NFP | Plan overview – HDHPQ OAPIN
This overview summarizes your HDHPQ OAPIN health plan from The Responsive Auto Insurance Company, covering the period May 1 2026 – April 30 2027. It outlines key costs and highlights what the plan covers, your cost‑sharing responsibilities, and important benefit notes. Premium amounts are provided separately.
01 At a glance
Deductible (Individual)
$2,000
Out‑of‑Pocket Max (Individual)
$6,900
Primary Care Visit
$25 copay
Emergency Room Visit
$300 copay
02 What you’ll pay (in‑network)
| Service | Your Cost |
|---|---|
| Specialist visit | $75 copay per visit |
| Urgent care | $50 copay per visit |
| Generic drugs (Tier 1) | $10 / 30 days | $25 / 90 days |
| Preferred brand (Tier 2) | $35 / 30 days | $88 / 90 days |
| Non‑preferred brand (Tier 3) | $70 / 30 days | $175 / 90 days |
| Specialty drugs (Tier 4) | $150 per 30‑day supply |
| Imaging (CT/MRI/PET) | No charge |
| Outpatient surgery facility/physician | No charge |
| Inpatient hospital stay | No charge |
| Mental health outpatient | $75 copay per visit |
| Home health care | No charge (up to 40 visits per year) |
| Rehab services (physical/speech/occupational) | $75 copay per visit (30 visits max) |
| Chiropractic care | $75 copay per visit (20 visits max) |
| Habilitation therapy | $75 copay per visit (60 days max) |
| Skilled nursing care | No charge |
| Durable medical equipment | No charge |
| Hospice care | No charge |
03 Key observations
Preventive care — covered in‑network at no cost and not subject to the deductible.
Emergency room — $300 copay per visit (waived if admitted); out‑of‑network emergencies paid at in‑network rates.
Combined deductible & out‑of‑pocket — both medical and pharmacy expenses count toward the same totals.
No out‑of‑network coverage — except emergency and air ambulance care, all other services outside the network are not covered.