This comparison summarizes the HDHPQ OAP plan family for coverage periods May 1 2025 – April 30 2026 and May 1 2026 – April 30 2027. It outlines how cost‑sharing provisions and exclusions changed from the 2025 OAP plan to the streamlined 2026 OAPIN Net Only version.
Headline change — out‑of‑network coverage removed in 2026
The prior 2025 OAP plan offered partial reimbursement for out‑of‑network services (about 50% coinsurance). Beginning 2026, the OAPIN Net Only plan excludes all out‑of‑network care, focusing solely on in‑network providers.
| Benefit | 2025 HDHPQ OAP | 2026 HDHPQ OAPIN |
|---|---|---|
| Individual deductible | $2,000 (in/out‑network) | $2,000 (in‑network only) |
| Family deductible | $4,000 (in/out‑network) | $4,000 (in‑network only) |
| Out‑of‑pocket maximum (Individual) | $6,900 IN / $8,000 OON | $6,900 IN only – no OON limit |
| Primary care visit | $25 copay IN / 50% coins OON | $25 copay IN only – OON not covered |
| Specialist visit | $75 copay IN / 50% coins OON | $75 copay IN only – OON not covered |
| Preventive care | No charge IN / not covered OON | No charge IN only (unchanged) |
| Imaging (CT/MRI/PET) | No charge IN / 50% OON | No charge IN only – OON not covered |
| Emergency room visit | $300 copay; OON paid at IN rate | $300 copay; OON paid at IN rate (unchanged) |
| Urgent care | $50 copay IN / 50% coins OON | $50 copay IN only – OON not covered |
| Generic Rx (Tier 1) | $10 / $25 copay IN / 50% OON | $10 / $25 copay IN only – OON not covered |
| Preferred brand Rx (Tier 2) | $35 / $88 copay IN / 50% OON | $35 / $88 copay IN only – OON not covered |
| Non‑preferred brand Rx (Tier 3) | $70 / $175 copay IN / 50% OON | $70 / $175 copay IN only – OON not covered |
| Specialty Rx (Tier 4) | $150 copay IN / 50% OON | $150 copay IN only – OON not covered |
| Hospital stay (facility & physician) | No charge IN / 50% coins OON | No charge IN only – OON not covered |
| Mental health outpatient | $75 copay IN / 50% OON | $75 copay IN only – OON not covered |
| Rehabilitation / habilitation therapy | $75 copay IN / 50% OON (30–40 visits) | $75 copay IN only (30–60 visits) – OON not covered |
| Skilled nursing care | No charge IN / 50% OON | No charge IN only – OON not covered |
| Home health care | No charge IN / 50% OON | No charge IN only – OON not covered |
| Durable medical equipment | No charge IN / 50% OON | No charge IN only – OON not covered |
| Children’s dental / vision | Not covered | Not covered (unchanged) |
| Excluded services | Adult dental, vision, foot care, cosmetic, bariatric | Same plus explicit OON exclusion added |
Legend: Changed this year