Health & Well-being

Vision plan at a glance

Service	Description	Frequency	Your copay	Out-of-network reimbursement
Eye exams	Well Vision Exam focuses on your eye health and overall wellness covered in full	Every 12 months	$10	Up to $45
Lenses	Glass or plastic, single vision, lined bifocal, lined trifocal or lenticular prescription lenses are covered in full	Every 12 months	$25 (lenses & frames)	Up to $30/$50/$65
Frames	Frames are covered up to the retail allowance of $150	Every 24 months	$25 (lenses & frames)	Up to $70
Contact lenses	Elective contact lens materials are covered up to $130 toward any type of prescription contact lenses, instead of eyeglasses	Every 12 months	Up to $60 (fitting & evaluation)	Up to $105

Coverage & copay

Here’s a look at what services are included in your coverage and the copay amount you will pay when you use the VSP network. When you go out of the VSP network for vision services, you will pay for your services up front and then be reimbursed for only a certain amount of each expense.

Eye exams

Well Vision Exam focuses on your eye health and overall wellness, covered in full

Frequency: Every 12 months
Your copay: $10
Out-of-network reimbursement: Up to $45

Lenses

Glass or plastic, single vision, lined bifocal, lined trifocal or lenticular prescription lenses, covered in full

Frequency: Every 12 months
Your copay: $25 (lenses & frames)
Out-of-network reimbursement: Up to $30/$50/$65

Frames

Frames are covered up to the retail allowance of $150

Frequency: Every 24 months
Out-of-network reimbursement: Up to $70

Contact lenses

Elective contact lens materials are covered up to $130 toward any type of prescription contact lenses, instead of eyeglasses

Frequency: Every 12 months
Your copay: Up to $60 (fitting & evaluation)
Out-of-network reimbursement: Up to $105

LASIK

The Veradigm Vision Plan also provides you with access to the VSP Laser Vision Care Program. This program offers discounts on PRK, LASIK and Custom LASIK through VSP-contracted facilities.

Employee Assistance Program (EAP)

Significant changes in familiar routines and uncertainty about the future can lead to stress, anxiety or depression. Our Employee Assistance Program (EAP) helps with little issues, big problems and everything in between.

Health Advocate, Veridigm’s Employee Assistance Program (EAP) provider, is ready to help with small issues, big problems and everything in between.

Contact Health Advocate: 866.799.2728 | healthadvocate.com/members

Kaiser Self-care Resources

If you are enrolled in a Veradigm Kaiser medical plan you have access to many tools including self-care apps at no cost, wellness coaching, and classes. Try personalized programs from myStrength, Calm, or Ginger to help manage depression, stress, anxiety, and more.

Visit kp.org/mentalhealth/resources for more information.

Health Reimbursement Account (HRA)

If you enroll in the BCBS or Kaiser Permanente HRA plans, an HRA account is set up for you.

Each plan year, Veradigm makes contributions to your account that you can use to pay for eligible medical deductible and coinsurance expenses.

Unused HRA funds roll over at the end of the plan year, allowing you to accumulate funds for future healthcare expenses, as long as you remain in the same HRA option from year-to-year.

If you use all of the available funds in your HRA before your deductible is met and/or before the plan year is over, you are responsible for paying all incurred medical expenses and/or remaining deductible. Once your deductible is met, you share the cost of medical services with Veradigm until you reach the out-of-pocket maximum.

Using your HRA

The funds in your HRA are available to use for eligible medical expenses as processed through the Veradigm Medical Plan. Your doctor/healthcare provider submits medical claims to process. Your medical plan provider will apply any available funds from your HRA toward your claims. Remember, your HRA dollars can only be applied towards deductible and coinsurance expenses incurred with the medical plan. HRA funds cannot be used towards dental and/or vision expenses.

Note: Prescription drug copayments are not eligible for reimbursement under an HRA.

Veradigm HRA contributions

If you enroll in the BCBS or Kaiser HRA plan, you will receive 100% of Veradigm contributions on January 1 of the plan year.

Coverage level	Veradigm maximum annual HRA contributions
Associate only	$500
Associate + spouse/DP	$750
Associate + child(ren)	$750
Associate + family	$1000

Health Savings Account (HSA)

If you enroll in the BCBS or the Kaiser Permanente HSA medical plan and are eligible for a health savings account (HSA), an HSA account is set up for you automatically.

The HSA is a tax-favored savings account that is owned by you. You can use money in your account to pay for qualified health care expenses, including deductibles and copays—or keep it for future expenses, even those you incur in retirement.

Here’s a brief look at how the HSA works:

Your contributions to the HSA are pre-tax. You can select a contribution amount when you enroll/re-enroll each year, and contributions are taken from your paycheck pre-tax.
Veradigm also makes contributions to your account.
For 2025, the maximum total annual contribution (yours and Veradigm’s) to your HSA is:
- $4,300 for associate only coverage, and $8,550 if you cover dependents.
You can contribute an additional $1,000 if you are age 55 or older.
Any money in your HSA that you don’t spend stays in your account to help you save for future medical and retiree health care expenses.

Are you eligible for an HSA?

Because HSA plans have certain tax advantages, the IRS defines specific rules for participants.

You are not eligible for an HSA if you:

Are enrolled in Medicare.
Are covered by another healthcare plan that’s not a qualified high deductible health plan.
Can be claimed as a dependent on someone else’s tax return.
Are covered by veterans’ benefits and have used Veterans Affairs medical services within the past three months. Veterans who have a service-connected disability can participate in an HSA regardless of when they received VA benefits.
Are enrolled in or covered by a general purpose Healthcare Flexible Spending Account (FSA) or Health Reimbursement Account (HRA), including one through your spouse’s/domestic partner’s employer.

Important: HSAs are personally owned health savings accounts subject to annual IRS maximum contributions. Individuals must monitor their pre-tax elections and Veradigm contributions throughout the tax year to ensure they do not exceed the annual limits.

To change your HSA contributions during the year:

Go to veradigmbenefitsus.com.
Click Start Here.
Select Life Event and then HSA Mid-Year Change.

Changes to your HSA throughout the year will be effective at the beginning of the next month.

Veradigm HSA Contributions

If you enroll in the BCBS or Kaiser HSA medical plan, you will receive a quarterly contribution to your account on the first day of each quarter of the plan year (starting January 1), as follows:

Coverage level	Veradigm quarterly HSA contributions				Veradigm maximum annual HSA contributions
	Q1	Q2	Q3	Q4
Associate only	$160	$80	$80	$80	$400
Associate + spouse/DP	$240	$120	$120	$120	$600
Associate + child(ren)	$240	$120	$120	$120	$600
Associate + family	$320	$160	$160	$160	$800

To receive Veradigm’s contributions

Veradigm will contribute to your Health Savings Account (HSA) only if you enroll in either the BCBS or Kaiser HSA medical plan during Open Enrollment (or as a new hire or newly benefits-eligible). Follow these steps to ensure you receive the contribution:

Elect the BCBS HSA or Kaiser HSA medical plan through the Veradigm benefits enrollment system.
Confirm your HSA participation:
- If you want to participate, select “I Want Coverage.”
  - You’ll be prompted to choose your contribution amount for 2025.
  - If you don’t want to contribute but still want Veradigm’s contributions, enter $0 as your contribution amount.
- If you don’t want to participate, select “Waive Coverage.”
  Note: If you waive coverage, you will not receive Veradigm’s contributions to your HSA.

How long do I have to elect COBRA?

Within a few weeks after your termination date, you will receive a COBRA Enrollment Kit in the mail that will include a COBRA Enrollment Form.

To enroll for COBRA, you must complete the Enrollment Form and postmark it within 60 days from the later of the date your active benefits end or the COBRA notification is sent to you. You may also elect COBRA online within the same timeline. COBRA benefits are not active until you have made your first payment.

The COBRA packet received via mail will contain a document stating the end date of your benefits. This document can be used as proof of benefit coverage and coverage ending.

Note: You have access to an electronic copy of your COBRA Kit within approximately 48 hours of your termination date. To access this document login to VeradigmBenefitsUS.com, select the drop down in the top right corner by your name, then select Personal Documents.

If you require additional assistance pertaining to your benefits or logging into the site, please call the AllCare Service Center at 844.705.4101.

COBRA cost and payments

How much does COBRA coverage cost?

You must pay the full cost of the benefit premium plus a 2% administration fee for the coverage you elect.

When are my COBRA payments due?

The costs for coverage will be included in your COBRA Enrollment Kit. Your Initial payment is due 45 days from your election date. After that, your payments are due on the first of each month with a 30-day grace period.

If you have a personal email address on file with Businessolver:
You will receive an email to your personal email address at the beginning of each month to let you know your COBRA Account Statement is available at VeradigmBenefitsUS.com. If you do not receive the COBRA Account Statement it may have gone to your junk folder in your personal email.
If you do not have a personal email address on file with Businessolver:
The COBRA Account Statement will be mailed to your home address. The COBRA Account Statement will reflect the amount billed and include a mail in coupon if you are paying by mail. If you have billing questions you can contact Businessolver at 844.705.4101. Your personal email address can be updated at any time by going to VeradigmBenefitsUS.com.

COBRA benefits

When will my COBRA benefits begin?

Your COBRA benefits will not be active until you make your initial payment. Once your enrollment forms and payment are received by Businessolver, all appropriate vendors will be notified of your COBRA enrollment within 10 days.

How long do COBRA benefits last?

In general, they last 18 months with a limited extension in the case of disability or other qualifying events. If you fail to pay your premiums on time, your COBRA coverage will end on the last day of the month for which payment was made and will not be reinstated.

Will I need new medical ID cards?

No, your current medical ID card will remain in effect, no new card will be issued.

Are there other coverage options besides enrolling in COBRA continuation coverage?

Yes, you can explore various health insurance possibilities, such as those offered through the Health Insurance Marketplace, Medicare, Medicaid, and the Children’s Health Insurance Program (CHIP). Additionally, you might consider enrolling in another group health plan, like a plan through a spouse’s employer through what is called a “special enrollment period.” Some of these alternatives could be more affordable than COBRA continuation coverage. For more comprehensive information about many of these choices, visit www.healthcare.gov.

COBRA Premiums

Plan	Your Monthly Cost
BCBSNC – HSA
Associate Only	$778.99
Associate + Spouse/Domestic Ptr	$1,869.58
Associate + Child(ren)	$1,402.19
Associate + Family	$2,414.87
BCBSNC – HRA
Associate Only	$846.09
Associate + Spouse/Domestic Ptr	$2,030.62
Associate + Child(ren)	$1,522.96
Associate + Family	$2,622.88
BCBSNC – PPO
Associate Only	$783.43
Associate + Spouse/Domestic Ptr	$1,880.23
Associate + Child(ren)	$1,410.17
Associate + Family	$2,428.63
Kaiser Medical – HSA
Associate Only	$509.24
Associate + Spouse/Domestic Ptr	$1,222.17
Associate + Child(ren)	$916.63
Associate + Family	$1,578.65
Kaiser Medical – HRA
Associate Only	$563.16
Associate + Spouse/Domestic Ptr	$1,351.59
Associate + Child(ren)	$1,013.70
Associate + Family	$1,745.81
Kaiser Medical – HMO
Associate Only	$560.66
Associate + Spouse/Domestic Ptr	$1,345.59
Associate + Child(ren)	$1,009.19
Associate + Family	$1,738.05
Vision
Associate Only	$7.61
Associate + Spouse/Domestic Ptr	$14.44
Associate + Child(ren)	$15.20
Associate + Family	$22.34
Dental – PPO
Associate Only	$50.82
Associate + Spouse/Domestic Ptr	$97.56
Associate + Child(ren)	$102.63
Associate + Family	$163.59
Dental – HMO
Associate Only	$13.96
Associate + Spouse/Domestic Ptr	$25.47
Associate + Child(ren)	$29.88
Associate + Family	$44.19

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 co-insurance 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)

Plan features	Kaiser HRA	Kaiser HSA	Kaiser HMO
Deductible	$1,500 person $3,000 family	$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
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.

*Effective Jan. 1, 2025: Under the Kaiser HSA Plan, if more than one individual is enrolled, the per person deductible of $3,300 applies. Once the family deductible has been met, the plan will pay each enrolled family member’s covered expenses based on the co-insurance level. However, one individual may satisfy the per person out-of-pocket maximum.

Veradigm contributions to HRA and HSA Health Accounts

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 subject to the out-of-network deductible and coinsurance.

Preventive care services covered under the Affordable Care Act

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.

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.)

Prescription drug benefit

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

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%

*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 2024 Preventive Drug list, your coverage will be 100% with no deductible or coinsurance applied.
To see 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)

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

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

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

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

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.

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

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.

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).