Glossary

Claim

A provider’s request to your plan administrator asking to be paid for a service you’ve received.

COBRA

The Consolidated Omnibus Budget Reconciliation Act (COBRA) provides continued coverage of your health benefits if certain events occur that would normally result in the termination of coverage. Events under which COBRA continuation health coverage can be extended include job loss, reduction in hours worked, death, divorce and other life events. In most cases, coverage under COBRA may be extended for up to 18 months, though coverage may be extended to 36 months in some cases.

Coinsurance

The percentage of the cost you pay for covered health care services, after you meet your calendar-year deductible.

Deductible

The amount you pay out of pocket for health care each calendar year before the plan begins to share in the cost of covered services. All Cigna medical plans have separate deductibles for in-network and out-of-network care. What you pay for one doesn’t count toward the other.

Explanation of Benefits

After you get care, you’ll receive an Explanation of Benefits (EOB) from Cigna, the claims administrator. The EOB provides information about how your claim was paid, including how much you owe or will be reimbursed.

Flexible Spending Accounts (FSAs)

These are special tax-advantaged plans that you can use to pay for eligible expenses. The general purpose healthcare FSA can be used to pay for eligible medical expenses. The limited purpose healthcare FSA can be used to pay for eligible dental and vision care expenses if you have a Health Savings Account. The Dependent Care FSA can be used to pay for eligible care expenses for your dependents.

Formulary

A list of drugs determined and maintained by Cigna or Accredo to use for the prescription drug program. The formulary is designed to assist physicians in prescribing drugs that are medically necessary and cost-effective.

Generic drugs

Approved by the FDA as a therapeutic equivalent to the brand-name drug; has the same active ingredient as the brand-name version but at a lower cost.

In-network

The facilities, providers, and suppliers Cigna has contracted with to provide covered health care services.

Health Savings Account (HSA)

A special savings account that you can participate in if you enroll in the HSA Base Plan. You save on taxes three ways with the HSA: no taxes on your contributions (including those from Veradigm), no taxes when you use the money to pay for eligible medical expenses, and no taxes on interest earned on your account.

Maintenance medications

Prescribed to treat chronic health conditions—such as asthma, diabetes, high blood pressure, or high cholesterol—and are taken on an ongoing, regular basis to maintain health.

Non-preferred brand

Prescription drugs listed under “non-preferred” generally have higher copays than preferred brand-name drugs.

Out-of-network

Providers that are not in the Cigna network or have not contracted with Cigna and have not agreed to charge certain rates for certain services.

Out-of-pocket maximum

The most you’ll pay for covered health care services in a calendar year. Once you reach it, the plan pays 100% of the costs for covered services for the rest of the year.

Preferred brand drugs

These are drugs for which generic equivalents are not available. However, they have been on the market for a time and are widely accepted. They cost more than generics but are less expensive than non-preferred brand-name drugs.

Preventive care

All Veradigm medical plans provide preventive services at no cost to you if you visit a participating provider and claims submitted are coded correctly. Covered preventive care is based on your age and gender. Follow-up testing for a diagnosed medical condition will generally not be covered as preventive.

Specialty medications

These are drugs that are used to treat complex or chronic conditions that usually require close monitoring, such as multiple sclerosis, hepatitis, rheumatoid arthritis, cancer, and other conditions that are difficult to treat with traditional therapies. Specialty drugs are obtained from Accredo specialty pharmacy and may require prior authorization.