Cigna Open Access Plus vs. PPO: How Your Plan Works

Introduction

If you get health insurance through work in New York, your plan may be from Cigna. And if you've looked at your card, you may have seen a name like Open Access Plus, OAP, or PPO, without a clear sense of what it means for you. That's common. Plan names often get chosen by an employer during open enrollment, and the details get lost.

The good news is that Cigna's most common employer plans are fairly easy to use once you know a few rules. The differences between them come down to referrals, out-of-network care, and how big your network is.

At Morningside Medical, we want you to feel sure about your coverage before you book. We're in network with Cigna Open Access Plus, PPO, LocalPlus, and Network POS employer plans. In this article, we explain how those plans work, how they differ, what LocalPlus is, what happened to Cigna's Medicare plans, and how to check that a clinician is in your network.

What is Open Access Plus?

Open Access Plus, or OAP, is one of Cigna's most common employer plans. According to Cigna's description of the plan:

• You don't need referrals. You can see in-network specialists directly.
• A primary care provider is optional. Cigna recommends choosing one to help coordinate your care, but it's not required.
• Out-of-network care is covered, at a higher cost. You may also have to file the claim yourself.

There's also a version called Open Access Plus In-Network, sometimes shown as OAP IN. It works the same way, with one big difference: it covers out-of-network care only in emergencies. If your card says "In-Network," plan on staying in network for routine care.

What is a Cigna PPO?

PPO stands for preferred provider organization. According to Cigna's ID card guide, a Cigna PPO:

• Doesn't require referrals to see specialists
• Encourages, but doesn't require, a primary care provider
• Covers care both in and out of network, with out-of-network care paid at a lower level

If that sounds a lot like Open Access Plus, it is. For most everyday care, the two plans work in much the same way.

Open Access Plus vs. PPO, side by side

Here's how the two compare on the questions people ask most:

• Referrals: neither plan requires them for in-network specialists.
• Primary care provider: both encourage one, and neither requires it.
• Out-of-network care: both cover it at a higher cost, except OAP In-Network, which covers it only in emergencies.
• Network: both use Cigna's network, and the exact network depends on your employer's plan.

The differences that matter most are usually in the costs your employer chose: your deductible, copays, and coinsurance. Those are listed in your plan's summary of benefits and coverage.

How to tell which plan you have

Your member ID card is the best place to start. Cigna's ID card guide explains that cards show the plan and network information clinicians use to check your coverage. Look for the plan name, any "IN" or "In-Network" label, and the member services number.

You can also log in to myCigna to see your plan details, or call the number on your card. Our article on how to read your insurance card explains the most common parts.

LocalPlus and other network plans

Some employers offer a plan with a smaller network to keep costs down. One example in the New York City area is LocalPlus. According to Cigna, LocalPlus plans don't require a primary care provider or referrals. The tradeoff is a smaller network. According to Cigna's ID card guide, some versions, called LocalPlus IN, don't cover out-of-network care except in emergencies.

If you have a LocalPlus plan, it's especially important to check Cigna's directory for your specific network before you book. A clinician who takes "Cigna" may not be in your LocalPlus network.

Cigna's Network and Network POS plans work differently. In the New York area, one example is Seamless – Metro New York. According to Cigna's ID card guide, these plans ask you to choose an in-network primary care provider and get referrals to see specialists, except for OB-GYN care. If your card shows one of these plan types, follow its rules instead.

Prior authorization

Even without referrals, some care needs approval first. Cigna notes that prior authorization may be required for certain services and procedures. Your clinician's office usually handles the request, but it's worth asking whether a test or procedure needs approval before it's scheduled.

Cigna Medicare is now HealthSpring

If you had a Medicare Advantage plan from Cigna, its name has changed. Health Care Service Corporation (HCSC) completed its purchase of Cigna's Medicare business on March 19, 2025. HCSC said at the time of the sale that coverage would continue unchanged. Plans can change from year to year, though, so check your 2026 plan documents for current benefits.

The plans now use the name HealthSpring. According to HealthSpring, members were sent new ID cards with their HealthSpring plan, and in 2026 they use the HealthSpring directory to find clinicians.

If you have a HealthSpring plan, your plan documents explain its rules. To compare Medicare plans, visit Medicare.gov or call 1-800-MEDICARE.

Cigna and City of New York employees

City of New York workers sometimes ask about Cigna. According to the City's fall 2024 notice, the City's Cigna plan for active employees ended on January 1, 2025.

Cigna's network still matters for some City members, though. According to the City's summary of its health plans, members of HIP HMO Preferred and DC 37 Med-Team use Cigna's national network when they get care outside New York State. For care in New York, those plans use their own networks.

Using your plan away from home

Many Cigna plans use a national network, so you can often find in-network care when you travel or if a family member lives in another state. Before you get routine care away from home, search Cigna's directory for that area and confirm the clinician is in your plan's network.

This matters most if your plan has an "In-Network" label, such as OAP In-Network or LocalPlus IN. Those plans cover out-of-network care only in emergencies. LocalPlus plans also use a local network, so check how your plan covers care away from home. With a standard Open Access Plus or PPO plan, out-of-network care is covered, but you'll pay more and may need to file the claim yourself.

In an emergency, get care right away, wherever you are. Then call the member services number on your card as soon as you can, so the plan knows about your visit.

Choosing a plan at open enrollment

Some employers offer more than one Cigna plan, such as an Open Access Plus plan and a PPO, or a standard plan and a LocalPlus plan. If you're choosing, these questions can help:

• Are your current clinicians in each plan's network? This matters most for narrower plans like LocalPlus.
• Do you see doctors outside New York? Out-of-network coverage can matter if you travel or have family elsewhere.
• What will you pay for the visits you make most often? Compare copays, the deductible, and coinsurance.
• How much is taken from your paycheck? A lower premium can come with higher costs when you get care.

Your employer's benefits team can answer questions about the options it offers.

If you change jobs

A new job often means a new plan, even if it's Cigna again. You'll usually get a new ID card, and your network and costs may be different. Before your next visit, check that your clinicians are in your new plan's network. If you're in the middle of treatment, ask your new plan whether it offers help moving your care over.

Your first visit with a new clinician

It's fine if it's been years since your last checkup. A first visit is a chance to go over your health history, your medications, and any screenings you're due for. Bring your Cigna ID card, a list of your medications, and any recent test results or records. If you have an ongoing condition, your clinician can help you plan follow-up care.

Reading your explanation of benefits

After a visit, Cigna sends an explanation of benefits, often called an EOB. It shows what the clinician billed, what the plan paid, and what you may owe. It isn't a bill, but it's worth reading. If something looks wrong, like a visit you expected to be in network showing as out of network, call the member services number on your card and ask them to review it.

How to find an in-network clinician

Before your first visit, take two minutes to confirm the clinician is in your network. Cigna gives you two ways to check:

1. Use Find a Doctor at cigna.com, or search in myCigna.
2. Call the member services number on the back of your card.

HealthSpring members should use the HealthSpring directory instead.

When you call, it helps to ask:

• Is this clinician in the network for my specific plan?
• Is my plan an "In-Network" version that doesn't cover out-of-network care?
• What will I pay for this type of visit?
• Does this test or procedure need prior authorization?

It's also worth asking the practice whether it's accepting new patients and how soon you can be seen.

Same-day care with Cigna

When you get sick, a same-day visit with a primary care practice is often a good first step. You can be seen for things like a sore throat, a urinary tract infection, or a rash, and the same practice can handle your follow-up. Many practices offer same-day visits, but their rules differ, so ask whether new patients can book them and whether you need an appointment first.

For a medical emergency, don't wait. Call 911 or go to the nearest emergency room for severe chest pain or pressure, trouble breathing, signs of a stroke, or heavy bleeding.

Plan words, in plain language

• Network: the clinicians, hospitals, and labs your plan works with.
• Referral: an OK from a primary care provider to see a specialist.
• Prior authorization: approval from your plan before certain tests or treatments.
• Copay: a set amount you pay for a visit or service.
• Deductible: the amount you pay each year before your plan starts paying for some services.
• Coinsurance: a percentage of the bill you pay after your deductible.

Getting the most from your Cigna plan

• Know your plan name. OAP, OAP In-Network, PPO, LocalPlus, and Network POS each work a little differently.
• Check for "In-Network." If your plan has that label, stay in network for routine care.
• Choose a primary care clinician. It isn't required, but a clinician who knows you makes care simpler.
• Ask before you book. Confirm the clinician is in network for your specific plan.
• Ask about preventive care. Check which checkups and screenings your plan covers at no cost.

How Morningside can help

Morningside Medical is in network with Cigna Open Access Plus, PPO, LocalPlus, and Network POS employer plans, and with HealthSpring, formerly Cigna Medicare. You can see the details on our Cigna page.

All of our clinicians are accepting new patients. Same-day appointments are available during all open hours, Monday through Friday, and new patients can book them. We also offer telehealth visits, plus labs and ultrasound at our office. New rheumatology patients are being seen now. We don't take walk-ins, so please book first. Spanish translation is available.

If you have a different plan, our articles on Empire and Anthem, EmblemHealth's GHI and HIP plans, and NYCE PPO may help. For the basics, see how health insurance works.

Please confirm your coverage with Cigna or HealthSpring before your visit, since some details depend on your plan. Morningside Medical isn't affiliated with or endorsed by Cigna or HealthSpring.

This article is for general information and is not a substitute for professional medical advice. Talk to your clinician about your specific situation.

You're always welcome to book an appointment.