The Open Access Plus In-Network Planoffers benefits through a nationwide network of providers, but does not cover non-emergency services received from providers outside the network. The Open Access Plus High Deductible Health Plan, offers both in-network and non-network coverage after payment of a significant deductible, and is partnered with a Health Savings Account where pretax dollars
may be saved for medical expenses
If an employee wishes to enroll in one of these plans, he/she must submit a completed insurance application form to the Division of Human Resources within 30 days from his/her first date of employment or subsequent benefit eligibility. Insurance is in effect on the first day of the month that follows the completion of 30 days of employment in an eligible status.
Under the OAPin plan, members receive care from participating providers in the national CIGNA Open Access Plus network. Care received from providers who do not participate in the network is not covered, except in the case of emergency. Referrals are not required to visit in-network specialists. There is a $20 co-pay for physician office visits. Inpatient hospital expenses are covered in full, after paying a $300 copay. Lab and other diagnostic tests are covered at 90% of the approved rate. Prescriptions are $10 for Generic, $30 for Preferred Brand, $50 for Non-Preferred Brand and $75 for Specialty prescription drugs at participating pharmacies. This plan also offers a mail order drug program, and coverage for a complete vision exam through CIGNA Vision.
The OAPHD plan is paired with a Health Savings Account (HSA) where you can make pre-tax contributions to help you pay for medical expenses before reaching the deductible or expenses that aren't covered by the plan. For plan year 2019, the deductible for in-network providers is $1,350/individual and $2,700/family. The county also makes a contribution to your HSA when you choose this plan. After meeting the deductible, expenses from in-network providers are generally covered at 90% and those from non-participating providers are covered at 80%. Prescription drug benefits are subject to the annual deductible, then pay the same as in the OAPin plan. Vision coverage (see above) is also included in this plan.
This link leads to the machine readable files that are made available in response to the federal Transparency in Coverage Rule and includes negotiated service rates and out-of-network allowed amounts between health plans and healthcare providers. The machine-readable files are formatted to allow researchers, regulators, and application developers to more easily access and analyze data