Your Medical Benefits
OAP HDHPQ Plan - HDHPQ OAP
Benefit Summary
Group # 00652047
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 80% | Plan pays 60% |
| Individual Deductible | Individual - Employee Only: $2,000 Individual - within a Family: $3,400 | Individual - Employee Only: $4,000 Individual - within a Family: $6,800 |
| Family Deductible | Family Maximum: $4,000 | Family Maximum: $8,000 |
| Individual Out-of-Pocket | Individual - Employee Only: $4,000 Individual - within a Family: $4,000 | Individual - Employee Only: $8,000 Individual - within a Family: $8,000 |
| Family Out-of-Pocket | Family Maximum: $8,000 | Family Maximum: $16,000 |
| Primary Care Office Visit | Plan pays 80% | Plan pays 60% |
| Specialist Care Office Visit | Plan pays 80% | Plan pays 60% |
| Emergency Room | Plan pays 80% | |
| Urgent Care | Plan pays 80% | Plan pays 60% |
| Outpatient Radiology | Plan pays 80% | Plan pays 60% |
| Independent Laboratory | Plan pays 80% | Plan pays 60% |
| Outpatient Physical, Speech, Hearing, and Occupational Therapy | Plan pays 80% | Plan pays 60% |
| Pharmacy Formulary | Advantage | |
| Retail Pharmacy Customer Share | Retail: You pay 20% Your plan pays 80% | Not Covered for all benefits |
| Home Delivery Pharmacy Customer Share | Home Delivery: You pay 20% Your plan pays 80% | 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 # 00652047
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.
Plan Documents
| In-Network | Out-of-Network | |
|---|---|---|
| Plan Name | OAP HDHPQ Plan - HDHPQ OAP | |
| Plan Coinsurance | Plan pays 80% | Plan pays 60% |
| Individual Deductible | Individual - Employee Only: $2,000 Individual - within a Family: $3,400 | Individual - Employee Only: $4,000 Individual - within a Family: $6,800 |
| Family Deductible | Family Maximum: $4,000 | Family Maximum: $8,000 |
| Individual Out-of-Pocket | Individual - Employee Only: $4,000 Individual - within a Family: $4,000 | Individual - Employee Only: $8,000 Individual - within a Family: $8,000 |
| Family Out-of-Pocket | Family Maximum: $8,000 | Family Maximum: $16,000 |
| Primary Care Office Visit | Plan pays 80% | Plan pays 60% |
| Specialist Care Office Visit | Plan pays 80% | Plan pays 60% |
| Emergency Room | Plan pays 80% | |
| Urgent Care | Plan pays 80% | Plan pays 60% |
| Outpatient Radiology | Plan pays 80% | Plan pays 60% |
| Independent Laboratory | Plan pays 80% | Plan pays 60% |
| Outpatient Physical, Speech, Hearing, and Occupational Therapy | Plan pays 80% | Plan pays 60% |
| Pharmacy Formulary | Advantage | |
| Retail Pharmacy Customer Share | Retail: You pay 20% Your plan pays 80% | Not Covered for all benefits |
| Home Delivery Pharmacy Customer Share | Home Delivery: You pay 20% Your plan pays 80% | 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.