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Plan Name HSA OAPIN OAPIN BaseIn Network BenefitsDeductible(Employee / Family)$5,500 / $11,000 $3,000 / $7,500Coinsurance(Member Pays)20% 20%Maximum Out of Pocket Cost (MOOP)(Employee / Family)$6,550 / $13,100 $5,720 / $14,300Primary Care Provider (PCP) 15% After Deductible $40 CopayWellness & Preventative Covered at 100% Covered at 100%Specialist 20% After Deductible $60 CopayInpatient Hospitalization 20% After Deductible 20% After DeductibleOutpatient Facility 20% After Deductible 20% After DeductibleEmergency Room 20% After Deductible 20% After DeductibleUrgent Care 20% After Deductible 20% After DeductibleLaboratory 20% After Deductible 20% After DeductibleX-Ray 20% After Deductible 20% After DeductibleImaging (CT, MRI, PET) 20% After Deductible 20% After DeductibleBenefit Period Calendar Year Calendar YearGatekeeper Non-gated Non-gatedOut-of-Network BenefitsDeductible(Employee / Family)Not Covered Not CoveredCoinsurance(Member Pays)Maximum Out-of-Pocket Cost (MOOP)(Employee / Family)Prescription BenefitsGeneric / Preferred / Non-Preferred$10 copay / $35 copay / $70 copayRx Deductible: N/A: Integrated with Medical$15 copay / $35 copay / $55 copayRx Deductible: N/A: Integrated with MedicalMedical Plans & Prescription BenefitsMancini Duffy offers Four Cigna medical plans with prescription benefits: All planscover wellness and preventive care at 100%.Plan 1 Plan 28