Open Access Plus (1250) Plan
The Open Access Plus (1250) Plan allows you to see any licensed provider you choose, though benefits are higher when you receive care from a provider in the Open Access Plus network. Members have the option to choose a Primary Care Physician (PCP) to serve as a personal physician to help coordinate health needs.
Deductible and coinsurance apply. Once you reach your out-of-pocket maximum, the plan pays 100% of covered medical expenses for the rest of the year. You can compare the Open Access Plus (500) plan benefits to the other medical plans to determine if this plan is right for you.
Providers
With the Open Access Plus (1250) plan, you have the freedom to receive care from any licensed provider. You will pay less when you use doctors, hospitals, and other health care facilities that participate in the Cigna network and have agreed to provide services to plan members at special discounted rates.
You will pay expenses up to your plan’s annual deductible ($1250). Once you’ve met the deductible, you and the plan share in the costs – with the plan paying a larger portion – until you reach the annual out-of-pocket maximum ($4,000). This is known as “coinsurance.”
After you reach the out-of-pocket maximum, the plan picks up 100% of expenses for the rest of the year.
No referrals are necessary to see any physician or specialist in the network.
Preventative Care
Preventive care office visits and related procedures performed in the doctor’s office (coded as preventive by your physician) are covered at 100% only in-network. Recommended procedures performed outside the doctor’s office may result in deductible and coinsurance charges.
Some preventive drugs are covered at 100% with no co-pay or deductible; commonly used drugs are covered at 100%.
For a complete list of prescription drugs, please visit myCigna.
Open Access Plus (1250) Plan (under construction!)
| Coverage | In-Network | Out-of-Network |
|---|---|---|
| Deductible – Individual – Family | – $1,250 – $2,500 | – $2,500 – $5,000 |
| Coinsurance (Co-ins.) | 80/20% | 60/40% |
| Maximum Out-of-Pocket – Individual – Family | – $2,000 – $4,000 | – $8,000 – $16,000 |
| Rx Out-of-Pocket – Individual – Family | – $1,750 – $3,500 | N/A |
| Preventative Care Office Visit | 100% | Not Covered |
| Sick Office Visit | $25 copay | Deductible & 20% Co-ins. |
| Lab/X-Ray | Deductible & Co-ins. | Deductible & Co-ins. |
| CT/MRI/PET Scans | Deductible & Co-ins. | Deductible & Co-ins. |
| Outpatient Surgery | Deductible & Co-ins. | Deductible & Co-ins. |
| Hospital Visits | Deductible & Co-ins. | Deductible & Co-ins. |
| Specialist Visits | $30 copay | Deductible & 20% Co-ins. |
| Emergency Room | Deductible & 20% Co-ins. | Deductible & 20% Co-ins. |
| Retail Prescription Drugs (30-day supply) – Generic – Preferred – Non-Preferred | – $10 – $25 – $40 | N/A |
| Mail-Order Prescription Drugs (90-day supply) – Generic – Preferred – Non-Preferred | – $20 – $50 – $80 | N/A |
| Mental Health & Substance Abuse – Inpatient – Outpatient | – Deductible & Co-ins. – $30 copay | – Deductible & Co-ins. – Deductible & 20% Co-ins. |