Medical Benefits Plan Comparison
Cigna OAP Plan High Plan
Cigna OAP Plan Low Plan In-Network Only
In-Network
Out-of-Network
Plan pays 80% After Deductible
$20 Copay
$25 Copay
Primary Care Visit
Plan pays 80% After Deductible
$50 Copay
$50 Copay
Specialist Office Visit
$25 Copay /Visit
Urgent Care Visit
$25 Copay / Visit
Prescription Drug Retail
$15/$30/$60
N/A
$20/$30/$60
Prescription Drug Mail Order
$30/$60/$120
N/A
$40/$60/$120
$100 Copay / Visit
Emergency Room
$100 Copay / Visit
Inpatient Services
Plan Pays 100% After Deductible
Plan pays 80% After Deductible
Plan pays 100% After Deductible
Outpatient Services
Plan Pays 100% After Deductible
Plan pays 80% After Deductible
Plan pays 100% After Deductible
Outpatient Lab and X-ray
Plan pays 100% No Deductible
Plan pays 80% After Deductible
Plan pays 100% No Deductible
Advanced Radiology
Plan Pays 100% After Deductible
Plan pays 80% After Deductible
Plan pays 100% After Deductible
Plan Coinsurance
100%
80%
100%
Lifetime Maximum
Unlimited
Deductible (Individual/Family)
$1,000/$3,000
$1,000/$3,000
$1,000/$3,000
Annual Out-of-Pocket Maximum
$5,350/$10,700
$2,000/$4,000
$6,350/$12,700
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