Medical Plans & Pharmacy

You have two options when it comes to your medical and prescription drug plan, each with different levels of coverage. Both plans available to you are PPO (Preferred Provider Organization) plans, which allows you to receive care both in and out of the Cigna Open Access Plus (OAP) provider network. When you receive care from In-Network providers, those contracted in Cigna’s OAP network, your costs are less. When receiving care from Out-of-Network providers you will pay a higher coinsurance amount and may be balance billed for all costs over Cigna’s allowed charges. Also, with PPO plans, you are not required to select a Primary Care Provider (PCP) and you do not need a referral to see a Specialist.

Understanding Your Plan Options:

Base Plan – Cigna OAP HDHP (High Deductible Health Plan) with Health Savings Account (HSA)

Under the Base HDHP, for nearly all services except preventive care, you will first need to satisfy your deductible; then you will pay a percentage of the cost (coinsurance) or copay until your out-of-pocket maximum is reached, after which the plan will pay 100% of the cost of covered services for the remainder of the plan year.

The HDHP can be paired with an HSA. An HSA is a type of savings account that lets you set aside money on a pre-tax basis, thereby lowering your taxable income, to pay for qualified medical expenses, including dental and vision. See details on the HSA, including specifics on Operation Smile’s dollar-for-dollar match, later in this guide.

Buy-up Plan – Cigna OAP

Under the Buy-up OAP, certain covered services, such as Dr. office visits, urgent care visits and prescription drugs, are not subject to the deductible; rather, you just have a copay or coinsurance that applies. Just like with the Base HDHP, all your deductible, copay and coinsurance costs add up until you reach the plan’s out-of-pocket maximum, after which the plan will pay 100% of the cost of covered services for the remainder of the plan year.

Comparing the Options

Before you review your medical plan options, you should understand how they work. Start with these terms:

• Coinsurance: A set percentage you pay off the cost of the care you receive, for example, 20%.
• Copay: A set dollar amount you pay when you receive health care, for example, $35 when you see a specialist.
• Deductible: A set amount you must pay out of your pocket before the plan starts paying part of the cost unless a copay applies.
• Out-of-pocket maximum: The most you will pay in a calendar year for provider visits, prescriptions, etc., for covered expenses and includes your deductible, copays, and coinsurance. This “safety net” provides peace of mind for those who have a serious condition or illness.