Cigna OAPIN
The OAPIN plan is a copay-based plan that requires you to use in-network providers only.
Cigna OAPIN
Plan Details
- Carrier
- Cigna
- Plan Type
- OAPIN
- Network
- Cigna
- HSA Eligible
- No
- HRA Included
- No
EE Only
- Monthly Premium
- $1,231.61
EE + Children
- Monthly Premium
- $2,586.70
EE + Spouse
- Monthly Premium
- $3,096.34
EE + Family
- Monthly Premium
- $4,438.03
| Coverage Tier | Monthly Premium |
|---|---|
| EE Only | $1,231.61 |
| EE + Children | $2,586.70 |
| EE + Spouse | $3,096.34 |
| EE + Family | $4,438.03 |
DFW Contributions - Per Individual
- Network
- N/A
DFW Contributions - Per Family
- Network
- N/A
Annual Deductible (Excludes Prescription Copayments) - Per Individual
- Network
- N/A
Annual Deductible (Excludes Prescription Copayments) - Per Family
- Network
- N/A
Annual Out-of-Pocket Limit (Includes the Deductible, Copays, and Coinsurance) - Per Individual
- Network
- $2,500
Annual Out-of-Pocket Limit (Includes the Deductible, Copays, and Coinsurance) - Per Family
- Network
- $5,000
Coinsurance/Copayments - Preventive Care
- Network
- 100% covered
Coinsurance/Copayments - LW Clinic Visit
- Network
- 100% covered
Coinsurance/Copayments - Office Visits
- Network
- $30 copayment
Coinsurance/Copayments - Specialist Office Visits
- Network
- $60 copayment
Coinsurance/Copayments - Outpatient Surgery
- Network
- Office visit copayment if performed in physician’s office; $200 copayment if performed in hospital or outpatient facility, then covered 100%
Coinsurance/Copayments - Hospitalization and Inpatient Surgery
- Network
- $500 copayment per admission, then covered 100%
Coinsurance/Copayments - Mental Health (Inpatient/Outpatient)
- Network
- Inpatient: $500 copayment per admission, then covered 100% Outpatient: $30 copayment per visit
Coinsurance/Copayments - Virtual visits powered by MDLive Medical and Behavioral Mental Health
- Network
- $0 copayment
Coinsurance/Copayments - Urgent Care Facility
- Network
- $75 copayment
Coinsurance/Copayments - Emergency Room
- Network
- $150 copayment; waived if admitted to a hospital or outpatient facility
Coinsurance/Copayments - Ambulance
- Network
- $150 copayment
| Benefit | Network |
|---|---|
| DFW Contributions - Per Individual | N/A |
| DFW Contributions - Per Family | N/A |
| Annual Deductible (Excludes Prescription Copayments) - Per Individual | N/A |
| Annual Deductible (Excludes Prescription Copayments) - Per Family | N/A |
| Annual Out-of-Pocket Limit (Includes the Deductible, Copays, and Coinsurance) - Per Individual | $2,500 |
| Annual Out-of-Pocket Limit (Includes the Deductible, Copays, and Coinsurance) - Per Family | $5,000 |
| Coinsurance/Copayments - Preventive Care | 100% covered |
| Coinsurance/Copayments - LW Clinic Visit | 100% covered |
| Coinsurance/Copayments - Office Visits | $30 copayment |
| Coinsurance/Copayments - Specialist Office Visits | $60 copayment |
| Coinsurance/Copayments - Outpatient Surgery | Office visit copayment if performed in physician’s office; $200 copayment if performed in hospital or outpatient facility, then covered 100% |
| Coinsurance/Copayments - Hospitalization and Inpatient Surgery | $500 copayment per admission, then covered 100% |
| Coinsurance/Copayments - Mental Health (Inpatient/Outpatient) | Inpatient: $500 copayment per admission, then covered 100% Outpatient: $30 copayment per visit |
| Coinsurance/Copayments - Virtual visits powered by MDLive Medical and Behavioral Mental Health | $0 copayment |
| Coinsurance/Copayments - Urgent Care Facility | $75 copayment |
| Coinsurance/Copayments - Emergency Room | $150 copayment; waived if admitted to a hospital or outpatient facility |
| Coinsurance/Copayments - Ambulance | $150 copayment |
Retail Rx (up to 30-day supply)
- You Pay
Retail Rx - Tier 1 Generic Drugs
- You Pay
- $5 copayment
Retail Rx - Tier 2 Brand-name drugs (on the Preferred Drug List)
- You Pay
- $30 copayment
Retail Rx - Tier 3 Brand-name drugs (not on the Preferred Drug List)
- You Pay
- $60 copayment
Retail Rx - Tier 4 Specialty retail drugs (injection, infused or oral)
- You Pay
- $100 copayment (30-day supply)
Mail Order Rx (31 to 90-day supply)
- You Pay
Mail Order Rx - Tier 1 Generic Drugs
- You Pay
- $10 copayment
Mail Order Rx - Tier 2 Brand-name drugs (on the Preferred Drug List)
- You Pay
- $60 copayment
Mail Order Rx - Tier 3 Brand-name drugs (not on the Preferred Drug List)
- You Pay
- $120 copayment
Mail Order Rx - Tier 4 Specialty mail order drugs (injection, infused or oral)
- You Pay
- $100 copayment (30-day supply)
| Tier | You Pay |
|---|---|
| Retail Rx (up to 30-day supply) | |
| Retail Rx - Tier 1 Generic Drugs | $5 copayment |
| Retail Rx - Tier 2 Brand-name drugs (on the Preferred Drug List) | $30 copayment |
| Retail Rx - Tier 3 Brand-name drugs (not on the Preferred Drug List) | $60 copayment |
| Retail Rx - Tier 4 Specialty retail drugs (injection, infused or oral) | $100 copayment (30-day supply) |
| Mail Order Rx (31 to 90-day supply) | |
| Mail Order Rx - Tier 1 Generic Drugs | $10 copayment |
| Mail Order Rx - Tier 2 Brand-name drugs (on the Preferred Drug List) | $60 copayment |
| Mail Order Rx - Tier 3 Brand-name drugs (not on the Preferred Drug List) | $120 copayment |
| Mail Order Rx - Tier 4 Specialty mail order drugs (injection, infused or oral) | $100 copayment (30-day supply) |
- DFW’s plan is a mandatory generic plan. If you choose a brand-name drug when a generic is available, you will pay the difference in cost between the generic and brand-name drug plus the applicable brand copayment.
Plan Notes
- Prescription drug coverage is administered through Cigna and Express Scripts.
- Preventive medications are available at a $0 copayment.
- Maintenance medications can be delivered to your home through Express Scripts Pharmacy (800-835-3784).