Medical 2027
Your current medical election will not carry over to 2027. If you want Veradigm medical coverage next year, you must actively enroll during Open Enrollment. Even if you want coverage similar to what you have today, take a fresh look at your options. Two BCBS plans have new names for 2027, and there are important changes to plan features and costs.
What’s new or changing for 2027
Medical rates are staying the same
Across the U.S., health care and prescription drug costs continue to rise. Veradigm has been able to keep associate medical rates and plan designs unchanged for the past three years—and your medical rates will not increase for 2027.
To help manage rising costs while continuing making several plan design changes for 2027. The changes are also intended to simplify your medical plan options and make them easier to understand and compare.
New names for two BCBS medical plans for 2027
- HRA Plan → Gold Plan
- PPO Plan → Silver Plan
- HSA Plan → keeps current name
Gold Plan: Lower deductible and out-of-pocket maximum
The current HRA Plan will become the Gold Plan for 2027. The Health Reimbursement Account (HRA) will be eliminated, so Veradigm will no longer contribute funds to an HRA beginning in 2027.
At the same time, the Gold Plan will have a lower deductible and medical out-of-pocket maximum, which means you’ll have less to pay before the plan begins sharing certain costs and a lower limit on what you could pay for covered medical care during the year.
If you have HRA funds remaining at the end of 2026, you’ll have until June 30, 2027, to use those funds. No new funds will be added to your HRA in 2027.
Silver Plan: Some costs are changing
The current PPO Plan will become the Silver Plan. Some copays will increase, and prescription drug coverage will change to more closely align with Veradigm’s other BCBS plans. For full details, please review the BCBS medical and prescription drug chart below.
New BCBS ID cards for 2027
BCBS members will receive a new digital ID card for 2027. Beginning Jan. 1, be sure to use your new card whenever you receive care. If you prefer a physical card, log in to blueconnectnc.com to request one. (Your other benefit ID cards, including Kaiser and dental HMO cards,
are not changing for 2027.)
Kaiser Permanente medical plans (for California residents only)
- The Kaiser HRA Plan will not be offered for 2027.
- The Kaiser HSA and Kaiser Co-pay plans will have the same plan features and costs for 2027.
Any remaining HRA funds may be used for eligible expenses incurred through Dec. 31, 2026. Beginning Jan. 1, 2027, you will have 90 days to submit 2026 claims for reimbursement. After that period, no additional claims will be accepted.
New programs for 2027
A new approach to GLP-1 medications for weight loss for BCBS members
Beginning in 2027, GLP-1 medications prescribed for weight loss will no longer be covered through Veradigm’s prescription drug plan.
Based on associate feedback about the current Virta program, Veradigm is moving to Vida’s RxSaveCard Program. Vida already supports Veradigm associates through its chronic condition support program and offers a comprehensive approach to weight management.
If you want to use a GLP-1 medication for weight loss in 2027, you’ll need to enroll in Vida’s RxSaveCard program. Vida will be Veradigm’s exclusive pathway for accessing GLP-1 medications for weight loss.
Through the program:
- GLP-1 medications for weight loss will be purchased outside the Veradigm BCBS prescription drug plans.
- Veradigm will provide a subsidy through the RxSaveCard to help with the cost.
- You’ll use the RxSaveCard to purchase your medication at an available pharmacy.
More information, including when and how to enroll, will be provided soon.
New! Hinge Health virtual physical therapy
Beginning in 2027, associates enrolled in a BCBS medical plan will have access to Hinge Health at no cost. Hinge Health provides virtual musculoskeletal care and physical therapy for a variety of needs, including:
- Injury prevention.
- Pelvic health.
- Acute conditions and chronic pain.
- Fall prevention.
- Rehabilitation before or after surgery.
With virtual care, you can get support from wherever it’s convenient for you.
Your 2027 medical options
BCBS medical and prescription drug benefits
Here’s an overview of your BCBS medical plan options for 2027. If you enroll in one of the BCBS medical plans, your prescription drug benefits are administered by Optum Rx. The coinsurance and copays shown below reflect what you pay for care and prescription drugs under each BCBS medical plan. For more information, review the Summary of Benefits and Coverage (SBC) for each plan.
| Plan features | BCBS Gold Plan | BCBS HSA | BCBS Silver Plan | |||
|---|---|---|---|---|---|---|
| In-network | Out-of-network | In-network | Out-of-network | In-network | Out-of-network | |
| Deductible |
$1,200 person $2,400 family |
$3,600 person $7,200 family |
$2,500 person $5,000 family |
$5,000 person $10,000 family |
$3,500 person $7,000 family |
$7,000 person $14,000 family |
| Coinsurance | 20% after deductible | 50% after deductible | 25% after deductible | 50% after deductible | 30% after deductible | 50% after deductible |
| Out-of-pocket maximum | $4,700 person $9,400 family |
$9,400 person $18,800 family |
$6,000 person $12,000 family |
$12,000 person $24,000 family |
$8,500 person $17,000 family |
$17,000 person $34,000 family |
| Preventive care visit | Fully covered | 50% after deductible | Fully covered | 50% after deductible | Fully covered | 50% after deductible |
| Primary care physician office visit | 20% after deductible | 50% after deductible | 25% after deductible | 50% after deductible | $30 copay | 50% after deductible |
| Specialist office visit | 20% after deductible | 50% after deductible | 25% after deductible | 50% after deductible | $60 copay | 50% after deductible |
| Urgent care | 20% after deductible | 20% after deductible | 25% after deductible | 25% after deductible | $75 copay | $75 copay |
| Emergency room | 20% after deductible | 20% after deductible | 25% after deductible | 25% after deductible | $300 | $300 |
| 30-day supply through retail or mail order | ||||||
| Preventive | No copay | 50% after deductible | 0%, no deductible | 50% after deductible | No copay | 50% |
| Generic | $15 copay | 50% after deductible | 25% after deductible | 50% after deductible | $15 copay | 50% |
| Preferred brand | 30% up to $125 max | 50% after deductible | 30% after deductible (up to $125 max) |
50% after deductible | 30% up to $125 max |
50% |
| Non-preferred brand | 40% up to $225 max | 50% after deductible | 40% after deductible (up to $225 max) |
50% after deductible | 40% up to $225 max |
50% |
| Specialty (limited to a 30-day supply) |
40% up to $225 max | 50% after deductible | 40% after deductible (up to $225 max) |
50% after deductible | 40% up to $225 max |
50% |
| 90-day supply through retail or mail order (Note: Mail order is not covered out-of-network.) | ||||||
| Preventive | No copay | 50% after deductible | 0%, no deductible | 50% after deductible | No copay | 50% |
| Generic | $37 copay | 50% after deductible | 25% after deductible | 50% after deductible | $37 copay | 50% |
| Preferred brand | 30% up to $312 max | 50% after deductible | 30% after deductible (up to $312 max) | 50% after deductible | 30% up to $312 max |
50% |
| Non-preferred brand | 40% up to $562 max | 50% after deductible | 40% after deductible (up to $562 max) | 50% after deductible | 40% up to $562 max |
50% |
GLP-1 medications prescribed for weight loss will no longer be covered through Veradigm’s BCBS prescription drug benefits in 2027. See the 2027 Open Enrollment Newsletter for information about the new Vida RxSaveCard GLP-1 Weight Loss Program.
Kaiser Permanente medical and prescription drug benefits
This overview chart shows in-network benefits only. For full details, see the Kaiser SBCs.
| Plan features | Kaiser HSA | Kaiser HMO |
|---|---|---|
| Deductible | $2,500/person for employee only coverage
$3,400/person for employee plus spouse/DP or employee plus child(ren) coverage* $5,000* family |
$3,000 person
$6,000 family |
| Coinsurance | 0% after deductible | 30% after deductible |
| Out-of-pocket maximum | $4,600 person
$9,200 family |
$6,000 person
$12,000 family |
| Preventive care | No copay (deductible does not apply) | No copay (deductible does not apply) |
| Primary care physician office visit | $30 per visit after deductible | $40 per visit |
| Specialist office visit | $50 per visit after deductible | $50 per visit |
| Urgent care | $30 per visit after deductible | $40 per visit |
| Emergency room | $200 per visit after deductible | 30% after deductible |
| Retail generic (up to a 30-day supply) |
$10 copay after deductible | $10 copay |
| Retail brand formulary (up to a 30-day supply) |
$30 copay after deductible | $30 copay |
| Mail generic (up to a 100-day supply) |
$20 copay after deductible | $20 copay |
| Mail brand formulary (up to a 100-day supply) |
$60 copay after deductible | $60 copay |
| Specialty (up to a 30-day supply) |
20% coinsurance after deductible (not to exceed $250) |
20% coinsurance (not to exceed $250) |
*For any coverage above employee-only, each enrolled member has a $3,400 deductible, up to a $5,000 maximum for all enrolled members. The plan begins paying coinsurance once an individual or the overall deductible is met.