The CIGNA OAP includes a national network of doctors and hospitals who have contracted with CIGNA to provide medical care at a low cost to you. You also have the option of choosing a physician or hospital that is not in the CIGNA network, but you will receive higher coverage with an in-network provider.
With the CIGNA OAP plan, you do not need to select a primary care physician (PCP) as you would with an HMO plan. Furthermore, you can see any doctor, including a specialist, whenever you choose without the hassle of obtaining a referral.
|
Annual Deductible
Individual
Family
(2 or more persons)
|
None
None
|
$1,000
$3,000 (for 3 or more persons)
|
|
Annual Out-of-Pocket Maximum
Individual
Family (2 or more persons)
|
None
None |
$3,000
$6,000 |
| Lifetime Maximum |
Unlimited |
Unlimited |
| Plan Coinsurance (what the plan pays) |
Plan pays 100% |
Plan pays 70% of R&C
after deductible |
|
Physician Office Visits
-
Primary Care Office Visits
(including OB/GYN)
- Specialist Office Visits
|
-
$15 per visit copay
- $20 per visit copay
|
Plan pays 70% of R&C
after deductible |
|
Routine Preventative Care
-
Routine Physical Exams (adult)
- Well Woman Care (including Pap Test)
-
Mammogram
-
Well Child Care
|
-
$15 per visit copay
-
$15 per visit copay
- Plan pays 100%
- $15 per visit copay
|
Plan pays 70% of R&C
after deductible |
| Urgent Care Facility Visit |
$50 per admission copay, waived if admitted
|
$50 per admission copay, waived if admitted
|
| Emergency Room Visit |
$100 copay, waived if admitted; $200 admission fee applies.
|
Plan pays the in-network level if it is a true emergency; 70% after deductible if it is not a true emergency.
|
| Ambulance |
Plan pays 100% |
Plan pays 70% of R&C
after deductible |
|
Inpatient Hospital
-
Admission
- Facility Services
- Professional Services (Surgeon, Radiologist, Pathologist, Anesthesiologist)
|
Plan pays 100% after $200 per admission copay
|
Plan pays 70% of
R&C
after deductible |
| Outpatient Pre-admission Diagnostic
Tests |
Plan pays 100% |
Plan pays 70% of R&C
after deductible |
| Advanced Radiology Tests (excludes mammography and maternity-related services) |
$20 copay |
$20 copay; plan pays 70% of R&C after deductible |
|
Outpatient Hospital
-
Facility Services
- Professional Services (Surgeon, Radiologist, Pathologist, Anesthesiologist)
|
Plan pays 100% after $100 per visit copay
|
Plan pays 70% of
R&C
after deductible |
| Second Opinion (Includes all physician
billed charges) |
$20 per visit copay
|
Plan pays 70% of R&C
after deductible |
|
Inpatient Rehabilitation Facility
-
Cardiac Rehabilitation
- Cognitive Rehabilitation
-
Occupational Therapy
-
Physical Therapy
-
Speech Therapy
|
Plan pays 100%
(Up to 60 days per calendar year for all therapies combined. In-network and out-of network combined benefit maximum.) |
Plan pays 70% of
R&C
after deductible
(Up to 60 days per calendar year for all therapies combined. in-network and out-of network combined benefit maximum.) |
|
Short-Term Therapy (Outpatient)
-
Cardiac Rehabilitation
- Chiropractic Therapy
- Cognitive Rehabilitation
- Occupational Rehabilitation
- Physical Therapy
-
Speech Therapy
|
$20 per office visit
copay
(Up to 60 days per calendar year for all therapies combined. In-network and out-of network combined benefit maximum.)
|
Plan pays 70% of
R&C
after deductible
(Up to 60 days per calendar year for all therapies combined. In-network and out-of network combined benefit maximum.) |
| Home Health Care |
Plan pays 100%, unlimited visits |
Plan pays 70% of R&C
after deductible |
|
Hospice Care
-
Inpatient
- Outpatient
-
Bereavement Counseling
(up to 3 sessions per occurrence, per family)
|
Plan pays 100% |
Plan pays 70% of R&C
after deductible |
| Skilled Nursing Facility — (up to
60 days per calendar year, no prior hospitalization required) |
Plan Pays 100% |
Plan pays 70% of R&C
after deductible |
Outpatient Private Duty Nursing
(unlimited visits)
|
Plan pays 100% |
Plan pays 70% of R&C
after deductible |
|
Maternity Care
All prenatal and postnatal visits and delivery
Hospital Admission
Inpatient physician visits and Consultations
Birthing Centers
|
$15 copay for initial visit to confirm pregnancy — no copay thereafter
Plan pays 100%
Plan pays 100%
Plan pay 100% if associated with in-network hospital
|
Plan pays 70% of R&C
after deductible |
Infertility
Testing and Diagnosis
Includes testing, diagnosis, and diagnostic surgical procedures,
and determination of treatment to correct medical condition.
|
$15 per visit copay if at PCP
$20 per visit copay if at specialist
$200 surgical copay (diagnostic procedures only)
|
Plan pays 70% of R&C
after deductible |
Durable Medical Equipment
(Based on medical necessity/ appropriateness)
|
Plan pay 100% |
Plan pays 70% of R&C
after deductible |
|
Temporomandibular Joint
Dysfunction (TMJ)
-
Office Visit
- Inpatient
- Outpatient Facility
-
Physician Services
-
Appliances
-
Medically necessary surgery
|
-
$15 per visit copay if at PCP/$20 per visit copay if at specialist
-
Plan pays 100% after $200 per admission copay
-
Plan pays 100% after $100 per admission copay
-
Plan pays 100%
-
Plan pays 100%
-
Plan pays 100%
|
Plan pays 70% of R&C
after deductible |
Mental Health Treatment
Inpatient (unlimited days)
Outpatient (individual/group therapy) |
Plan pays 100% after $200 per admission copay
$20 per visit copay |
Plan pays 70% of R&C
after deductible |
Substance Abuse Treatment
Inpatient (30-day per calendar year maximum)
Outpatient (60-day per calendar year maximum)
|
Plan pays 100% after $200 per admission copay
$20 per visit copay |
Plan pays 70% of R&C
after deductible |
|
Enhanced CIGNA Healthy Babies Program*
-
Lactation Pumps
- Lactation Consultants
- Lamaze/Birthing classes
*Member must enroll within 1st or 2nd trimester and remain compliant throughout pregnancy
|
100%
Enrollment during 1st trimester: $250 allowance for approved items
Enrollment during 2nd trimester: $100 allowance for approved items
|
WeightWatchers®
|
$100 for reaching 10% of goal weight ($100 lifetime maximum)
$100 for acheiving lifetime goal ($100 lifetime maximum)
|
Not Covered |
Nutritional Counseling
(Provided by a Registered Dietician)
|
100% ($150 lifetime maximum. Does not apply to Jenny Craig or Atkins.) |
100% ($150 lifetime maximum. Does not apply to Jenny Craig or Atkins.)
|
