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Medical Benefits

Cigna – OAPIN Plan

What is the overall deductible?

  • 0$

What is the out-of-pocket limit for this plan?

  • $3,000Individual/$6,000 Family

Do you need a referral to see a specialist?

  • NO


Common Medical Events

Primary care visit to treat an injury or an illness: $10.00 Copayment per visit

Specialist visit: $15.00 Copayment per visit

Preventive care/screening/immunization: NO CHARGE

Diagnostic test (x-ray, blood work): NO CHARGE for Office, Independent, Laboratory, Outpatient Hospital

Imaging (CT/PET scans, MRIs): $100.00 Copayment per visit for Network Outpatient Facility and in a Network Doctor’s Office


If you need drugs to treat your illness or condition – Tier 1 Provider

Generic Drugs: $10.00 Copayment/Retail

Preferred Brand Drugs: $25.00 Copayment/Retail

Non-preferred brand drugs: $50.00 Copayment/Retail


If you have outpatient surgery

Facility fee (e.g., ambulatory surgery center): $150.00 Copayment per visit for Ambulatory Surgical Center, Outpatient Hospital

Physician/surgeon fees: No charge for Ambulatory Surgical Center, Outpatient Hospital


If you need medical attention

Emergency room care: $100 Copayment per visit for Outpatient Hospital

Emergency medical transportation: NO CHARGE

Urgent Care: $40.00 Copayment


If you have a hospital stay

Facility Fee (e.g., hospital room): $250


If you need mental health, behavioral health, or substance abuse services – Tier 1 Provider

Outpatient Services: $15.00 Copayment


(Subject to change at plan renewal time WITHOUT notice and currently, the Malachy Family pays 80% of this Platinum Plan by Cigna!)