Open Access (OAP1N)

 

OAPIN

Open Access+Network

Out-of-Network

Office Visit

 

 

Primary Care Physician

$40

No Coverage

Specialist

$80

No Coverage

Consigilio Wellness Center

$0

 

Deductible

 

 

Individual

$500

N/A

Individual + More

$1,000

N/A

Coinsurance

20%

No Coverage

Out-of-Pocket Maximum

 

 

Individual

(includes deductible)

$3,000

N/A

Individual + More

(includes deductible)

$6,000

N/A

 

 

 

 

OAPIN

Prescription Drug

Preventive

Non-Preventive

Retail In-Network

(34 day supply)

 

 

Generic

$0

$15

Preferred Brand

$25

$25

Non-Preferred Brand

$40

$40

Mail Order In-Network

(90 day supply)

 

 

Generic

$0

$30

Preferred Brand

$50

$50

Non-Preferred Brand

$80

$80