Medical
At Veradigm we understand that associate health is a priority and that your overall well-being is important to you and to the success of the company. We offer comprehensive and competitive medical plans that provide a wealth of resources, information and tools to ensure that you receive the best care and live a healthy life.
Veradigm offers medical plan options ranging in value and cost to you. While all three options have characteristics in common, there are significant differences that you need to understand so you can choose the plan that will best meet your needs.
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 | 50% after deductible | 25% after deductible | 25% after deductible | $75 copay | $75 copay |
| Emergency room | 20% after deductible | 50% after deductible | 25% after deductible | 25% after deductible | $200 | $200 |
* 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.
Kaiser Permanente HMO Medical Options (for California residents)
| Plan features | Kaiser HRA | Kaiser HSA | Kaiser HMO |
|---|---|---|---|
| Deductible | $1,500 person $3,000 family |
$2,500 person $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 |
*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.
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 services covered under the Affordable Care Act
Preventive care received out-of-network is subject to the out-of-network deductible and coinsurance.
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’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 Allscripts, Medicare pays secondary benefits to both you and your spouse. The Allscripts 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 Allscripts, 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 Allscripts, Medicare pays primary benefits for your domestic partner. The Allscripts plan pays secondary benefits regardless of whether your domestic partner enrolls in Medicare. This means that the Allscripts 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 Allscripts, Allscripts pay primary benefits for you and Medicare pays secondary benefits. For your domestic partner, the Allscripts plan continues to pay primary benefits.
Can you have COBRA as well as Medicare?
If you leave Allscripts 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.)