OAP
Reduce your out-of-pocket costs when you need care through a lower deductible and higher premiums.
We want you to make the most of your medical plan options and choose the coverage that is right for you and your family.
AXA XL offers three medical plans for you to choose from: OAP, OAP HSA 1, and OAP HSA 2, so you can have choice and control over your healthcare spending. All three options are available through Allegiance.
If you’re new to AXA XL, review the new colleague presentation for help determining which medical plan is right for you.
Our medical plans use the Cigna Open Access Plus network of providers, administered through Allegiance. All three medical plans give you the freedom to choose any provider you like for care. However, you’ll pay less out of pocket when you use providers in the Cigna Open Access Plus network, and your costs will be lowest of all if you use Tier 1 providers.
Whenever you need support with your medical coverage, Quantum Health is your first stop for help. Quantum Health serves two primary roles: as your well-being advisor and as the primary interface for your medical plan. As a healthcare guide, Quantum Health houses all of AXA XL's benefits under one roof, and expert Care Navigators, well-versed in AXA XL benefits, are available to offer advice on optimizing your benefits choices. Call 844-460-2821 or visit axaxl-quantum.com to get started.
Medical plans
OAP HSA 1
Take charge of your spending through mid-level premiums, mid-level deductibles, and a tax-free Health Savings Account (HSA) (with contributions from AXA XL) that you own for life.
OAP HSA 2
Take charge of your spending through the lowest premiums, the highest deductibles, and a tax-free Health Savings Account (HSA) (with contributions from AXA XL) that you own for life.
All our medical plans provide:
- Comprehensive, affordable coverage for a wide range of healthcare services. Tip: If you need extra protection from large or unexpected medical expenses, you may also choose to enroll in supplemental health coverage.
- Telehealth services for medical and behavioral health care, so you and your covered family members can see a doctor without leaving the house. MDLIVE offers you fast, affordable diagnosis and treatment for many common conditions through video consult on your mobile phone or computer.
- Free in-network preventive care, with services such as annual physicals, recommended immunizations, and routine cancer screenings covered at 100%. See more covered preventive services.
- Prescription drug coverage included with each medical plan. Prescription benefits.
- Financial protection through annual out-of-pocket maximums that limit the amount you’ll pay each year.
You will be able to choose from three options: OAP, OAP HSA 1 and the OAP HSA 2. All of these plans cover the same services and are a part of the Open Access Plus (OAP) network through Cigna. Keep in mind that the difference in cost of the plans will depend on your utilization, the premium, deductible, and out-of-pocket maximum.
How the plans differ
The OAP and the OAP HSA plans share features, but differ in some ways, as well. Review the chart below to see how the OAP and OAP HSA plans compare.
| What’s the same | What’s different |
|---|---|
| Covered services and provider choices. All of the medical plan options cover the same services from preventive care to specialist visits and more. And, with each plan, you have access to the Open Access Plus (OAP) provider network. | Lower contributions. The OAP HSA plans have a higher deductible than the OAP. You pay less per paycheck when you enroll in one of the HSA plans. |
| 100% covered preventive care. When you use an in-network provider, you pay nothing for eligible preventive care services — no deductible, and no copay. | Higher deductible. The OAP HSA plans have a higher deductible you must reach before the plan begins to pay for covered services, including prescription drugs and physician office visits. Preventive care is not subject to the deductible. |
| Responsibility for the deductible. You must meet the applicable annual deductible before the plan begins to pay for certain healthcare expenses. | “True” family deductible under the HSA plans. If you elect to cover dependents, you must meet the entire family deductible before the plan starts to pay benefits for any individual family member. This is different from the OAP plan in which each covered family member needs to satisfy only the individual deductible. |
| Cost protection. Once you meet your deductible, the plan pays a percentage of the cost of covered services, and you pay the remaining percentage (the coinsurance) or copays until you reach the annual out-of-pocket maximum. Then, the plan pays 100% of covered expenses for the rest of the calendar year. | Health Savings Account (HSA). If you are enrolled in one of the HSA plans, you can pay for qualified healthcare expenses using pre-tax dollars with your HSA. The Company will contribute annually to the account and you may also contribute to this account, up to IRS limits, less what the company contributes. Money in your HSA can be carried over from year to year and is always yours to keep. |
Plan comparison
See how each plan pays for benefits below.
| OAP | OAP HSA 1 | OAP HSA 2 | |
|---|---|---|---|
| HSA-eligible | No | Yes | Yes |
| AXA XL contribution to HSA (Individual/family)1 | N/A | $500/ $1,000 |
$500/ $1,000 |
| Deductible2 (Single/family) | In-Network: $750/$1,500 Out-of-Network: $2,500/$5,000 |
In-Network: $1,600/$3,200 Out-of-Network: $3,000/$6,000 |
In-Network: $2,500/$5,000 Out-of-Network: $4,000/$8,000 |
| Out-of-pocket maximum3 (Single/family) | In-Network: $3,000/$6,000 Out-of-Network: $6,000/$12,000 |
In-Network: $4,000/$8,000 Out-of-Network: $6,000/$12,000 |
In-Network: $5,000/$10,000 Out-of-Network: $8,000/$16,000 |
| PCP office visits | TIER 1 Cigna Care Network: $10 Non-Tier 1 Providers: $25 Out-of-Network: 40% after deductible |
TIER 1 Cigna Care Network: 10% after deductible Non-Tier 1 Providers: 20% after deductible Out-of-Network: 40% after deductible |
TIER 1 Cigna Care Network: 10% after deductible Non-Tier 1 Providers: 20% after deductible Out-of-Network: 40% after deductible |
| Specialist office visits | TIER 1 Cigna Care Network: $25 Non-Tier 1 Providers: $50 Out-of-Network: 40% after deductible |
TIER 1 Cigna Care Network: 10% after deductible Non-Tier 1 Providers: 20% after deductible Out-of-Network: 40% after deductible |
TIER 1 Cigna Care Network: 10% after deductible Non-Tier 1 Providers: 20% after deductible Out-of-Network: 40% after deductible |
| Emergency room visits | $150 copay | 20% after deductible | 20% after deductible |
| Preventive care4 | In-network: Covered at 100% Out-of-Network: 40% after deductible |
In-network: Covered at 100% Out-of-Network: 40% after deductible |
In-network: Covered at 100% Out-of-Network: 40% after deductible |
| Prescription drugs5 | |||
| Prescription drug deductible (Single/family) | $125/$250 | Medical deductible applies | Medical deductible applies |
| Prescription drug out-of-pocket maximum (Single/family) | $1,250/$2,500 | Medical out-of-pocket maximum applies | Medical out-of-pocket maximum applies |
Short-term prescription drugs (CVS Caremark retail pharmacy network, up to a 30-day supply)6
|
$10 for one 30-day supply 30% for one 30-day supply 40% for one 30-day supply |
20% after deductible for one or three 30-day supplies 30% after deductible for one or three 30-day supplies 40% after deductible for one or three 30-day supplies |
20% after deductible for one or three 30-day supplies 30% after deductible for one or three 30-day supplies 40% after deductible for one or three 30-day supplies |
Long-term prescription drugs (CVS Caremark mail service pharmacy or CVS pharmacy locations; up to a 90-day supply)
|
$20 copay 30% 40% |
20% after deductible 30% after deductible 40% after deductible |
20% after deductible 30% after deductible 40% after deductible |
1 The company’s HSA contribution is prorated for the number of full months you’re enrolled in the plan.
2 Under the OAP HSA 1 and OAP HSA 2, if you enroll in employee + child(ren), employee + spouse, or family coverage, you and your dependents must meet the full family deductible before the plan shares in the cost of non-preventive care for any one family member. Medical expenses from any covered person or combination of family members can meet the deductible.
3 Under the OAP HSA 1 and OAP HSA 2, you have embedded individual out-of-pocket maximums. This means that after each eligible family member meets his or her individual out-of-pocket maximum, the plan will play 100% of their covered expenses. Or, after the family out-of-pocket maximum has been met, the plan will pay 100% of each eligible family member’s covered expenses.
4 Preventive care services include, but are not limited to well baby, well child, adult preventive care, well woman exams, mammograms, PSA, and pap smears.
5 When a generic is available, but the pharmacy dispenses the brand-name medication for any reason, you will pay the difference between the brand-name medication and the generic plus the brand copay. The difference does not apply to the deductible or out-of-pocket maximum.
6 Specialty drugs follow plan coinsurance.
With the OAP HSA 1 plan, for most services, you’ll pay out-of-pocket until you reach your deductible. Then you will pay coinsurance for eligible services and expenses until you reach your out-of-pocket maximum. Remember: You can use your tax-advantaged HSA, including HSA contributions from the Company, to pay for eligible out-of-pocket expenses. Learn more about the HSA in the Savings and Spending Account section.
How the OAP HSA 1 and OAP HSA 2 plans work:
You pay the plan premiums from your paycheck to have coverage.
HSA
You can set aside tax-free money from your paycheck and receive company contributions to help cover your costs — now, or in the future.
Deductible
You pay 100% of your medical and prescription costs until you meet the annual deductible.*
Coinsurance
After meeting the deductible, you and the plan share the cost of covered medical care and prescriptions, with the plan paying the majority.
Out-of-Pocket Maximum
You’re protected by an annual limit on costs — the plan pays 100% of any further covered expenses for the rest of the year.**
*Under the OAP HSA 1 and OAP HSA 2, if you enroll in employee + child(ren), employee + spouse, or family coverage, you and your dependents must meet the full family deductible before the plan shares in the cost of non-preventive care for any one family member. Medical expenses from any covered person or combination of family members can meet the deductible.
** Under the OAP HSA 1 and OAP HSA 2, you have embedded individual out-of-pocket maximums. This means that after each eligible family member meets his or her individual out-of-pocket maximum, the plan will play 100% of their covered expenses. Or, after the family out-of-pocket maximum has been met, the plan will pay 100% of each eligible family member’s covered expenses
Use your HSA to save money and plan ahead!
Contributing to your HSA is a great way to budget for deductibles and other out-of-pocket expenses while also saving money — your HSA contributions are tax-free!*
Keep in mind:
- The OAP HSA 1 and OAP HSA 2 cost you less from your paycheck, so you may have extra money available to put in your HSA.
- You can only spend HSA money that’s actually been deposited into your account. If you don’t have enough money in your HSA when you need it, you can pay another way and reimburse yourself later so you take full advantage of your HSA’s tax savings.
- You will never forfeit any money left in your HSA — it rolls over year after year. If you know about future expenses or want to save for your health care costs in retirement, set aside a little extra each paycheck so your balance can grow over time.
- You can change your HSA contribution amount throughout the year as needed to keep up with any changes in your situation.
*HSA contributions are not subject to federal income tax, but are currently subject to state income tax in CA and NJ. Consult with your tax advisor to understand the potential tax implications of enrolling in an HSA. Money in an HSA can be withdrawn tax-free as long as it is used to pay for qualified health-related expenses. If money is used for ineligible expenses, you will pay ordinary income tax on the amount withdrawn, plus a 20% penalty tax if you withdraw the money before age 65.
With the OAP plan, you’ll pay more in premiums, but have a lower deductible and smaller copays when you visit the doctor or require medical care. You will also have a deductible and coinsurance for other services.
How the OAP Plan works
You pay for covered in-network doctor’s visits with flat fees, called copays. The medical plan deductible only applies for certain in-network diagnostic services, such as X-rays or lab work. There is a prescription drug deductible, which you must meet before you begin paying copays for various tiers of prescription drugs.
Save money with an FSA!
A Health Care Flexible Spending Account (FSA) lets you take advantage of tax-free savings when paying for health care. But, be sure to plan your FSA contributions carefully: the money in your FSA does not carry over to the next plan year; you must “use it or lose it.” You can only carry over up to $610 of unused money in your FSA to the next year; you will forfeit any remaining amount above $610.
You automatically receive prescription drug coverage when you enroll in the OAP, OAP HSA 1, or the OAP HSA 2 medical plans.
With the prescription drug benefit through CVS Caremark, you can either get your prescriptions at a participating retail pharmacy or use their mail order service.
To get started, sign in or register at caremark.com/startnow and follow the instructions to:
- Request a new 90-day prescription
- Refill an existing prescription, if available to you
Additional tools and resources are available to you to help you manage your prescriptions at www.caremark.com.
Drug tiers
The cost of your prescription drugs under each medical plan depends on the tier of the medication — generic, preferred, or non-preferred.
Generic drugs
Same active ingredients as brand-name equivalents and meet the same standards for quality and effectiveness, but usually cost much less.
You pay: $
Preferred drugs
Brand-name medications included on the formulary and favored by CVS Caremark.
You pay: $$
Non-preferred drugs
Brand-name medications not preferred by CVS Caremark. They may still be covered but may require prior authorization and cost more.
You pay: $$$
Access the CVS Caremark prescription drug lists
Becoming familiar with the CVS Caremark prescription drug lists can save you time and even money. Visit www.caremark.com for the most up-to-date lists, including the formulary, medications that require preauthorization, and preventive generic drug lists. Be sure to check back often as these lists are occasionally updated.
Keep in mind that you pay nothing for prescription drugs found on the preventive generic drug list.
The cost of prescription drugs is rising faster than many other health care services and supplies. But, there are ways for you to save.
- Ask your doctor about generic medications. Generic medications are generally just as effective as brand-name medications, but they typically cost between 80% and 85% less.
Through CVS Caremark, you also have access to the following features:
- ScriptSync: Schedule multiple prescriptions for pickup at the same time—at no cost to you. To get started, sign in to www.caremark.com and go to the Automatic Refills page to see which of your prescriptions are eligible for you to pick up together.
- Check Drug Cost tool: Quickly check drug costs and see real-time lower-cost available options. Access the tool by going www.caremark.com and clicking on “Plan & Benefits” or through the CVS Caremark mobile app.
For more information, go to www.caremark.com and see how you can save time—and money—on your prescriptions.
Mandatory All Access Maintenance Choice Program
If you take long-term medications, you’ll need to fill a 90-day supply through mail order or retail pickup at CVS through the Mandatory All Access Maintenance Choice Program in order for your prescription drug to be covered by the plan.
With this program, you can avoid paying more for your long-term prescriptions. All you need to do is have 90-day supplies filled through the CVS Mail Service or at a CVS pharmacy.
Whether you choose delivery or pick-up, you can:
- Save money: You’ll pay less for 90-day refills.
- Get shipping at no extra cost: 90-day refills are delivered in discreet packaging and can be tracked on line at www.caremark.com.
- Have peace of mind: You’ll have the medications you need, when you need them.
Note: If you do not switch to the All Access Maintenance Choice Program after one initial retail fill and one refill, your maintenance medication will no longer be covered under the prescription drug plan.
To get started, call the Customer Care number on your prescription ID card or visit www.caremark.com.
Specialty drugs
AXA XL partners with ArchimedesRx, the industry leader in specialty drug management solutions. Specialty medications are generally prescribed for people with complex or ongoing medical conditions such as multiple sclerosis, hemophilia, and rheumatoid arthritis. Eligible colleagues will be contacted directly by ArchimedesRx.
Need another CVS Caremark ID card?
If you're enrolled in an AXA XL medical plan, you'll receive two CVS Caremark pharmacy ID cards in the mail. The ID cards have your name on them, but will apply to all covered family members.
You may obtain additional ID cards by:
- Visiting www.caremark.com access and print them
- Accessing your ID card using the CVS Caremark mobile app
- Calling CVS Caremark at 844-462-0196
Quantum Health fulfills two key functions: it serves as your dedicated well-being advisor and acts as the primary gateway to your medical plan. All AXA XL colleagues, regardless of their chosen medical plan, have free access to Quantum Health for support with AXA XL benefits.
Functioning as a comprehensive healthcare resource, Quantum Health consolidates all of AXA XL's benefits in one convenient location. It also offers a team of expert Care Navigators who are well-versed in AXA XL benefits that can provide valuable guidance to help you optimize your benefit choices and answer any benefit related questions you may have.
The Quantum Health app provides easy access to your AXA XL benefits. With single sign-on features to your AXA XL medical, dental, and vision coverage accounts, you’ll be able to access your benefit details seamlessly from one app. Plus, with a dedicated dashboard for your savings and spending accounts, and a secure messaging platform with Care Navigators, you can monitor your claims and account details and get healthcare support in one single place.
The Quantum Health Care Navigators can help to do the following and more:
Find in-network care
Quantum Health Care Navigators can schedule appointments with in-network doctors, create a list of providers that match your preferences, and help you understand when you need to see a provider, when you’re enrolled in the AXA XL medical plan.
Understand and optimize your benefits
Quantum Health can help you understand your healthcare bills so you can make informed decisions about your healthcare.
Direct you to the appropriate resource(s)
Have a health concern and not sure what to do? Quantum Health ’s team can point you in the direction of the appropriate benefit AXA XL offers, or the community resources to address your needs.
Advocate at your side
Need help with a claim or assistance setting up an account? Quantum Health Care Navigators can work with vendors on your behalf to resolve questions, claims, and other outstanding issues.
Get started with Quantum Health today by downloading the Quantum Health app on Google Play or the Apple App Store, visiting axaxl-quantum.com, or calling 844-460-2821 .
Health needs don’t keep office hours. Whether you’re sick while travelling, or it’s 2 am and your baby is crying, consider telehealth for your health needs. MDLIVE is available to you if you are enrolled in any one of the AXA XL medical plan options.
With MDLIVE you have access to board-certified physicians 24/7 through video conference, telephone, or secure email.
This service helps you:
- Decide between the ER or urgent care center for a non-emergency medical issue
- Gain access to medical care when your primary care physician is not available
- Get answers to questions about non-emergency medical issues
- Fill a prescription or get a refill when you cannot reach your regular doctor
- Receive non-emergency medical attention when traveling
Telemedicine visits with MDLIVE can be a cost-effective alternative to a convenience care clinic or urgent care center, and cost less than going to the emergency room. And the cost of a phone or online visit is usually the same or less than the cost of an office visit to your doctor. Remember, MDLIVE is only available for minor, non-life-threatening medical conditions and medical visits. In an emergency, dial 911 or go to the nearest hospital.
Behavioral telehealth
In addition to telehealth for non-emergency physical health needs, you can also use it for behavioral health services. Both MDLIVE and Evernorth Behavioral Health program offer convenient, affordable access to licensed psychiatrists, clinical social workers, counselors, and therapists who can help you navigate a wide range of emotional and social issues.
With behavioral health virtual care, you get the care and attention you’d expect from an in-office visit, and you can:
- Talk privately with a licensed counselor or psychiatrist via video or phone
- Have a prescription sent directly to your local pharmacy
- Pay the same out-of-pocket cost as an in-office behavioral health visit
In addition to support offered through MDLIVE and Evernorth Behavioral Health, medical plan enrollees have access to Lyra, a mental health service that helps connect you with mental health providers with shorter wait times for appointments.
How to get started with telehealth:
- To schedule an appointment through MDLIVE, go to https://app.mdlive.com/landing/allegiance.
- To find a Evernorth Behavioral Health network provider, visit Cigna.com, go to “Find Care & Costs” and enter “Virtual counselor” under Doctor by Type.
Or reach out to a Quantum Health Care Navigator at 844-460-2821 or axaxl-quantum.com for one-on-one help selecting a provider, or for any other telehealth-related issues.
Coinsurance
The amount you pay out-of-pocket for covered services when you receive care. You and AXA XL both pay a percentage of the cost.
Copay
The fixed dollar amount you pay when you visit a doctor or other healthcare provider, or purchase certain prescription drugs in-network.
Deductible
The amount you pay for covered services before the plan pays benefits.
Eligible dependent(s)
Eligible dependents include your legal spouse, your children up to the end of the calendar year in which they turn 26, your children 26 and older who are handicapped and dependent on your for support, your domestic partner, and your domestic partner's children who qualify as described above.
In-network
Providers who have agreed to a discounted rate negotiated by Cigna, which means you can save money by using their services. In-network medical claims must be filed within 90 days of the date of service by the provider.
Out-of-network
Providers who are not part of the Cigna network; you will typically pay higher costs for care (deductible, coinsurance, and amounts billed over the allowed amount). When you see an out-of-network provider, you are responsible for filing a claim for reimbursement. Out-of-network medical claims must be filed within 180 days of the date of service.
Out-of-pocket maximum
The most you will pay each year toward the cost of covered medical expenses (excluding amounts exceeding the Reimbursable Rate. Once you reach this maximum, the plan will pay 100% of eligible expenses for the rest of the year. The maximum depends on your medical plan option, your coverage level, and whether you use in- or out-of-network providers.
PPO
A Preferred Provider Organization (PPO) Plan covers 100% of preventive care and requires you to pay copays for certain medical treatments, such as office visits, urgent care, and prescriptions. For other types of care, you pay 100% until you reach the deductible. Once you reach your out-of-pocket maximum, the plan pays for 100% of care for the rest of the plan year.
High Deductible Health Plan
A High-Deductible Health Plan (HDHP) covers 100% of preventive care and requires you to pay 100% of all non-preventive care and prescription costs up to the deductible. After reaching the deductible, you pay 10% of the cost of care for things like specialist visits, and the plan pays until you reach your out-of-pocket maximum. Once you hit your out-of-pocket maximum, the plan pays for all additional care through the end of the plan year.
Transparency in Coverage Rules
The federal Transparency in Coverage Rules require certain group health plans to publicly disclose price and cost-sharing information. This information includes in-network provider rates as well as historical out-of-network allowed amounts and billed charges for covered items and services, which is to be shared via two separate machine-readable files (MRFs). The machine-readable files are formatted to allow researchers, regulators, and application developers to more easily access and analyze data. The MRFs for AXA XL's medical plans can be found here.
No Surprises Act
The No Surprises Act provides protections against surprise billing, or balance billing, under medical plans, such as the one offered by AXA XL. This legislation prohibits medical providers from sending surprise bills for most emergency and some non-emergency out-of-network care. For example, if you visit an in-network facility for emergency services, you may see providers, such as specialists like an anesthesiologist, who don't participate in AXA XL's medical plan network. The No Surprises Act now protects you from charges and balance bills for these additional services.
You can find more information here and learn more about your rights.