Health

2023 Cigna Medical Options

Here’s an overview of our Cigna medical options for 2023. Remember, you must actively enroll in a medical plan during open enrollment to have coverage for 2023; your current election will not roll over.

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.

2023 Allscripts Contributions to Health Account

2023 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.

2023 Allscripts Contributions to Health Account

2022 Cigna Medical plan

2022 Cigna Medical plan

Plan features HRA Plus HSA Base HRA Value
Type of account Health reimbursement account (HRA) Health savings account (HSA) Health reimbursement account (HRA)
Allscripts contributions to health account
Associate only Up to $500 annually Up to $500 annually Up to $500 annually
Associate & spouse/ domestic partner or associate & child(ren) Up to $750 annually Up to $750 annually Up to $750 annually
Family Up to $1,000 annually Up to $1,000 annually Up to $1,000 annually
What you pay when you receive services
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
$1,750 person
$3,500* family
$5,250 person
$10,500* family
$2,250 person
$4,500 family
$6,750 person
$13,500 family
Coinsurance 20% after deductible 50% after deductible 20% after deductible 50% after deductible 25% after deductible 50% after deductible
Out-of-pocket maximum $5,000 person
$10,000 family
$10,000 person
$20,000 family
$5,750 person
$11,500 family
$11,500 person
$23,000 family
$7,150 person
$14,300 family
$14,300 person
$28,600 family
Preventive care visit Fully covered 50% after deductible Fully covered 50% after deductible Fully covered 50% after deductible
Primary care physician office visit
(General practice, family practice, internal medicine, Pediatricians, Obstetrics/Gynecologists)
20% after deductible 50% after deductible 20% after deductible 50% after deductible 25% after deductible 50% after deductible
Specialist office visit
(Specialist such as Allergist, Cardiologist, Orthopedist, Physical Therapist)
20% after deductible 50% after deductible 20% after deductible 50% after deductible 25% after deductible 50% after deductible
Chiropractic or acupuncture
(30 visits combined)
20% after deductible 50% after deductible 20% after deductible 50% after deductible 25% after deductible 50% after deductible
Urgent care 20% after deductible 50% after deductible 20% after deductible 50% after deductible 25% after deductible 50% after deductible
Outpatient surgery 20% after deductible 50% after deductible 20% after deductible 50% after deductible 25% after deductible 50% after deductible
Outpatient lab & X-ray 20% after deductible 50% after deductible 20% after deductible 50% after deductible 25% after deductible 50% after deductible
X-ray scans
(CT, PET, MRI)
20% after deductible 50% after deductible 20% after deductible 50% after deductible 25% after deductible 50% after deductible
Hospital facility charge 20% after deductible 50% after deductible 20% after deductible 50% after deductible 25% after deductible 50% after deductible
Physician charge in hospital 20% after deductible 50% after deductible 20% after deductible 50% after deductible 25% after deductible 50% after deductible
Outpatient mental health & substance abuse 20% after deductible 50% after deductible 20% after deductible 50% after deductible 25% after deductible 50% after deductible
Inpatient mental health & substance abuse 20% after deductible 50% after deductible 20% after deductible 50% after deductible 25% after deductible 50% after deductible

*Under the HSA Base 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. However, one individual may satisfy the per person out-of-pocket maximum.

Preventive care

Preventive care

All Allscripts 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?

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 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.)

Need assistance?

Cigna

800.244.6224
Visit website
Group Number 3339080

Ready to enroll?

The enrollment system will open from Monday, Oct. 31 through Monday, Nov. 14.

Go to our All Care Benefits Service Center enrollment system or use the MyChoice Mobile AppSM.

ENROLL

If you need help enrolling or resetting your password, call 1-844-705-4101.

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2023 Cigna prescription drug benefit

2023 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% after deductible
Generic $15 copay 50% after deductible 20% after deductible 50% after deductible $15 copay 50% after deductible
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% after deductible
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% after deductible
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% after deductible
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% after deductible
Generic $37 copay 50% after deductible 20% after deductible 50% after deductible $37 copay 50% after deductible
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% after deductible
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% after deductible

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.

2023 Kaiser Permanente Prescription drug benefits (for California residents)

2023 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.

2022 Cigna prescription drug benefit

2022 Cigna prescription drug benefit

Plan features HRA Plus HSA Base HRA Value
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% after deductible
Generic $15 copay 50% after deductible 20% after deductible 50% after deductible $15 copay 50% after deductible
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% after deductible
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% after deductible
Accredo Specialty Pharmacy
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% after deductible
90-day supply through retail or mail order
Preventive No copay 50% after deductible 0%, no deductible 50% after deductible No copay 50% after deductible
Generic $37 copay 50% after deductible 20% after deductible 50% after deductible $37 copay 50% after deductible
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% after deductible
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% after deductible
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.

Maintenance medications are filled through Cigna 90 Now.

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.

Accredo Specialty Pharmacy

Preventive medications

Preventive medications

There is no cost for medications on Cigna’s No Cost-Share Preventive Medication (ACA) list for all plan participants.

Additionally, for HSA Base Plan participants, when you purchase other preventive medications listed on Cigna’s 2022 Preventive Generics and Preferred Brands Drug list, you will pay 20% coinsurance, but no deductible applies.

Health Reimbursement Account (HRA)

Health Reimbursement Account (HRA)

If you enroll in the HRA Plus or HRA Value plan, an HRA account is set up for you automatically by Cigna.

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

Even though associates cannot contribute to an HRA, you can earn Allscripts contributions to your account by participating in the All Well Wellness Program, through Virgin Pulse.

Unused HRA funds rollover at the end of the plan year, allowing you to accumulate funds for future healthcare expenses, as long as you remain in one of the HRA options 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 Allscripts 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 Allscripts Medical Plan. Your healthcare provider submits medical claims to process. Cigna 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.

See HRA or HSA: Which is right for you? below for more details about the health accounts.

Health Savings Account (HSA)

Health Savings Account (HSA)

If you enroll in the HSA Base plan and are eligible for a health savings account (HSA), an HSA account is set up for you automatically by Cigna.

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.
  • Allscripts also makes contributions to your account. See “Allscripts contributions to your health account” below for details.
  • The 2022 maximum total annual contribution (yours and Allscripts) to your HSA is $3,650 for associate coverage and $7,300 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.

See HRA or HSA: Which is right for you? below for more details about the health accounts.

 

Allscripts contributions to your health savings account

Allscripts contributions to your health savings account

Allscripts automatically makes contributions to your health account (HRA or HSA) each plan year depending on the coverage level and the plan you choose. You can earn additional Allscripts contributions by participating in the All Well Wellness program through Virgin Pulse.

For current associates

  • Allscripts contributes 40% of the Allscripts annual contribution total into your account on Jan. 1 of the plan year.
  • Each calendar quarter (starting Jan. 1 through Sept. 30), you can earn an additional 20% in contributions by reaching Level 3 (12,000 points) in the All Well Wellness Program.
  • These quarterly contributions will be deposited into your health account within 7 to 10 business days following the end of each calendar quarter.

For new hires or newly eligible for benefits

  • Allscripts contributes 40% of the annual contribution total to your health account (HSA or HRA) within 7 to 10 business days following the first day of the month after your enrollment is finalized.
  • Each subsequent calendar quarter (through Sept. 30), you can earn an additional 20% in contributions by reaching Level 3 (12,000 points) in the All Well Wellness Program.
  • These quarterly contributions will be deposited into your health account within 7 to 10 business days following the end of each calendar quarter.

NOTE: For new associates, in addition to the Allscripts automatic annual contribution (40% as stated above), you can earn up to the quarterly amounts shown in the chart during each calendar quarter for deposit to your HSA/HRA. You will not be eligible to earn dollars for deposit to your HSA/HRA for previous calendar quarters.

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 Allscripts 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.

HRA or HSA: Which is right for you?

HRA or HSA: Which is right for you?

HRA HSA
What is it?
A reimbursement account that helps you meet your deductible and/or pay coinsurance each year. An individually owned savings account that helps you save money for current and future healthcare.
Who is eligible for these accounts?
You are eligible for the HRA if you enroll in the HRA Plus or HRA Value medical plans. You are eligible for the HSA if you enroll in the HSA Base medical plan and meet eligibility requirements outlined in “Are you eligible for an HSA?” above.
Who owns the account?
Allscripts You
Does Allscripts contribute to my account?
Yes. See Allscripts contributions to your health account above for details. Yes. See Allscripts contributions to your health account above for details.
Can I contribute to my account?
No, associates cannot contribute to an HRA. Yes, you can contribute up to the IRS maximums each year (tax-free).

The limits are:
For 2022: $3,650 associate only/$7,300 family
For 2021: $3,600 associate only/$7,200 family

If you are age 55 or older, you can contribute an additional $1,000 in catch-up contributions.

Are contributions subject to income tax?
No No
Does interest accrue?
No Yes
Balance carry over (or rollover)?
Yes, under the current plan design, unused funds are carried over to the following year as long as you remain in one of the HRA plans. Yes, unused funds are carried over to the following year. Your HSA is your own account that you manage.
Is this benefit portable?
No. You forfeit any unused money in the account if you change to a non-HRA plan or leave Allscripts and do not elect COBRA. Yes. Your HSA is a personal Health Savings Account that goes with you. Your balance is not forfeited if you change plans or leave Allscripts.
Proof of expenses required?
Yes. IRS regulations governing HRAs require each claim be substantiated by an “explanation of benefits” statement or through itemized receipts. No; however, you should be prepared to substantiate to the IRS the expense has been incurred, the amount of the expense, and its eligibility.
Investment options?
No. Yes, after you have at least $2,000 in your account.
Eligible to participate in the Healthcare FSA?
Yes, you can participate in the General Purpose FSA. You can participate in the Limited Purpose (Combination) Healthcare FSA to pay for eligible dental and vision expenses and qualified medical expenses once the deductible has been met.
How do I access the funds?
When Cigna processes an approved claim that is subject to the deductible and/or co-insurance, they withdraw amounts due from any available balance and pay your provider on your behalf. You are responsible for paying any balance due after your HRA is depleted. You can access your explanation of benefits (EOB) at www.mycigna.com. Your financial responsibility will be listed on the EOB. You can access your HSA (at HSA Bank) directly from Cigna when logged in at www.mycigna.com. The amount(s) due will be reflected in your HSA Bank account. You can easily pay your provider directly from your HSA Bank account. You can also reimburse yourself for qualifying expenses you paid with non-HSA funds. Tip: Do not turn on “auto pay” functionality. Reconcile all your EOBs before submitting payment to your provider.

For more details about both types of health accounts, see IRS Publication 969.