CIGNA OAP

The Cigna OAP medical plan features copays for common services such as primary care or specialty visits with no deductible required. For other services such as eligible inpatient and outpatient care, you’ll pay coinsurance after you satisfy your deductible up to the out-of-pocket maximum. This plan also includes transgender health services.

Cigna OAP Medical Plan (Group # 3344694)

	In-Network Benefits	Out-of-Network Benefits
Annual Deductible	$250 per individual, up to $750 per family	$750 per individual, up to $2,250 per family
Accumulation Period	Time period to incur eligible expenses toward the deductible: Calendar Year
Annual Out-of-Pocket Maximum	$2,250 per individual, up to $4,500 per family (combined with out-of-network)	$3,500 per individual, up to $7,000 per family
Office Visit	$10 copay for primary care physician or specialist	30% after deductible for primary care physician or specialist
Chiropractic	$25 copay (coverage limited to 20 visits per calendar year combined with out-of-network)	30% after deductible (coverage limited to 20 visits per calendar year combined with in-network)
Lab and X-ray	Lab & x-ray: $10 copay after deductible in center; $35 copay after deductible in outpatient hospital; advance imaging: 10% after deductible in radiology	30% after deductible (coverage limited to $350/day at outpatient hospital)
Urgent Care	$10 copay	30% after deductible
Emergency Room	$150 copay then 10% (copay waived if admitted)	$150 copay then 10% (copay waived if admitted)
Hospitalization	10% after deductible	30% after deductible (coverage limited to $600/day)
Outpatient Surgery	5% after deductible at center; 15% after deductible at outpatient hospital	30% after deductible (coverage limited to $350/day)
Outpatient Mental Health	No charge	No charge
Fertility Coverage	$20k lifetime maximum fertility coverage has been added to Cigna plans starting on January 1st, 2024. Services include: • IUI, IVF, GIFT, ZIFT • Infertility drugs, testing, treatment • Short-term fertility preservation, preimplantation genetic testing, and more This change provides you with in-network resources, is tax-advantageous, and will simplify your fertility experience.
Transgender Health Services	After deductible, copays/coinsurance apply. Patients should work with a Cigna Case Manager to navigate care, find specialized providers, and ensure authorizations are in place for treatment along your journey. Covered services include but are not limited to: • Gender reassignment procedures including prosthetics; hair removal; top, bottom, and facial surgeries; and voice therapy • Hormone therapy and related lab testing • Behavioral counseling and routine medical care

Plan Documents

Cigna OAP Plan Benefit Summary

Prescription Drug Coverage

	In-Network	Out-of-Network
Deductible	None	None
Out-of-Pocket Maximum	Combined with medical	Combined with medical
Generic	$10 copay	25% coinsurance up to $250 per script
Brand Name	Preferred: $30 copay; Non-Preferred: $50 copay	25% coinsurance up to $250 per script
Specialty	30% coinsurance up to $250 per script	25% coinsurance up to $250 per script
Mail Order	90 days supply	N/A
Generic	$20 copay	Not covered
Brand Name	Preferred: $60 copay; Non-Preferred: $100 copay	Not covered
Specialty	30% coinsurance up to $500 per script	N/A

Save on Prescriptions

Go Generic: If you’re looking to minimize your out-of-pocket costs, use generic drug options when possible. Generic drugs have the same active ingredients as their brand-name counterparts but your copay will be less.

Mail-Order: If you’re taking a medication for a chronic condition, you can also save money by utilizing mail-order options, offering convenience and a larger supply for the same copay.