Is Cigna Open Access Plus a PPO?

Cigna Open Access Plus (OAP) is a type of preferred provider organization (PPO) health insurance plan offered by Cigna. As a PPO, the OAP plan provides more flexibility in choosing doctors compared to health maintenance organization (HMO) plans. But you may be wondering, what exactly is a PPO and how does the Cigna OAP plan work? This article will explain what you need to know.

What is a PPO Health Insurance Plan?

A PPO is a type of health insurance plan that contracts with a broad network of healthcare providers, including doctors, hospitals, and facilities. The “preferred” providers agree to provide medical services at lower negotiated rates for plan members.

Here are some key features of PPO plans:

• Nationwide network of providers – PPOs offer access to a large network of in-network providers across the country. This makes it easier to find participating doctors if you travel or have children away at college.

• No referrals required – You can visit any in-network specialist without needing a referral from your primary care physician. This makes it easy to get the care you need.

• Out-of-network care – PPOs allow you to visit out-of-network providers, but you’ll pay more out-of-pocket compared to seeing in-network doctors.

• Higher premiums – PPO plans typically have higher monthly premiums than HMOs, but provide more flexibility in choosing providers.

In general, PPOs offer more provider choice than HMOs, but you pay more for that increased flexibility. PPOs are one of the most common types of health plans offered by employers.

Is Cigna OAP a PPO Plan?

Yes, Cigna Open Access Plus is a type of PPO plan offered by Cigna. The OAP plan provides the flexibility of a PPO, allowing you to visit any healthcare provider without needing a referral.

Cigna offers two main types of OAP plans:

• Cigna Open Access Plus – This option allows you to visit out-of-network providers, but you’ll pay more compared to seeing in-network doctors.

• Cigna Open Access Plus In-Network – This plan only covers in-network providers, except for emergency care. You must stay in-network for routine and preventive care.

Both plans allow you to visit any in-network specialist without a referral. And neither OAP plan requires you to have a primary care physician or get referrals to see specialists.

This flexibility makes the Cigna OAP plan a type of PPO insurance. However, the OAP offers a nationwide network of over 1 million doctors and health facilities to choose from.

Comparing OAP to HMO Plans

OAP plans differ from HMO plans in several important ways:

Referrals

• OAP – No referrals needed to visit in-network specialists
• HMO – Referral required from primary care doctor to see specialists

Network size

• OAP – Large national network of providers
• HMO – Local or regional network of providers

Out-of-network care

• OAP – Covered but costs more (except OAP In-Network plan)
• HMO – Not covered except for emergencies

Premiums

• OAP – Higher monthly premiums
• HMO – Lower monthly premiums

Primary care doctor

• OAP – Not required
• HMO – Must select an in-network PCP

HMO plans cost less per month but restrict you to a local network and require referrals to see specialists.

How Does the Cigna OAP Plan Work?

Here are some key details on how the Cigna Open Access Plus plan works if you enroll through an employer:

Choosing a Primary Care Provider

• You don’t need to select a primary care physician with the OAP plan. However, it’s recommended to establish care with a PCP for preventive care and coordination of specialized services.

• Your PCP can be a family medicine doctor, general practitioner, OB/GYN, pediatrician, or internal medicine physician.

• If you don’t select a PCP, any in-network doctor you visit will be considered your chosen primary care provider.

Visiting Specialists

• You can self-refer to any in-network specialist without needing approval from a PCP first.

• Examples of specialists include cardiologists, dermatologists, orthopedists, gynecologists, and mental health providers.

• Be sure the specialist is in the Cigna OAP network to get the highest level of coverage.

Getting Care Out-of-Network

• The Cigna OAP plan covers out-of-network care, but you’ll pay more compared to seeing in-network providers.

• Out-of-network specialists may bill you for any charges above the “allowed amount” set by Cigna for covered services.

• You may have to file claims yourself when seeing out-of-network doctors and hospitals.

• The OAP In-Network plan only covers out-of-network emergency care. All other services must be received from in-network providers.

Hospitalization and Surgery

• Non-emergency hospital stays and some types of outpatient surgery require prior authorization from Cigna before getting care.

• Your doctor will submit the request for approval to Cigna on your behalf. Make sure authorization is obtained first to avoid lack of coverage.

• Maternity care may also require prior authorization depending on your plan’s benefits. Always double check first.

Emergency and Urgent Care

• The OAP plans cover emergency care from in- and out-of-network providers at the same cost share.

• Urgent care services are also covered from in- and out-of-network urgent care centers.

• Care provided at hospital ERs or freestanding ERs are billed as emergency services.

Costs and Coverage with the OAP Plan

The Cigna OAP plan has associated costs and out-of-pocket expenses for covered medical services:

Premiums – Monthly premiums are paid to maintain coverage under the plan. Your employer may cover some or all of the premium costs.

Deductible – The annual deductible is a set amount you pay out-of-pocket before the plan starts covering services. Many plans have separate in-network and out-of-network deductibles.

Copays – A fixed amount you pay at the time of a doctor visit, prescription fill, or other medical service. Copays don’t apply toward your deductible.

Coinsurance – After meeting your deductible, you pay a percentage of costs for covered services. For example, you may pay 20% coinsurance for an MRI.

Out-of-pocket max – This yearly limit protects you from high healthcare bills. Once reached, the OAP plan pays 100% of covered expenses for the rest of the year.

Always check your plan documents to understand the costs for different services based on the provider’s network status. Out-of-network care on the OAP plan often comes with higher deductibles, coinsurance, and copays.

Finding In-Network Providers

To get the most from your OAP benefits and save on healthcare costs, staying in-network is important. Here are some tips:

• Check if your current doctors are in-network – You can search the Cigna provider directory online by name, specialty, and location.

• Look for in-network hospitals – Search for hospitals and facilities in the Cigna network when choosing where to get lab tests, imaging scans, physical therapy, surgery, and other care.

• Ask about specialist networks – Some benefit plans have a subset “network within a network” for certain specialties like cardiology, orthopedics, or radiology. Use these higher tier specialists when possible to pay the least.

• Search nationally – Since OAP has a nationwide network, you can look for in-network providers across the country. This makes finding care easier when traveling.

• Consider telehealth – Telehealth visits through MDLive can connect you with doctors and psychiatrists on your phone or computer 24/7. In-network telehealth is covered by many plans.

Using the tools on Cigna’s website makes finding in-network providers for your OAP plan simple. This allows you to maximize your coverage and minimize surprises on medical bills.

Pros and Cons of the OAP Plan

Here are some potential advantages and disadvantages of the Cigna OAP plan to think about:

Pros

• No P