Health & Well-being

BCBS Medical Options

BCBS Medical Options

Plan features BCBS HRA BCBS HSA BCBS PPO
In-network Out-of-network In-network Out-of-network In-network Out-of-network
Deductible
$1,500 person
$3,000 family
$4,500 person
$9,000 family
$2,500 person
$5,000* family
$5,000 person
$10,000* family
$3,000 person
$6,000 family
$6,000 person
$12,000 family
Coinsurance 20% after deductible 50% after deductible 25% after deductible 50% after deductible 30% after deductible 50% after deductible
Out-of-pocket maximum $5,000 person
$10,000 family
$10,000 person
$20,000 family
$6,000 person
$12,000 family
$12,000 person
$24,000 family
$7,300 person
$14,600 family
$14,600 person
$29,200 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 $20 copay 50% after deductible
Specialist office visit 20% after deductible 50% after deductible 25% after deductible 50% after deductible $50 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 $200 $200

If you enroll in medical coverage, you are automatically enrolled in prescription drug coverage.

*Under the HSA Plan, if more than one individual is enrolled, the family deductible must be met. Once the family deductible has been met, the plan will pay each enrolled family member’s covered expenses based on the coinsurance level. One individual may satisfy the per person out-of-pocket maximum.

Veradigm contributions to HRA and HSA Health Accounts

Kaiser Permanente Medical Options (for CA residents)

Kaiser Permanente Medical Options (for CA residents)

This overview chart shows in-network benefits only. For full details, see the Kaiser SBCs in the Resources section.

Plan features Kaiser HRA Kaiser HSA Kaiser HMO
Deductible $1,500 person
$3,000 family
2026:
$2,500/person for employee only coverage
$3,400/person for employee plus spouse/DP or employee plus child(ren) coverage*
$5,000* family2025:
$2,500/person for employee only coverage
$3,300/person for employee plus spouse/DP or employee plus child(ren) coverage*
$5,000* family
$3,000 person
$6,000 family
Coinsurance 20% after deductible 0% after deductible 30% after deductible
Out-of-pocket maximum $3,000 person
$6,000 family
$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) No copay (deductible does not apply)
Primary care physician office visit $20 per visit after deductible $30 per visit after deductible $40 per visit
Specialist office visit $20 per visit after deductible $50 per visit after deductible $50 per visit
Urgent care $20 per visit after deductible $30 per visit after deductible $40 per visit
Emergency room 20% after deductible $200 per visit after deductible 30% after deductible

If you enroll in medical coverage, you are automatically enrolled in prescription drug coverage.

*If more than one individual is enrolled, the per person deductible applies: $3,400 in 2026. Once the family deductible has been met, the plan will pay each enrolled family member’s covered expenses based on the coinsurance level. However, one individual may satisfy the per person out-of-pocket maximum.

Veradigm contributions to HRA and HSA Health Accounts

Preventive care

Preventive care

All Veradigm Medical Plans cover in-network preventive care services, such as annual check-ups, immunizations and age appropriate screenings at 100 percent.

You pay nothing for these services that help keep you healthy:

  • Well-adult exams
  • Well-child exams
  • Child immunizations
  • Age and gender-related screenings
  • Flu shot (once a year)

Preventive care received out-of-network is not covered.

Preventive care services covered under the Affordable Care Act

What is preauthorization?

What is preauthorization?

Preauthorization is the determination of a medical necessity review, which is a review process that determines whether or not certain medical services or medications are necessary and will be covered by our plan. This determination for approval by your medical insurance provider is based on evidence-based medicine guidelines. Its primary purpose is to help assure you get the right care, at the right time, in the right place and at the right cost.

Your in-network provider is responsible for initiating the preauthorization process with your medical insurance provider. You are responsible to make sure your provider has received the preauthorization.

If you are eligible for Medicare

If you are eligible for Medicare

If you’re an active associate considering enrolling in Medicare, it’s important to understand how Medicare impacts medical coverage for you and your spouse or domestic partner:

  • If you and your spouse are both age 65 or older. If you continue medical coverage under Veradigm, Medicare pays secondary benefits to both you and your spouse. The Veradigm plan pays primary benefits. You’re not required to enroll in Medicare at age 65 because you already have employer-provided coverage in place.
  • If one of you (you and your spouse) is under age 65 and the other is over age 65. If you continue medical coverage under Veradigm, Medicare pays secondary benefits to the participant who is 65 or older. You’re not required to enroll in Medicare at age 65 because you already have employer-provided coverage in place.
  • If you’re under age 65 or over age 65, and your domestic partner is age 65 or older. If you continue medical coverage under Veradigm, Medicare pays primary benefits for your domestic partner. The Veradigm plan pays secondary benefits regardless of whether your domestic partner enrolls in Medicare. This means that the Veradigm medical plan will only pay secondary benefits after what Medicare would pay, regardless of whether your domestic partner is enrolled in Medicare.
  • If you’re age 65 or older and your domestic partner is under age 65. For you, if you continue medical coverage under Veradigm, Veradigm pays primary benefits for you and Medicare pays secondary benefits. For your domestic partner, the Veradigm plan continues to pay primary benefits.

Can you have COBRA as well as Medicare?

If you leave Veradigm and continue medical coverage through COBRA and are Medicare-eligible, COBRA benefits depend on when you become entitled to Medicare:

  • If your Medicare benefits (Part A or Part B) become effective on or before the day you elect COBRA coverage, you can continue COBRA coverage as well as having Medicare. This is true even if your Part A benefits begin before you elect COBRA but you don’t sign up for Part B until later. In this situation, Medicare is always primary to COBRA coverage.
  • If you become entitled to Medicare after you’ve signed up for COBRA, your COBRA benefits cease. (But if COBRA covers your spouse and/or dependent children, their coverage may be extended for up to 36 months because you qualified for Medicare.)

Good news — your medical premiums are staying the same for 2026

This is the third consecutive year Veradigm has been able to maintain flat premium costs despite rising medical expenses nationwide. Through continued efforts to manage plan costs and support associate well-being, we’re pleased to keep your contribution rates steady for another year.

BCBSNC provider network

Visit the BCBS website to view the network providers and to find general information.

bcbsnc.com

Provider Contact

BCBSNC

1-888-705-7050
blueconnectnc.com
Group Number 14181146

Kaiser Permanente

800.464.4000
kp.org

Looking for the SPDs?

Veradigm associates can find summary plan descriptions (SPDs) on the U.S. Benefits Intranet Page.

BCBS/Optum prescription drug benefits

BCBS/Optum prescription drug benefits

If you enroll in one of the BCBS medical plans, the prescription drug benefits will be administered by Optum Rx.

Maintenance medications (prescriptions taken regularly over an extended period to manage ongoing health conditions) must be filled through CVS or Optum mail order pharmacy.

Plan features BCBS HRA/Optum Rx BCBS HSA/Optum Rx BCBS PPO/Optum Rx
In-network Out-of-network In-network Out-of-network In-network Out-of-network
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 copay 50%
Non-preferred brand 40% up to $225 max 50% after deductible 40% after deductible
(up to $225 max)
50% after deductible $60 copay 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 $80 copay 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 $75 copay 50%
Non-preferred brand 40% up to $562 max 50% after deductible 40% after deductible (up to $562 max) 50% after deductible $150 copay 50%

*Preventive medications must be filled through CVS or Optum mail order pharmacy. You can obtain specific preventive medications in-network with no cost-share as follows:

  • There is no cost for medications Optum Rx’s Preventive drug (ACA) list for all plan participants.
  • Additionally, for Optum Rx HSA Plan participants, when you purchase other preventive medications listed on Optum Rx’s 2026 Preventive Drug list, your coverage will be 100% with no deductible or coinsurance applied.
  • To see the Optum Rx’s lists of preventive medications, visit optumrx.com. For cost details regarding preventive medications and the Optum Rx Premium Formulary, contact Optum Rx at 1-844-368-0693.
Kaiser Permanente Prescription drug benefits (for California residents)

Kaiser Permanente Prescription drug benefits (for California residents)

Plan features Kaiser HRA Kaiser HSA Kaiser HMO
Retail Generic
(up to a 30-day supply)
$10 copay $10 copay after deductible $10 copay
Retail Brand Formulary
(up to a 30-day supply)
$30 copay $30 copay after deductible $30 copay
Mail Generic
(up to a 100-day supply)
$20 copay $20 copay after deductible $20 copay
Mail Brand Formulary
(up to a 100-day supply)
$60 copay $60 copay after deductible $60 copay
Specialty
(up to a 30-day supply)
20% coinsurance
(not to exceed $150)
20% coinsurance after deductible
(not to exceed $250)
20% coinsurance
(not to exceed $250)
Generics

Generics

Generic drugs usually cost less than brand name drugs.

Generic drugs are reviewed by the FDA to ensure that they work the same as the brand-name drug in dosage, safety, quality, performance, strength and usage.

To help keep prescription drug costs in check, prescriptions are automatically filled with a chemically equivalent generic drug, if available and appropriate. If you choose a brand drug when a generic is available, you will pay the difference between the brand medication and the generic, plus the coinsurance. However, if your doctor indicates “Dispense as Written” on your prescription because the brand is medically necessary, you will receive the brand drug and only pay the brand copay.

Note: If you choose a brand drug when a generic is available, you will pay the difference between the brand medication and the generic, plus the coinsurance.

Preferred brand drugs

Brand-name drugs on the Optum Rx preferred list are less expensive than using a non-preferred drug.

Non-preferred brand drugs

Brand-name drugs that are not on your preferred list may cost you more, even if they are recommended by your doctor.

Maintenance medications

Maintenance medications

Long-term medications, also known as maintenance drugs, are taken on a regular basis (three months or longer) to treat conditions such as high cholesterol, high blood pressure and asthma.

Specialty drugs

Specialty drugs

A specialty drug is a medication used to treat chronic, complex conditions like multiple sclerosis, hepatitis C and cancer. Specialty medications can include oral solids, or can be injected, infused or inhaled and may require special handling, such as refrigeration.

Preventive medications

Preventive medications

Certain preventive medications and supplies are covered at no cost to you and are not subject to meeting a deductible. These medications require a prescription and are subject to certain eligibility requirements. Check with your medical plan provider for details.

Dental plan at a glance

Dental plan at a glance

Plan features DPPO DHMO
In-network Out-of-network In-network only
Deductible (individual/family) $0/$0 $50/$150 No deductible
Annual benefit maximum (per person) $2,000 $2,000 No maximum
Orthodontia lifetime maximum (per person) $1,500 $1,500 No maximum
Preventive and Diagnostic

  • Cleanings
  • Oral examinations
  • Fluoride
  • X-rays
  • Space maintainers for dependent children up to age 19
  • Sealants
100% of the DPPO fee 100% of the reasonable and customary (R&C) fee 100%
Basic Care

  • Fillings
  • Simple extractions
  • Crown, denture, bridge repair/recommendations
  • General anesthesia (when in connection with oral surgery, extraction or other covered services)
  • Periodontal maintenance
80% of the DPPO fee 80% of the R&C fee, after deductible The DHMO sets the cost for services based on a Patient Charge Schedule (PCS)
Major Care

  • Implants
  • Bridges and dentures
  • Crowns, inlays, onlays
  • Endodontics
  • Oral surgery
  • Periodontal surgery
60% of the DPPO fee 60% of the R&C fee, after deductible See the PCS
Orthodontia Services 60% of the DPPO fee 60% of the R&C Fee, after deductible  See the PCS
Dental Card No Yes
How does the Cigna DPPO plan work?

How does the Cigna DPPO plan work?

With the Cigna DPPO plan:

  • You can go to any dentist but typically spend less when you visit a Cigna in-network dentist.
  • You do not have to choose a network dentist ahead of time, you choose a dentist when you are ready to make an appointment.
  • No ID Cards needed. Your Group Number (3339080) is all your dentist will need to confirm your dental coverage and submit a claim.

DPPO in-network services are based on the fee amount the DPPO provider has agreed to charge for covered services. An in-network provder will not bill you for charges in excess of the in-network negotiated fees.

DPPO out-of-network services are based on the reasonable and customary (R&C) amount that Cigna determines using the lowest of either the dentist’s actual charge, the dentist’s usual charge, or the charge of most dentists in the same geographic area for the same/similar service. Out-of-network dentists may bill you for amounts that exceed the R&C fee limit.

How does the Cigna DHMO plan work?

How does the Cigna DHMO plan work?

With the DHMO plan:

  • There are no deductibles to meet.
  • Your share of out-of-pocket costs is listed on your Patient Charge Schedule (PCS).
  • Referrals are required for some specialty care services. Exceptions are pediatric dentists for children under 7, orthodontics and endodontics.
  • There are no dollar maximums, no matter the amount of your covered expenses.
  • There are no claim forms to file and no waiting periods for coverage.
  • You will receive a dental card

When you enroll in the Cigna DHMO plan, you’ll be assigned a dentist from the Cigna Dental Care Access Plus network who will be your source for basic care, advice and referrals to other in-network specialists, if you need them. If you want to select a different dentist from the network, you can call Cigna to make a switch.

Under the DHMO, Cigna allows your network dentist to charge a certain amount. Then you pay a fixed portion of that cost, as listed in the Patient Charge Schedule (PCS). The DHMO pays the rest.

Out-of-network benefits are not offered with the Cigna DHMO plan (except for emergencies or where required by law).