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.
Cigna OAP Summary of Benefits and Coverage
If you have questions or need assistance, please contact the PSA Benefits Hotline at 1-877-716-6618 or email Loyola@psafinancial.com.
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 investigate the Cigna Home Delivery Pharmacy. Members can sign up for mail order today by calling 1-800-244-6224or 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.