The OAP plan allows you to see any doctor– including specialists – without a referral. The Cigna Open Access Plus (OAP) network is a national network of providers; however, you may use any licensed provider you choose. There are two levels of coverage under the plan. Your level of coverage is determined each time you receive care, depending on whether you use a network or non-network provider. Your out-of-pocket costs under both levels of coverage may include office visit copayments, deductibles and coinsurance.
Summary of Benefits and Coverage (SBC OAP)
If you have questions or need assistance, please contact the PSA Benefits Hotline at 1-877-716-6618 or email Loyola@psafinancial.com.
IMPORTANT MESSAGE - Critical Information about Transparency in Coverage
This link - https://www.cigna.com/legal/compliance/machine-readable-files, 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.
Wellness
Medical plan participants and their spouses/LDAs can qualify for reduced medical plan premiums by completing the wellness steps at myCigna.com. For additional information go to the Wellness page.
Omada Program - Get healthy, your way!
Omada is a personalized, virtual care program that empowers you to achieve your health goals - whether that’s losing weight, gaining energy, or improving your overall health through sustainable lifestyle change. Combining data-powered human coaching, connected devices, and curriculum tailored to your specific circumstances, the program is designed to help you build healthy patterns for life. See if you are eligible by answering a few questions at https://go.omadahealth.com/omadaforcigna.
Accessing Care
In-Network: This level of benefits applies when you use a physician, specialist or other provider who is a member of the Cigna OAP network. By utilizing In-Network providers, you will pay lower copayments, deductibles and coinsurance than you will using Out-of-Network providers.
Loyola University Maryland is a religious institution, and has a (birth control coverage) exemption as a “religious employer” and prescriptions for contraceptives are excluded on the Loyola medical plan. However, these services are available directly from Cigna. Access the benefit by providing your insurance card as you normally do to an in-network pharmacy (services and procedures will not be covered out-of-network). Cigna will in turn arrange payment directly to the pharmacy. Contact Cigna directly at 1-800-244-6224 for additional information.
Mental Health/ Substance Abuse
The Plan provides inpatient, intermediate and outpatient care. There is a network of Mental Health Preferred Providers for mental health and substance use disorder services. If a Member chooses one of these Mental Health Preferred Providers, the cost to the Member is lower than if the Member chooses a Mental Health Non-Preferred Provider. The Schedule of Benefits lists payments as either “In-Network: Mental Health Preferred Provider” or “Out-of-Network: Mental Health Non-Preferred Provider”, but you may go to any provider. Benefits are paid differently, depending on whether you use network or non-network providers. Please see the OAP Summary of Benefits and Coverage for more information.
Prescription Drug Plan
Participants in the plan automatically participate in the prescription drug plan. You can choose between retail and mail order options. Your prescription benefits are structured to take advantage of the savings associated with generic drugs. With Restricted Generics, you will save the most by choosing generic drugs (when available) versus brand-name drugs. Unless you doctor writes “Dispense as Written” of DAW on your brand-name drug prescription, you will pay both the non-preferred brand copay plus the cost difference between the generic and brand-name drug.
Health care reform under the Patient Protection and Affordable Care Act (PPACA) requires plans to cover certain preventive medications and products at 100% or no cost-share ($0) to you. Visit mycigna.com to learn more about how the plan covers preventive medications.
If you are taking maintenance prescription medication, we encourage you to review the Express Scripts Pharmacy. Express Scripts Pharmacy service begins on July 1, 2020.
• Customers will continue to call the same home delivery phone number and will continue to speak with Cigna Customer Service Advocates.
• Customers will continue to use the myCigna® app or website to manage their prescriptions online. Cigna will automatically connect them from myCigna to the new online Express Scripts account portal.
• Customers will have to provide their payment and shipping information directly to Express Scripts Pharmacy. They can do this online or over the phone.
• Enrollment in the Express Scripts Pharmacy auto fill program is available. Cigna Home Delivery Pharmacy. Members can sign up for mail order today by calling 1-800-244-6224 or through mycigna.com.
Filing a Claim
When you use a network provider, that provider will submit your claim to Cigna on your behalf. Cigna will pay the provider as determined by plan rules and send you an Explanation of Benefits (EOB) which details for you the total amount billed by the provider, the amount that Cigna paid, and the amount for which you are liable. Your provider will send you an invoice for the amount for which you are liable (if any). When you use a non-network provider, your provider may require you to pay the full bill at the time the service is rendered. You should then submit a copy of your invoice to Cigna. You will be reimbursed for any amount determined to be payable to you by the Plan.
Resources
Summary Plan Description
This website provides a summary of the benefits available. The University reserves the right to modify, amend, suspend or terminate any plan at any time, and for any reason without prior notification. You will be notified of any changes to these plans and how they affect your benefits, if at all. The plans described on this website are governed by insurance contracts and plan documents, which are available for examination. We have attempted to make explanations of the plans on this website as accurate as possible. However, should there be a discrepancy between this website and the provisions of the insurance contracts or plan documents, the provisions of the insurance contracts or plan documents will govern. In addition, you should not rely on any oral descriptions of these plans, since the written descriptions in the insurance contracts and plan documents will always govern.