusions and limitations, view the Summary of Benefits and Coverage.