Health & Well-being

Cigna Medical Options

Cigna Medical Options

Plan features Cigna HRA Cigna HSA Cigna 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)

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
$3,200/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
$4,500 person
$9,000 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 $100 per visit after deductible 30% after deductible

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, an individual deductible must be met per family member. 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

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?

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 Cigna 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 Cigna.

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 pay 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.)

Need assistance?

Cigna

800.244.6224
mycigna.com
Group Number 3339080

Kaiser Permanente

800.464.4000
kp.org

Need help deciding?

Take advantage of the Cigna Easy Choice ToolSM to help you compare and review your Cigna 2024 medical plan choices. Available 24/7.

888.806.5042

Cigna Easy Choice

Access code: 1MLXLAHF

Looking for the SPDs?

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

Cigna prescription drug benefit

Cigna prescription drug benefit

Plan features Cigna HRA Cigna HSA Cigna PPO
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 reduced cost-share as follows:

  • There is no cost for medications on Cigna’s No Cost-Share Preventive Medication (ACA) list for all plan participants.
  • Additionally, for Cigna HSA Plan participants, when you purchase other preventive medications listed on Cigna’s 2023 Preventive Generics and Preferred Brands Drug list, you will pay 20% coinsurance, but no deductible applies.
  • To see Cigna’s lists of preventive medications, visit mycigna.com. For cost details regarding preventive medications and the National Preferred Formulary, contact Cigna at 1-888-806-5042.

** You must fill maintenance medication prescriptions in a 90-day supply through Cigna 90 Now.

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)

*Under the HSA Plan, if more than one individual is enrolled, an individual deductible must be met per family member. Once this, or 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.

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 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.

Cigna participants: Maintenance medications are filled through Cigna 90 Now.

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.

Cigna participants: use Accredo Specialty Pharmacy for specialty drugs.

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.

Health Reimbursement Account (HRA)

Health Reimbursement Account (HRA)

If you enroll in the Cigna HRA 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 (Cigna or Kaiser Permanente) 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 contributions for Cigna and Kaiser HRA plans

If you enroll in the Cigna HRA 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

Note: If you enroll in the Kaiser HRA medical plan, you will receive 100% of Veradigm contributions on Jan. 1, 2024.

Health Savings Account (HSA)

Health Savings Account (HSA)

If you enroll in the Cigna HSA plan or the Kaiser Permanente HSA 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.
  • The 2024 maximum total annual contribution (yours and Veradigm’s) to your HSA is $4,150 for associate coverage and $8,300 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. You can review your year-to-date contributions through the single sign-on feature in www.mycigna.com. Changes to pre-tax HSA payroll contributions are permitted anytime throughout the year to account for necessary adjustments.

To change your HSA contributions during the year:

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

Veradigm HSA contributions for Cigna and Kaiser HSA plans

If you enroll in the Cigna HSA or Kaiser HSA 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