What does Cigna Open Access Plus cover? Most Cigna Open Access Plus (OAP) plans cover doctor visits, specialists, hospital stays, emergencies, lab work, mental health care and prescriptions. Preventive care, such as checkups and many screenings, is usually covered at 100% in network. Many plans also include virtual care. Your exact costs depend on the plan your employer chose, so the deductible, copays and coinsurance can vary a lot. Your Summary of Benefits and Coverage lists the details.
- OAP is a network type. Your employer's plan design decides your costs.
- In-network preventive care is usually free.
- Prescriptions are covered in tiers, with generics costing the least.
- Out-of-network care is covered on standard OAP, but at a higher cost.
What Cigna Open Access Plus Covers
- Preventive care. Annual checkups, immunizations and screenings, usually at no cost in network.
- Doctor visits. Primary care and specialists, with no referral needed.
- Virtual care. Many plans include video visits for urgent and routine care.
- Emergency and urgent care. Covered in and out of network.
- Hospital and surgery. Inpatient and outpatient care, often after the deductible.
- Labs and imaging. Blood work, X-rays and scans. Some need prior authorization.
- Mental health care. Therapy and behavioral health services.
- Prescriptions. Usually through a tiered drug list.
A Real Cigna OAP Plan Example
Here's how one employer's Cigna Open Access Plus plan sets its costs. It's a useful example, but your plan will have its own numbers.
| Service | In network | Out of network |
|---|---|---|
| Deductible | $450 individual | $450 individual |
| Plan pays after deductible | 80% | 60% |
| Preventive care | 100% covered | Not covered |
| Primary care or specialist visit | $40 copay | $50 copay |
| Virtual urgent care | $10 copay | Not covered |
| Emergency room | $150 copay, then 80% | Covered as emergency care |
| Out-of-pocket maximum | $3,500 individual | $5,950 individual |
Notice how much more you'd pay out of network. That gap is typical. Learn why in Cigna OAP out-of-network coverage.
Use your plan's virtual care first for minor issues. On many Cigna plans, a video visit costs a fraction of an urgent care or ER visit.
Prescription Coverage
Most Cigna OAP plans cover drugs in tiers. Generics cost the least, then preferred brands, then non-preferred brands. For example, the plan above charges $10 for a 30-day generic and $50 for a preferred brand. A 90-day supply often saves money, too.
Specialty drugs usually have their own cost share. So check your drug list before you fill a new prescription. Questions? Call 888-730-6031.
A licensed Vivna agent can quote Cigna dental and vision plus other carriers, at no cost to you.
Limits and Exclusions
- Prior authorization. Hospital stays and some outpatient care may need approval first. Skipping it can cost you.
- Out-of-network costs. Higher deductibles and coinsurance, plus possible balance bills.
- Adult dental and vision. Usually not included in medical plans. Many people add Cigna dental and vision coverage.
- Cosmetic care. Typically excluded.
How to Find Your Exact Benefits
- Read your Summary of Benefits and Coverage. Every plan must provide one.
- Log in to myCigna. You'll see your deductible progress and cost estimates.
- Check your ID card. It shows key copays and your network.
- Ask HR. Your benefits team has the full plan documents.
Comparing to other plan types? See our guide to Cigna plan options and what health insurance covers.
What Does Cigna Open Access Plus Cover: FAQs
Does Cigna Open Access Plus cover preventive care?
Yes. In-network preventive care is usually covered at 100%.
Does Cigna OAP cover mental health?
Yes. Behavioral health services are covered, with costs set by your plan.
Does Cigna OAP cover telehealth?
Many plans do. Some charge as little as $10 for virtual urgent care.
Does Cigna OAP cover dental?
Adult dental is usually separate. You can add a dental plan.
Is maternity care covered?
Most employer plans cover pregnancy and delivery. Check your plan documents.
We'll compare individual, short-term, dental and vision options. Call Monday through Friday, 9am to 6pm.
Sources
- Sample Cigna OAP benefits summary (Otero County, CO)
- Cigna: Open Access Plus plans
- Cigna: Open Access Plus for employers
- HealthCare.gov: Preventive care benefits
Benefits and costs vary by employer plan. The example shown is one employer's plan and is not a quote. Your Summary of Benefits and Coverage has the final word. Vivna Insurance is a licensed, independent agency (NPN 19168641) and an appointed broker with Cigna for select products. We are not Cigna and don't administer employer plans.
Related guides
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Prefer to talk it through? Call 888-730-6031 Monday through Friday, 9 a.m. to 6 p.m. Eastern, for free help from a licensed agent.
