Your Medical Benefits
Medical
Group # 00631777
Your employer has chosen Cigna for your healthcare benefits. The information below provides a high-level summary of your out-of-pocket costs (deductibles, copays and/or coinsurance) as well as your benefits and coverage.
Open Access Plus Plan - OAP Platinum | Open Access Plus Plan - OAP Silver | Open Access Plus Plan - OAP Gold | OAP HDHPQ Plan - HDHPQ OAP | Open Access Plus Plan - OAPIN Bronze | |
---|---|---|---|---|---|
Plan Coinsurance | |||||
In-Network | Plan pays 90% | Plan pays 80% | Plan pays 80% | Plan pays 90% | Plan pays 80% |
Out-Of-Network | Plan pays 70% | Plan pays 50% | Plan pays 60% | Plan pays 70% | Not Covered for all benefits |
Individual Deductible | |||||
In-Network | Individual: $1,000 | Individual: $3,000 | Individual: $500 | Individual - Employee Only: $3,000 Individual - within a Family: $3,000 | Individual: $7,000 |
Out-Of-Network | Individual: $3,000 | Individual: $6,000 | Individual: $1,500 | Individual - Employee Only: $6,000 Individual - within a Family: $6,000 | Not Covered for all benefits |
Family Deductible | |||||
In-Network | Family: $2,000 | Family: $6,000 | Family: $1,000 | Family Maximum: $6,000 | Family: $14,000 |
Out-Of-Network | Family: $6,000 | Family: $12,000 | Family: $3,000 | Family Maximum: $12,000 | Not Covered for all benefits |
Individual Out-of-Pocket | |||||
In-Network | Individual: $2,000 | Individual: $6,000 | Individual: $4,500 | Individual - Employee Only: $6,000 Individual - within a Family: $6,000 | Individual: $8,150 |
Out-Of-Network | Individual: $5,000 | Individual: $12,000 | Individual: $9,000 | Individual - Employee Only: $20,000 Individual - within a Family: $20,000 | Not Covered for all benefits |
Family Out-of-Pocket | |||||
In-Network | Family: $4,000 | Family: $12,000 | Family: $9,000 | Family Maximum: $12,000 | Family: $16,300 |
Out-Of-Network | Family: $10,000 | Family: $24,000 | Family: $18,000 | Family Maximum: $40,000 | Not Covered for all benefits |
Primary Care Office Visit | |||||
In-Network | $10 copay, and plan pays 100% | $25 copay, and plan pays 100% | $25 copay, and plan pays 100% | Plan pays 90% | $40 copay, and plan pays 100% |
Out-Of-Network | Plan pays 70% | Plan pays 50% | Plan pays 60% | Plan pays 70% | Not Covered for all benefits |
Specialist Care Office Visit | |||||
In-Network | $20 copay, and plan pays 100% | $50 copay, and plan pays 100% | $50 copay, and plan pays 100% | Plan pays 90% | $80 copay, and plan pays 100% |
Out-Of-Network | Plan pays 70% | Plan pays 50% | Plan pays 60% | Plan pays 70% | Not Covered for all benefits |
Emergency Room | |||||
$250 copay, and plan pays 100% | $300 copay, and plan pays 100% | $250 copay, and plan pays 100% | Plan pays 90% | $500 copay, and plan pays 100% | |
Urgent Care | |||||
In-Network | $50 copay, and plan pays 100% | $75 copay, and plan pays 100% | $50 copay, and plan pays 100% | Plan pays 90% | $100 copay, and plan pays 100% |
Out-Of-Network | Plan pays 70% | Plan pays 50% | Plan pays 60% | Plan pays 70% | Not Covered for all benefits |
Outpatient Radiology | |||||
In-Network | Plan pays 100% | Plan pays 100% | Plan pays 100% | Plan pays 90% | Plan pays 100% |
Out-Of-Network | Plan pays 70% | Plan pays 50% | Plan pays 60% | Plan pays 70% | Not Covered for all benefits |
Independent Laboratory | |||||
In-Network | Plan pays 100% | Plan pays 100% | Plan pays 100% | Plan pays 90% | Plan pays 100% |
Out-Of-Network | Plan pays 70% | Plan pays 50% | Plan pays 60% | Plan pays 70% | Not Covered for all benefits |
Outpatient Physical, Speech, Hearing, and Occupational Therapy | |||||
In-Network | $20 copay, and plan pays 100% | $50 copay, and plan pays 100% | $50 copay, and plan pays 100% | Plan pays 90% | $80 copay, and plan pays 100% |
Out-Of-Network | Plan pays 70% | Plan pays 50% | Plan pays 60% | Plan pays 70% | Not Covered for all benefits |
Pharmacy Formulary | |||||
Advantage | Advantage | Advantage | Advantage | Advantage | |
Retail Pharmacy Customer Share | |||||
In-Network | Retail (per 30-day supply): Generic: You pay $10 Preferred Brand: You pay $35 Non-Preferred Brand: You pay $60 | Retail (per 30-day supply): Generic: You pay $15 Preferred Brand: You pay $40 Non-Preferred Brand: You pay $75 | Retail (per 30-day supply): Generic: You pay $10 Preferred Brand: You pay $35 Non-Preferred Brand: You pay $60 | Retail: You pay 10% Your plan pays 90% | Retail (per 30-day supply): Generic: You pay $20 Preferred Brand: You pay $50 Non-Preferred Brand: You pay $100 |
Out-Of-Network | Not Covered for all benefits | Not Covered for all benefits | Not Covered for all benefits | Not Covered for all benefits | Not Covered for all benefits |
Home Delivery Pharmacy Customer Share | |||||
In-Network | Retail and Home Delivery (per 90-day supply): Generic: You pay $30 Preferred Brand: You pay $105 Non-Preferred Brand: You pay $180 | Retail and Home Delivery (per 90-day supply): Generic: You pay $45 Preferred Brand: You pay $120 Non-Preferred Brand: You pay $225 | Retail and Home Delivery (per 90-day supply): Generic: You pay $30 Preferred Brand: You pay $105 Non-Preferred Brand: You pay $180 | Home Delivery: You pay 10% Your plan pays 90% | Retail and Home Delivery (per 90-day supply): Generic: You pay $60 Preferred Brand: You pay $150 Non-Preferred Brand: You pay $300 |
Out-Of-Network | Not Covered for all benefits | Not Covered for all benefits | Not Covered for all benefits | Not Covered for all benefits | Not Covered for all benefits |
Open Access Plus Plan - OAP Platinum | |
---|---|
In-Network | Plan pays 90% |
Out-of-Network | Plan pays 70% |
Open Access Plus Plan - OAP Silver | |
---|---|
In-Network | Plan pays 80% |
Out-of-Network | Plan pays 50% |
Open Access Plus Plan - OAP Gold | |
---|---|
In-Network | Plan pays 80% |
Out-of-Network | Plan pays 60% |
OAP HDHPQ Plan - HDHPQ OAP | |
---|---|
In-Network | Plan pays 90% |
Out-of-Network | Plan pays 70% |
Open Access Plus Plan - OAPIN Bronze | |
---|---|
In-Network | Plan pays 80% |
Open Access Plus Plan - OAP Platinum | |
---|---|
In-Network | Individual: $1,000 |
Out-of-Network | Individual: $3,000 |
Open Access Plus Plan - OAP Silver | |
---|---|
In-Network | Individual: $3,000 |
Out-of-Network | Individual: $6,000 |
Open Access Plus Plan - OAP Gold | |
---|---|
In-Network | Individual: $500 |
Out-of-Network | Individual: $1,500 |
OAP HDHPQ Plan - HDHPQ OAP | |
---|---|
In-Network | Individual - Employee Only: $3,000 Individual - within a Family: $3,000 |
Out-of-Network | Individual - Employee Only: $6,000 Individual - within a Family: $6,000 |
Open Access Plus Plan - OAPIN Bronze | |
---|---|
In-Network | Individual: $7,000 |
Open Access Plus Plan - OAP Platinum | |
---|---|
In-Network | Family: $2,000 |
Out-of-Network | Family: $6,000 |
Open Access Plus Plan - OAP Silver | |
---|---|
In-Network | Family: $6,000 |
Out-of-Network | Family: $12,000 |
Open Access Plus Plan - OAP Gold | |
---|---|
In-Network | Family: $1,000 |
Out-of-Network | Family: $3,000 |
OAP HDHPQ Plan - HDHPQ OAP | |
---|---|
In-Network | Family Maximum: $6,000 |
Out-of-Network | Family Maximum: $12,000 |
Open Access Plus Plan - OAPIN Bronze | |
---|---|
In-Network | Family: $14,000 |
Open Access Plus Plan - OAP Platinum | |
---|---|
In-Network | Individual: $2,000 |
Out-of-Network | Individual: $5,000 |
Open Access Plus Plan - OAP Silver | |
---|---|
In-Network | Individual: $6,000 |
Out-of-Network | Individual: $12,000 |
Open Access Plus Plan - OAP Gold | |
---|---|
In-Network | Individual: $4,500 |
Out-of-Network | Individual: $9,000 |
OAP HDHPQ Plan - HDHPQ OAP | |
---|---|
In-Network | Individual - Employee Only: $6,000 Individual - within a Family: $6,000 |
Out-of-Network | Individual - Employee Only: $20,000 Individual - within a Family: $20,000 |
Open Access Plus Plan - OAPIN Bronze | |
---|---|
In-Network | Individual: $8,150 |
Open Access Plus Plan - OAP Platinum | |
---|---|
In-Network | Family: $4,000 |
Out-of-Network | Family: $10,000 |
Open Access Plus Plan - OAP Silver | |
---|---|
In-Network | Family: $12,000 |
Out-of-Network | Family: $24,000 |
Open Access Plus Plan - OAP Gold | |
---|---|
In-Network | Family: $9,000 |
Out-of-Network | Family: $18,000 |
OAP HDHPQ Plan - HDHPQ OAP | |
---|---|
In-Network | Family Maximum: $12,000 |
Out-of-Network | Family Maximum: $40,000 |
Open Access Plus Plan - OAPIN Bronze | |
---|---|
In-Network | Family: $16,300 |
Open Access Plus Plan - OAP Platinum | |
---|---|
In-Network | $10 copay, and plan pays 100% |
Out-of-Network | Plan pays 70% |
Open Access Plus Plan - OAP Silver | |
---|---|
In-Network | $25 copay, and plan pays 100% |
Out-of-Network | Plan pays 50% |
Open Access Plus Plan - OAP Gold | |
---|---|
In-Network | $25 copay, and plan pays 100% |
Out-of-Network | Plan pays 60% |
OAP HDHPQ Plan - HDHPQ OAP | |
---|---|
In-Network | Plan pays 90% |
Out-of-Network | Plan pays 70% |
Open Access Plus Plan - OAPIN Bronze | |
---|---|
In-Network | $40 copay, and plan pays 100% |
Open Access Plus Plan - OAP Platinum | |
---|---|
In-Network | $20 copay, and plan pays 100% |
Out-of-Network | Plan pays 70% |
Open Access Plus Plan - OAP Silver | |
---|---|
In-Network | $50 copay, and plan pays 100% |
Out-of-Network | Plan pays 50% |
Open Access Plus Plan - OAP Gold | |
---|---|
In-Network | $50 copay, and plan pays 100% |
Out-of-Network | Plan pays 60% |
OAP HDHPQ Plan - HDHPQ OAP | |
---|---|
In-Network | Plan pays 90% |
Out-of-Network | Plan pays 70% |
Open Access Plus Plan - OAPIN Bronze | |
---|---|
In-Network | $80 copay, and plan pays 100% |
Open Access Plus Plan - OAP Platinum | |
---|---|
$250 copay, and plan pays 100% |
Open Access Plus Plan - OAP Silver | |
---|---|
$300 copay, and plan pays 100% |
Open Access Plus Plan - OAP Gold | |
---|---|
$250 copay, and plan pays 100% |
OAP HDHPQ Plan - HDHPQ OAP | |
---|---|
Plan pays 90% |
Open Access Plus Plan - OAPIN Bronze | |
---|---|
$500 copay, and plan pays 100% |
Open Access Plus Plan - OAP Platinum | |
---|---|
In-Network | $50 copay, and plan pays 100% |
Out-of-Network | Plan pays 70% |
Open Access Plus Plan - OAP Silver | |
---|---|
In-Network | $75 copay, and plan pays 100% |
Out-of-Network | Plan pays 50% |
Open Access Plus Plan - OAP Gold | |
---|---|
In-Network | $50 copay, and plan pays 100% |
Out-of-Network | Plan pays 60% |
OAP HDHPQ Plan - HDHPQ OAP | |
---|---|
In-Network | Plan pays 90% |
Out-of-Network | Plan pays 70% |
Open Access Plus Plan - OAPIN Bronze | |
---|---|
In-Network | $100 copay, and plan pays 100% |
Open Access Plus Plan - OAP Platinum | |
---|---|
In-Network | Plan pays 100% |
Out-of-Network | Plan pays 70% |
Open Access Plus Plan - OAP Silver | |
---|---|
In-Network | Plan pays 100% |
Out-of-Network | Plan pays 50% |
Open Access Plus Plan - OAP Gold | |
---|---|
In-Network | Plan pays 100% |
Out-of-Network | Plan pays 60% |
OAP HDHPQ Plan - HDHPQ OAP | |
---|---|
In-Network | Plan pays 90% |
Out-of-Network | Plan pays 70% |
Open Access Plus Plan - OAPIN Bronze | |
---|---|
In-Network | Plan pays 100% |
Open Access Plus Plan - OAP Platinum | |
---|---|
In-Network | Plan pays 100% |
Out-of-Network | Plan pays 70% |
Open Access Plus Plan - OAP Silver | |
---|---|
In-Network | Plan pays 100% |
Out-of-Network | Plan pays 50% |
Open Access Plus Plan - OAP Gold | |
---|---|
In-Network | Plan pays 100% |
Out-of-Network | Plan pays 60% |
OAP HDHPQ Plan - HDHPQ OAP | |
---|---|
In-Network | Plan pays 90% |
Out-of-Network | Plan pays 70% |
Open Access Plus Plan - OAPIN Bronze | |
---|---|
In-Network | Plan pays 100% |
Open Access Plus Plan - OAP Platinum | |
---|---|
In-Network | $20 copay, and plan pays 100% |
Out-of-Network | Plan pays 70% |
Open Access Plus Plan - OAP Silver | |
---|---|
In-Network | $50 copay, and plan pays 100% |
Out-of-Network | Plan pays 50% |
Open Access Plus Plan - OAP Gold | |
---|---|
In-Network | $50 copay, and plan pays 100% |
Out-of-Network | Plan pays 60% |
OAP HDHPQ Plan - HDHPQ OAP | |
---|---|
In-Network | Plan pays 90% |
Out-of-Network | Plan pays 70% |
Open Access Plus Plan - OAPIN Bronze | |
---|---|
In-Network | $80 copay, and plan pays 100% |
Open Access Plus Plan - OAP Platinum | |
---|---|
Advantage |
Open Access Plus Plan - OAP Silver | |
---|---|
Advantage |
Open Access Plus Plan - OAP Gold | |
---|---|
Advantage |
OAP HDHPQ Plan - HDHPQ OAP | |
---|---|
Advantage |
Open Access Plus Plan - OAPIN Bronze | |
---|---|
Advantage |
Open Access Plus Plan - OAP Platinum | |
---|---|
In-Network | Retail (per 30-day supply): Generic: You pay $10 Preferred Brand: You pay $35 Non-Preferred Brand: You pay $60 |
Open Access Plus Plan - OAP Silver | |
---|---|
In-Network | Retail (per 30-day supply): Generic: You pay $15 Preferred Brand: You pay $40 Non-Preferred Brand: You pay $75 |
Open Access Plus Plan - OAP Gold | |
---|---|
In-Network | Retail (per 30-day supply): Generic: You pay $10 Preferred Brand: You pay $35 Non-Preferred Brand: You pay $60 |
OAP HDHPQ Plan - HDHPQ OAP | |
---|---|
In-Network | Retail: You pay 10% Your plan pays 90% |
Open Access Plus Plan - OAPIN Bronze | |
---|---|
In-Network | Retail (per 30-day supply): Generic: You pay $20 Preferred Brand: You pay $50 Non-Preferred Brand: You pay $100 |
Open Access Plus Plan - OAP Platinum | |
---|---|
In-Network | Retail and Home Delivery (per 90-day supply): Generic: You pay $30 Preferred Brand: You pay $105 Non-Preferred Brand: You pay $180 |
Open Access Plus Plan - OAP Silver | |
---|---|
In-Network | Retail and Home Delivery (per 90-day supply): Generic: You pay $45 Preferred Brand: You pay $120 Non-Preferred Brand: You pay $225 |
Open Access Plus Plan - OAP Gold | |
---|---|
In-Network | Retail and Home Delivery (per 90-day supply): Generic: You pay $30 Preferred Brand: You pay $105 Non-Preferred Brand: You pay $180 |
OAP HDHPQ Plan - HDHPQ OAP | |
---|---|
In-Network | Home Delivery: You pay 10% Your plan pays 90% |
Open Access Plus Plan - OAPIN Bronze | |
---|---|
In-Network | Retail and Home Delivery (per 90-day supply): Generic: You pay $60 Preferred Brand: You pay $150 Non-Preferred Brand: You pay $300 |
All plans have exclusions and limitations. For a summary of these exclusions and limitations, view the Summary of Benefits and Coverage.
Medical
Group # 00631777
Your employer has chosen Cigna for your healthcare benefits. The information below provides a high-level summary of your out-of-pocket costs (deductibles, copays and/or coinsurance) as well as your benefits and coverage.
Open Access Plus Plan - OAP Platinum | Open Access Plus Plan - OAP Silver | Open Access Plus Plan - OAP Gold | OAP HDHPQ Plan - HDHPQ OAP | Open Access Plus Plan - OAPIN Bronze | |
---|---|---|---|---|---|
Plan Coinsurance | |||||
In-Network | Plan pays 90% | Plan pays 80% | Plan pays 80% | Plan pays 90% | Plan pays 80% |
Out-Of-Network | Plan pays 70% | Plan pays 50% | Plan pays 60% | Plan pays 70% | Not Covered for all benefits |
Individual Deductible | |||||
In-Network | Individual: $1,000 | Individual: $3,000 | Individual: $500 | Individual - Employee Only: $3,000 Individual - within a Family: $3,000 | Individual: $7,000 |
Out-Of-Network | Individual: $3,000 | Individual: $6,000 | Individual: $1,500 | Individual - Employee Only: $6,000 Individual - within a Family: $6,000 | Not Covered for all benefits |
Family Deductible | |||||
In-Network | Family: $2,000 | Family: $6,000 | Family: $1,000 | Family Maximum: $6,000 | Family: $14,000 |
Out-Of-Network | Family: $6,000 | Family: $12,000 | Family: $3,000 | Family Maximum: $12,000 | Not Covered for all benefits |
Individual Out-of-Pocket | |||||
In-Network | Individual: $2,000 | Individual: $6,000 | Individual: $4,500 | Individual - Employee Only: $6,000 Individual - within a Family: $6,000 | Individual: $8,150 |
Out-Of-Network | Individual: $5,000 | Individual: $12,000 | Individual: $9,000 | Individual - Employee Only: $20,000 Individual - within a Family: $20,000 | Not Covered for all benefits |
Family Out-of-Pocket | |||||
In-Network | Family: $4,000 | Family: $12,000 | Family: $9,000 | Family Maximum: $12,000 | Family: $16,300 |
Out-Of-Network | Family: $10,000 | Family: $24,000 | Family: $18,000 | Family Maximum: $40,000 | Not Covered for all benefits |
Primary Care Office Visit | |||||
In-Network | $10 copay, and plan pays 100% | $25 copay, and plan pays 100% | $25 copay, and plan pays 100% | Plan pays 90% | $40 copay, and plan pays 100% |
Out-Of-Network | Plan pays 70% | Plan pays 50% | Plan pays 60% | Plan pays 70% | Not Covered for all benefits |
Specialist Care Office Visit | |||||
In-Network | $20 copay, and plan pays 100% | $50 copay, and plan pays 100% | $50 copay, and plan pays 100% | Plan pays 90% | $80 copay, and plan pays 100% |
Out-Of-Network | Plan pays 70% | Plan pays 50% | Plan pays 60% | Plan pays 70% | Not Covered for all benefits |
Emergency Room | |||||
$250 copay, and plan pays 100% | $300 copay, and plan pays 100% | $250 copay, and plan pays 100% | Plan pays 90% | $500 copay, and plan pays 100% | |
Urgent Care | |||||
In-Network | $50 copay, and plan pays 100% | $75 copay, and plan pays 100% | $50 copay, and plan pays 100% | Plan pays 90% | $100 copay, and plan pays 100% |
Out-Of-Network | Plan pays 70% | Plan pays 50% | Plan pays 60% | Plan pays 70% | Not Covered for all benefits |
Outpatient Radiology | |||||
In-Network | Plan pays 100% | Plan pays 100% | Plan pays 100% | Plan pays 90% | Plan pays 100% |
Out-Of-Network | Plan pays 70% | Plan pays 50% | Plan pays 60% | Plan pays 70% | Not Covered for all benefits |
Independent Laboratory | |||||
In-Network | Plan pays 100% | Plan pays 100% | Plan pays 100% | Plan pays 90% | Plan pays 100% |
Out-Of-Network | Plan pays 70% | Plan pays 50% | Plan pays 60% | Plan pays 70% | Not Covered for all benefits |
Outpatient Physical, Speech, Hearing, and Occupational Therapy | |||||
In-Network | $20 copay, and plan pays 100% | $50 copay, and plan pays 100% | $50 copay, and plan pays 100% | Plan pays 90% | $80 copay, and plan pays 100% |
Out-Of-Network | Plan pays 70% | Plan pays 50% | Plan pays 60% | Plan pays 70% | Not Covered for all benefits |
Pharmacy Formulary | |||||
Advantage | Advantage | Advantage | Advantage | Advantage | |
Retail Pharmacy Customer Share | |||||
In-Network | Retail (per 30-day supply): Generic: You pay $10 Preferred Brand: You pay $35 Non-Preferred Brand: You pay $60 | Retail (per 30-day supply): Generic: You pay $15 Preferred Brand: You pay $40 Non-Preferred Brand: You pay $75 | Retail (per 30-day supply): Generic: You pay $10 Preferred Brand: You pay $35 Non-Preferred Brand: You pay $60 | Retail: You pay 10% Your plan pays 90% | Retail (per 30-day supply): Generic: You pay $20 Preferred Brand: You pay $50 Non-Preferred Brand: You pay $100 |
Out-Of-Network | Not Covered for all benefits | Not Covered for all benefits | Not Covered for all benefits | Not Covered for all benefits | Not Covered for all benefits |
Home Delivery Pharmacy Customer Share | |||||
In-Network | Retail and Home Delivery (per 90-day supply): Generic: You pay $30 Preferred Brand: You pay $105 Non-Preferred Brand: You pay $180 | Retail and Home Delivery (per 90-day supply): Generic: You pay $45 Preferred Brand: You pay $120 Non-Preferred Brand: You pay $225 | Retail and Home Delivery (per 90-day supply): Generic: You pay $30 Preferred Brand: You pay $105 Non-Preferred Brand: You pay $180 | Home Delivery: You pay 10% Your plan pays 90% | Retail and Home Delivery (per 90-day supply): Generic: You pay $60 Preferred Brand: You pay $150 Non-Preferred Brand: You pay $300 |
Out-Of-Network | Not Covered for all benefits | Not Covered for all benefits | Not Covered for all benefits | Not Covered for all benefits | Not Covered for all benefits |
Open Access Plus Plan - OAP Platinum | |
---|---|
In-Network | Plan pays 90% |
Out-of-Network | Plan pays 70% |
Open Access Plus Plan - OAP Silver | |
---|---|
In-Network | Plan pays 80% |
Out-of-Network | Plan pays 50% |
Open Access Plus Plan - OAP Gold | |
---|---|
In-Network | Plan pays 80% |
Out-of-Network | Plan pays 60% |
OAP HDHPQ Plan - HDHPQ OAP | |
---|---|
In-Network | Plan pays 90% |
Out-of-Network | Plan pays 70% |
Open Access Plus Plan - OAPIN Bronze | |
---|---|
In-Network | Plan pays 80% |
Open Access Plus Plan - OAP Platinum | |
---|---|
In-Network | Individual: $1,000 |
Out-of-Network | Individual: $3,000 |
Open Access Plus Plan - OAP Silver | |
---|---|
In-Network | Individual: $3,000 |
Out-of-Network | Individual: $6,000 |
Open Access Plus Plan - OAP Gold | |
---|---|
In-Network | Individual: $500 |
Out-of-Network | Individual: $1,500 |
OAP HDHPQ Plan - HDHPQ OAP | |
---|---|
In-Network | Individual - Employee Only: $3,000 Individual - within a Family: $3,000 |
Out-of-Network | Individual - Employee Only: $6,000 Individual - within a Family: $6,000 |
Open Access Plus Plan - OAPIN Bronze | |
---|---|
In-Network | Individual: $7,000 |
Open Access Plus Plan - OAP Platinum | |
---|---|
In-Network | Family: $2,000 |
Out-of-Network | Family: $6,000 |
Open Access Plus Plan - OAP Silver | |
---|---|
In-Network | Family: $6,000 |
Out-of-Network | Family: $12,000 |
Open Access Plus Plan - OAP Gold | |
---|---|
In-Network | Family: $1,000 |
Out-of-Network | Family: $3,000 |
OAP HDHPQ Plan - HDHPQ OAP | |
---|---|
In-Network | Family Maximum: $6,000 |
Out-of-Network | Family Maximum: $12,000 |
Open Access Plus Plan - OAPIN Bronze | |
---|---|
In-Network | Family: $14,000 |
Open Access Plus Plan - OAP Platinum | |
---|---|
In-Network | Individual: $2,000 |
Out-of-Network | Individual: $5,000 |
Open Access Plus Plan - OAP Silver | |
---|---|
In-Network | Individual: $6,000 |
Out-of-Network | Individual: $12,000 |
Open Access Plus Plan - OAP Gold | |
---|---|
In-Network | Individual: $4,500 |
Out-of-Network | Individual: $9,000 |
OAP HDHPQ Plan - HDHPQ OAP | |
---|---|
In-Network | Individual - Employee Only: $6,000 Individual - within a Family: $6,000 |
Out-of-Network | Individual - Employee Only: $20,000 Individual - within a Family: $20,000 |
Open Access Plus Plan - OAPIN Bronze | |
---|---|
In-Network | Individual: $8,150 |
Open Access Plus Plan - OAP Platinum | |
---|---|
In-Network | Family: $4,000 |
Out-of-Network | Family: $10,000 |
Open Access Plus Plan - OAP Silver | |
---|---|
In-Network | Family: $12,000 |
Out-of-Network | Family: $24,000 |
Open Access Plus Plan - OAP Gold | |
---|---|
In-Network | Family: $9,000 |
Out-of-Network | Family: $18,000 |
OAP HDHPQ Plan - HDHPQ OAP | |
---|---|
In-Network | Family Maximum: $12,000 |
Out-of-Network | Family Maximum: $40,000 |
Open Access Plus Plan - OAPIN Bronze | |
---|---|
In-Network | Family: $16,300 |
Open Access Plus Plan - OAP Platinum | |
---|---|
In-Network | $10 copay, and plan pays 100% |
Out-of-Network | Plan pays 70% |
Open Access Plus Plan - OAP Silver | |
---|---|
In-Network | $25 copay, and plan pays 100% |
Out-of-Network | Plan pays 50% |
Open Access Plus Plan - OAP Gold | |
---|---|
In-Network | $25 copay, and plan pays 100% |
Out-of-Network | Plan pays 60% |
OAP HDHPQ Plan - HDHPQ OAP | |
---|---|
In-Network | Plan pays 90% |
Out-of-Network | Plan pays 70% |
Open Access Plus Plan - OAPIN Bronze | |
---|---|
In-Network | $40 copay, and plan pays 100% |
Open Access Plus Plan - OAP Platinum | |
---|---|
In-Network | $20 copay, and plan pays 100% |
Out-of-Network | Plan pays 70% |
Open Access Plus Plan - OAP Silver | |
---|---|
In-Network | $50 copay, and plan pays 100% |
Out-of-Network | Plan pays 50% |
Open Access Plus Plan - OAP Gold | |
---|---|
In-Network | $50 copay, and plan pays 100% |
Out-of-Network | Plan pays 60% |
OAP HDHPQ Plan - HDHPQ OAP | |
---|---|
In-Network | Plan pays 90% |
Out-of-Network | Plan pays 70% |
Open Access Plus Plan - OAPIN Bronze | |
---|---|
In-Network | $80 copay, and plan pays 100% |
Open Access Plus Plan - OAP Platinum | |
---|---|
$250 copay, and plan pays 100% |
Open Access Plus Plan - OAP Silver | |
---|---|
$300 copay, and plan pays 100% |
Open Access Plus Plan - OAP Gold | |
---|---|
$250 copay, and plan pays 100% |
OAP HDHPQ Plan - HDHPQ OAP | |
---|---|
Plan pays 90% |
Open Access Plus Plan - OAPIN Bronze | |
---|---|
$500 copay, and plan pays 100% |
Open Access Plus Plan - OAP Platinum | |
---|---|
In-Network | $50 copay, and plan pays 100% |
Out-of-Network | Plan pays 70% |
Open Access Plus Plan - OAP Silver | |
---|---|
In-Network | $75 copay, and plan pays 100% |
Out-of-Network | Plan pays 50% |
Open Access Plus Plan - OAP Gold | |
---|---|
In-Network | $50 copay, and plan pays 100% |
Out-of-Network | Plan pays 60% |
OAP HDHPQ Plan - HDHPQ OAP | |
---|---|
In-Network | Plan pays 90% |
Out-of-Network | Plan pays 70% |
Open Access Plus Plan - OAPIN Bronze | |
---|---|
In-Network | $100 copay, and plan pays 100% |
Open Access Plus Plan - OAP Platinum | |
---|---|
In-Network | Plan pays 100% |
Out-of-Network | Plan pays 70% |
Open Access Plus Plan - OAP Silver | |
---|---|
In-Network | Plan pays 100% |
Out-of-Network | Plan pays 50% |
Open Access Plus Plan - OAP Gold | |
---|---|
In-Network | Plan pays 100% |
Out-of-Network | Plan pays 60% |
OAP HDHPQ Plan - HDHPQ OAP | |
---|---|
In-Network | Plan pays 90% |
Out-of-Network | Plan pays 70% |
Open Access Plus Plan - OAPIN Bronze | |
---|---|
In-Network | Plan pays 100% |
Open Access Plus Plan - OAP Platinum | |
---|---|
In-Network | Plan pays 100% |
Out-of-Network | Plan pays 70% |
Open Access Plus Plan - OAP Silver | |
---|---|
In-Network | Plan pays 100% |
Out-of-Network | Plan pays 50% |
Open Access Plus Plan - OAP Gold | |
---|---|
In-Network | Plan pays 100% |
Out-of-Network | Plan pays 60% |
OAP HDHPQ Plan - HDHPQ OAP | |
---|---|
In-Network | Plan pays 90% |
Out-of-Network | Plan pays 70% |
Open Access Plus Plan - OAPIN Bronze | |
---|---|
In-Network | Plan pays 100% |
Open Access Plus Plan - OAP Platinum | |
---|---|
In-Network | $20 copay, and plan pays 100% |
Out-of-Network | Plan pays 70% |
Open Access Plus Plan - OAP Silver | |
---|---|
In-Network | $50 copay, and plan pays 100% |
Out-of-Network | Plan pays 50% |
Open Access Plus Plan - OAP Gold | |
---|---|
In-Network | $50 copay, and plan pays 100% |
Out-of-Network | Plan pays 60% |
OAP HDHPQ Plan - HDHPQ OAP | |
---|---|
In-Network | Plan pays 90% |
Out-of-Network | Plan pays 70% |
Open Access Plus Plan - OAPIN Bronze | |
---|---|
In-Network | $80 copay, and plan pays 100% |
Open Access Plus Plan - OAP Platinum | |
---|---|
Advantage |
Open Access Plus Plan - OAP Silver | |
---|---|
Advantage |
Open Access Plus Plan - OAP Gold | |
---|---|
Advantage |
OAP HDHPQ Plan - HDHPQ OAP | |
---|---|
Advantage |
Open Access Plus Plan - OAPIN Bronze | |
---|---|
Advantage |
Open Access Plus Plan - OAP Platinum | |
---|---|
In-Network | Retail (per 30-day supply): Generic: You pay $10 Preferred Brand: You pay $35 Non-Preferred Brand: You pay $60 |
Open Access Plus Plan - OAP Silver | |
---|---|
In-Network | Retail (per 30-day supply): Generic: You pay $15 Preferred Brand: You pay $40 Non-Preferred Brand: You pay $75 |
Open Access Plus Plan - OAP Gold | |
---|---|
In-Network | Retail (per 30-day supply): Generic: You pay $10 Preferred Brand: You pay $35 Non-Preferred Brand: You pay $60 |
OAP HDHPQ Plan - HDHPQ OAP | |
---|---|
In-Network | Retail: You pay 10% Your plan pays 90% |
Open Access Plus Plan - OAPIN Bronze | |
---|---|
In-Network | Retail (per 30-day supply): Generic: You pay $20 Preferred Brand: You pay $50 Non-Preferred Brand: You pay $100 |
Open Access Plus Plan - OAP Platinum | |
---|---|
In-Network | Retail and Home Delivery (per 90-day supply): Generic: You pay $30 Preferred Brand: You pay $105 Non-Preferred Brand: You pay $180 |
Open Access Plus Plan - OAP Silver | |
---|---|
In-Network | Retail and Home Delivery (per 90-day supply): Generic: You pay $45 Preferred Brand: You pay $120 Non-Preferred Brand: You pay $225 |
Open Access Plus Plan - OAP Gold | |
---|---|
In-Network | Retail and Home Delivery (per 90-day supply): Generic: You pay $30 Preferred Brand: You pay $105 Non-Preferred Brand: You pay $180 |
OAP HDHPQ Plan - HDHPQ OAP | |
---|---|
In-Network | Home Delivery: You pay 10% Your plan pays 90% |
Open Access Plus Plan - OAPIN Bronze | |
---|---|
In-Network | Retail and Home Delivery (per 90-day supply): Generic: You pay $60 Preferred Brand: You pay $150 Non-Preferred Brand: You pay $300 |
All plans have exclusions and limitations. For a summary of these exclusions and limitations, view the Summary of Benefits and Coverage.