Medical
Medical coverage provides healthcare protection for you and your family. You can visit any provider, but in-network doctors offer the highest level of benefits and lower out-of-pocket costs by charging reduced, contracted rates. Out-of-network providers set their own fees, so you may be responsible for charges above the Reasonable and Customary (R&C) limits. Preventive care—such as physical exams, flu shots, and screenings—is covered at 100% when you use in-network providers. The main differences between plan options are how much you pay per paycheck and what you pay when you receive care.
Each plan has different:
- Annual deductible amounts – the amount you pay each year for eligible in-network and out-of-network charges before the plan begins to pay.
- Out-of-pocket maximums – the most you will pay each year for eligible network services and/or prescriptions. After you reach your out-of-pocket maximum, the plan picks up the full cost of covered medical care for the remainder of the year.
- Copays – A copay is a fixed amount you pay for a health care service. Copays do not count toward your deductible but do count toward your annual out-of-pocket maximum.
- Coinsurance – Once you’ve met your deductible, you and the plan share the cost of care, which is called coinsurance. For example, you pay 20% for services and the plan will pay 80% of the cost until you have reached your out-of-pocket maximum.
OAP
Benefit Highlights
In-Network
Deductible (Individual/Family)
$500/$1,000
Out-of-Pocket Max (Individual/Family)
$2,000/$4,000
Preventive Care
$0
Primary Care Visit
$25 copay
Specialist Visit
$40 copay
Urgent Care
$25 copay
Emergency Room
$100 copay
Retail Rx (Up to 30-Day Supply)
Generic
$10 copay
Preferred Brand
$30 copay
Non-Preferred Brand
$50 copay
Specialty
$80 copay
Mail-Order Rx (Up to 90-Day Supply)
Generic
$20 copay
Preferred Brand
$60 copay
Non-Preferred Brand
$100 copay
Specialty
$80 (30-Day Supply)
Out-of-Network
Deductible (Individual/Family)
$800/$1,600
Out-of-Pocket Max (Individual/Family)
$4,000/$8,000
Preventive Care
30%
Primary Care Visit
30%
Specialist Visit
30%
Urgent Care
30%
Emergency Room
$100 copay
Retail Rx (Up to 30-Day Supply)
Generic
30%
Preferred Brand
30%
Non-Preferred Brand
30%
Specialty
30%
Mail-Order Rx (Up to 90-Day Supply)
Generic
Not covered
Preferred Brand
Not covered
Non-Preferred Brand
Not covered
Specialty
$80 (30-day supply)
Benefit Cost (Bi-weekly)
Employee Only: $107.25
Employee and Spouse: $386.10
Employee and Child(ren): $326.04
Employee and Family: $514.80
OAPin
Benefit Highlights
In-Network Only
Deductible (Individual/Family)
$500/$1,000
Out-of-Pocket Max (Individual/Family)
$2,000/$4,000
Preventive Care
$0
Primary Care Visit
$20
Specialist Visit
$40
Urgent Care
$30
Emergency Room
$150
Retail Rx (Up to 30-Day Supply)
Generic
$10
Preferred Brand
$30
Non-Preferred Brand
$50
Specialty
$80
Mail-Order Rx (Up to 90-Day Supply)
Generic
$20
Preferred Brand
$60
Non-Preferred Brand
$100
Specialty
$80 (30-day supply)
Benefit Cost (Bi-weekly)
Employee Only: $104.96
Employee and Spouse: $378.24
Employee and Child(ren): $319.42
Employee and Family: $504.33
OAPin Lite
Benefit Highlights
In-Network Only
Deductible (Individual/Family)
$4,500/$9,000
Out-of-Pocket Max (Individual/Family)
$8,000/$16,000
Preventive Care
$0
Primary Care Visit
$40
Specialist Visit
$60
Urgent Care
$50
Emergency Room
$200
Retail Rx (Up to 30-Day Supply)
Generic
$10
Preferred Brand
$40
Non-Preferred Brand
$60
Specialty
$100
Retail Rx (Up to 90-day Supply)
Generic
$20
Preferred Brand
$80
Non-Preferred Brand
$120
Mail-Order Rx (Up to 90-Day Supply)
Generic
$20
Preferred Brand
$80
Non-Preferred Brand
$120
Specialty
$100
Benefit Cost (Bi-weekly)
Employee Only: $0.00
Employee and Spouse: $245.87
Employee and Child(ren): $207.62
Employee and Family: $327.82