Medical

Overview

You have three options for medical coverage: a Premium or Standard plan provided through Cigna or the Surest Plan, a United Healthcare Company.

With the Premium and Standard plans, you can choose any health care provider when you need care, but your out-of-pocket costs are lowest when you choose providers in the Novant Health network. These plans also feature a preferred provider network through Cigna.

The Surest Plan plan has no deductible or coinsurance and you pay a copay based on the care you receive, with the lowest costs when you use a Novant Health network provider. The plan includes a flexible coverage option that allows you to activate coverage for plannable treatments and procedures when needed. You use a convenient app to search for services and prices when you need care. This plan also features a preferred provider network through UHC Choice Plus at United Healthcare.

Below is a high-level overview and comparison of your medical plan options

All of our medical plans provide:

Comprehensive, affordable coverage

for a wide range of health care services.

Free in-network preventive care

with services such as annual physicals, recommended immunizations, and routine screenings all 100% covered.

Prescription drug coverage

provided by MedImpact.

Financial protection

through annual out-of-pocket maximums that limit how much you’ll pay each year.

2024 medical plans

Plan Comparison

Use this interactive side-by-side plan comparison to understand key differences between the plans. You may choose any health care provider, but your out-of-pocket expenses are lowest when you use providers in the Novant Health Network.

The Cigna Standard and Premium Plans offer four tiers of benefits and the annual deductibles and out-of-pocket maximums vary depending on the providers you use for services. Services provided by Tier 3 providers under these plans are subject to the Tier deductible and out-of-pocket maximum.

In addition to the benefits in the Plan Comparison, all of the medical plan options include prescription drug benefits, administered by MedImpact. See Prescription Drugs for information about these benefits.

	Cigna Premium - Enhanced Network	Cigna Premium - Preferred Network	Cigna Premium - Non-Preferred Network	Cigna Premium - Out-of-Network***	Cigna Standard - Enhanced Network	Cigna Standard - Preferred Network	Cigna Standard - Non-Preferred Network	Cigna Standard - Out-of-Network***	Surest - Novant Health Network	Surest - UHC Choice Plus Network	Surest - Out-of-Network***
Annual deductible: Copays do not apply to the deductible; deductibles cross-accumulate
Employee Only	$680	$1,925	$2,800	$3,850	$850	$2,200	$3,200	$4,400	$0	$0	$0
Employee/Child(ren)	$1,000	$2,900	$4,200	$5,800	$1,275	$3,300	$4,800	$6,600	$0	$0	$0
Employee/Spouse	$1,200	$3,400	$4,900	$6,800	$1,500	$3,850	$5,600	$7,700	$0	$0	$0
Employee/Family	$1,360	$3,600	$5,200	$7,700	$1,700	$4,400	$6,400	$8,800	$0	$0	$0
Annual out-of-pocket maximum: + Cigna Premium and Cigna Standard Plans - Includes deductible, coinsurance, copays; all tiers cross-accumulate. Medical and pharmacy OOP are separate limits. Surest Plan - Includes all copay costs; all amounts cross-accumulate. Payroll deductions for coverages requiring activation do not accumulate toward out-of-pocket maximum.
Employee Only	$2,550	$3,600	$5,200	$7,200	$4,200	$4,700	$6,800	$9,400	$3,400	$4,400	$8,800
Employee/Child(ren)	$4,000	$5,600	$8,100	$11,200	$6,500	$7,300	$10,500	$14,600	$6,800	$8,800	$17,600
Employee/Spouse	$4,500	$6,300	$9,100	$12,600	$7,400	$8,200	$11,900	$16,400	$6,800	$8,800	$17,600
Employee/Family	$5,100	$7,450	$10,800	$14,400	$8,400	$9,400	$13,600	$18,800	$6,800	$8,800	$17,600
Medical OOP limit any one member	$2,550	$3,600	$5,200	N/A	$4,200	$4,700	$6,800	N/A	$3,400	$4,400	$8,800
Medical and Pharmacy OOP limit any one member	$4,150	$5,200	$6,800	N/A	$5,800	$6,300	$8,400	N/A	N/A	N/A	N/A
Pharmacy out-of-pocket maximum (Individual/Family)	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	$1,600/$3,200	$1,600/$3,200	Not covered
Health care visits: Your costs + All coinsurance amounts in-network and out-of-network are after annual deductible, except where noted.
Preventive care	$0	$0	$0	50%	$0	$0	$0	50%	$0	$0	$300
Hospital inpatient services	5%	20%	40%, tier 3 ded/oop	50%	10%	25%	40%, tier 3 ded/oop	50%	$450 to $1,000 (varies by procedure or treatment)	$1,000 - $3,950 (varies by procedure or treatment)	Up to $6,700 (varies by procedure or treatment)
Hospital outpatient services	5%, no deductible*	20%	40%, tier 3 ded/oop	50%	10%, no deductible*	25%	40%, tier 3 ded/oop	50%	$0 - $1,600 (varies by procedure or treatment)	$0 - $3,950 (varies by procedure or treatment)	Up to $6,700 (varies by procedure or treatment)
Physician inpatient visits	5%	20%	20%, tier 2 ded/oop	50%	10%	25%	25%, tier 2 ded/oop	50%	Included in hospital in patient services	Included in hospital in patient services	Included in hospital in patient services
Physician surgery, office	$75	20%	20%, tier 2 ded/oop	50%	$85	25%	25%, tier 2 ded/oop	50%	varies by procedure or treatment	varies by procedure or treatment	varies by procedure or treatment
Physician surgery, inpatient and outpatient	$100	20%	20%, tier 2 ded/oop	50%	$200	25%	25%, tier 2 ded/oop	50%	varies by procedure or treatment	varies by procedure or treatment	varies by procedure or treatment
Primary Care Physician office visit (excluding surgery)	$10	20%	20%, tier 2 ded/oop	50%	$25	25%	25%, tier 2 ded/oop	50%	$25	$50 - $220	$400
Specialist office visit (excluding surgery)	$50	20%	20%, tier 2 ded/oop	50%	$65	25%	25%, tier 2 ded/oop	50%	$65	$50 - $220	$400
Urgent care	$20	20%	40%, tier 3 ded/oop	20%	$35	25%	40%, tier 3 ded/oop	25%	$35	$160	$400
Virtual Care primary care/specialist (Cigna)	$10/$50	Not Covered	Not Covered	Not Covered	$25/$65	Not Covered	Not Covered	Not Covered	N/A	N/A	N/A
Virtual care primary care/specialist (Surest)	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	$25/$65	$50 - $220	$400
Emergency room	15%	15%	15%, tier 3 ded/oop	15%	20%	20%	20%, tier 3 ded/oop	20%	$500	$500	$500
X-rays, and lab services, including interpretation at office, urgent care	5%, no deductible*	20%	20%, tier 2 ded/oop	50%	10%, no deductible*	25%	25%, tier 2 ded/oop	50%	$0	$0	$0
X-rays, and lab services at outpatient hospital or independent facility	5%, no deductible*	20%	40%, tier 3 ded/oop	50%	10%, no deductible*	25%	40%, tier 3 ded/oop	50%	$0	$0	$0
Advanced radiology (MRI, PET, CT), office	$125	20%	20%, tier 2 ded/oop	50%	$200	25%	25%, tier 2 ded/oop	50%	$200	$500 - $1,500	$3,000
Advanced radiology (MRI, PET, CT), outpatient hospital	$125	20%	40%, tier 3 ded/oop	50%	$200	25%	40%, tier 3 ded/oop	50%	$200	$500 - $1,500	$3,000
Anesthesia, inpatient or outpatient	5%*	20%	40%, tier 3 ded/oop	50%	10%*	25%	40%, tier 3 ded/oop	50%	$0 (included in procedure or treatment copay)	$0 (included in procedure or treatment copay)	$0 (included in procedure or treatment copay)
Inpatient mental health and substance abuse	5%	5%, tier 1 ded/oop	5%, tier 1 ded/oop	50%	10%	10%, tier 1 ded/oop	10%, tier 1 ded/oop	50%	$1,000	$1,000	$6,000
Physician office mental and substance abuse	$10	$10	$10	50%	$25	$25	$25	50%	$25	$25	$300
Physical therapy (no visit limit)	$10	$25	Professional $25 Outpt facility 40%, tier 3 ded/oop	50%	$25	$40	Professional $40 Outpt facility 40%, tier 3 ded/oop	50%	$25	$40 - $100	$600
Occupational therapy (no visit limit)	$10	$25	Professional $25 Outpt facility 40%, tier 3 ded/oop	50%	$25	$40	Professional $40 Outpt facility 40%, tier 3 ded/oop	50%	$25	$40 - $100	$600
Speech therapy (no visit limit)	$10	$25	Professional $25 Outpt facility 40%, tier 3 ded/oop	50%	$25	$40	Professional $40 Outpt facility 40%, tier 3 ded/oop	50%	$25	$40 - $100	$600
Maternity, hospital	5%	20%	40%, tier 3 ded/oop	50%	10%	25%	40%, tier 3 ded/oop	50%	$500	$1,000 - $2,000	$6,000
Maternity, Physician Global	$100	20%	20%, tier 2 ded/oop	50%	$200	25%	25%, tier 2 ded/oop	50%	Covered in hospital copay	Covered in hospital copay	Covered in hospital copay
Durable medical equipment, home health care	5%**	5%, tier 1 ded/oop**	5%, tier 1 ded/oop**	50%	10%**	10%, tier 1 ded/oop**	10%, tier 1 ded/oop**	50%	Call Surest Help for assistance with copays	Call Surest Help for assistance with copays	Call Surest Help for assistance with copays

*Not all hospital-based providers at Novant Health facilities are in the Novant Health Network (tier 1), so you will receive the Cigna network (tier 2) benefit if the hospital-based provider is not in the Novant Health Network. Novant Health is seeking to expand the number of hospital-based providers in the Novant Health Network.
**Novant Health network tier applies when DME and HHC services are obtained through Cigna’s DME and HHC network, eviCore
***Out-of-network benefits are based on reasonable and customary charges. (MRC 110%)

Cigna Plans

The Premium and Standard plans are consumer-driven high deductible plans that offer four tiers of coverage that give you the freedom to access high-quality care where you choose. The tiers of coverage vary in cost depending on the providers you choose: Enhanced Network, Preferred network, Non-Preferred Network or out-of-network providers. You pay the lowest out-of-pocket costs when you use Enhanced network providers.

Network Name	Description
Enhanced Network	Known as tier 1 or Novant Health Network. Includes all Novant Health facilities, clinics and providers. Also, includes some independent providers in our communities.
Preferred Network	Known as tier 2 or Cigna Network. This is the default in-network tier and includes the Cigna Open Access Provider Network.
Non-Preferred Network	Known as tier 3. Applies to facility charges at local non-domestic facilities.
Out-of-Network	Known as tier 4 and is the highest cost tier.

The Premium plan requires the highest premiums of all three medical plan options, with the Standard plan requiring less than the Premium but more than the Surest Plan option.

How the PPOs work

You pay the plan premiums from your paycheck to have coverage. When you receive in-network preventive care, you pay nothing — it’s covered in full! If you need non-preventive care, it works like this:

Four Tiers: You Choose Providers and Your Costs Depend on Tier

Tier 1: Enhanced Network	Tier 2: Preferred Network	Tier 3: Non-Preferred Network	Tier 4: Out-of-Network
Most cost-effective Includes all Novant Health providers, clinics, facilities, and imaging center, along with certain independent providers in our communities Copays for most services instead of meeting a deductible Preventive care covered at 100%	Higher cost than Tier 1 Also known as the Cigna network. This is the default in-network tier and includes the Cigna Open Access provider network Includes in-network providers, but Tier 2 copays are only available for certain covered expenses (e.g., physical therapy and office visits with a behavioral health provider) Deductible must be met before coinsurance applies (Novant Health pays a portion of the cost and the participant pays a portion) Preventive care is covered at 100%	Applies to facility charges at local non-domestic facilities. All professional fees will process under tier 2	Highest cost Includes providers and facilities not in other tiers

Health Reimbursement Account (HRA)
The Premium and Standard medical plans include an HRA, which is funded by Novant Health. In the Premium Plan, Novant Health will contribute if you elect to enroll in dependent coverage, with the amount based on the coverage tier you select.

In both the Premium and Standard plans, you can earn Novant Health HRA contributions for completing well-being activities through the MotivateMe platform. Learn more about MotivateMe.

Here are the Novant Health HRA contributions available:

	Premium			Standard
Employer contribution to HRA:	Fixed with Salary ≤ $150,000	Fixed with Salary ≥ $150,000	Wellness Incentive Up to	Fixed with Salary ≤ $150,000	Fixed with Salary ≥ $150,000	Wellness Incentive Up to
Employee Only Employee/Child(ren) Employee/Spouse Employee/Family	$0 $375 $450 $750	$0 $0 $0 $0	$900 $900 $1,175 $1,175	$0 $0 $0 $0	$0 $0 $0 $0	$900 $900 $1,175 $1,175

Episode of Care Benefit Option

"Episodes of care" are bundled packages of healthcare services you can purchase for a single, all-inclusive price. The prices are usually less costly than what you would pay otherwise. You and your dependents who are covered by the Cigna medical plans are eligible to select the episode of care option — an innovative and affordable approach to management of certain services with a significantly reduced or eliminated copay. Enrollment exclusions may apply.

By choosing this benefit, team members covered by our Cigna medical plans will enjoy high-quality care plus exclusive concierge services, including:

Based on the episode you are participating in, you receive clearly defined care paths, including physician visits, physical therapy, imaging and hospital stays as needed—all with a single point of contact;
Personally guided assistance navigating the process via the episode’s portal and a dedicated member engagement specialist; and
A simplified billing experience, including upfront cost information and a single bill.

Available Episode of Care options are:

Elective total lower joint replacement
Maternity
Spine Care (Lower Back Pain/Laminectomy)

How the Episode of Care Process Works
Contact a member engagement specialist at 888-408-0558 or Novant.HolistaHealth.com/portal to learn how to opt into the episode benefit. You will be guided through registration on the “episode portal,” where you can launch important activities and access education designed to ensure quick recovery, so you can return to a normal life.

Surest Plan

The Surest Plan has no deductible, no coinsurance, and the ability to see upfront prices (copays) for health services before making an appointment. From day one, you have coverage for services, from colds to cancer treatment. Your Surest plan also includes the flexibility to activate coverage through a feature called flexible coverage. This means, for a set list of plannable treatments and procedures, you simply need to activate the coverage for your preferred provider at least three business days in advance of receiving the care.

The plan offers three tiers of coverage, which vary in cost depending on the providers you choose: Novant Health network providers, Surest network providers, or out-of-network providers. You pay the lowest out-of-pocket costs when you use Novant Health network providers.

How the Surest Plan works

You pay the plan premiums from your paycheck to have coverage and copays for basic every day care. When you need care to activate coverage for one of the plannable treatments and procedures covered by the plan, you pay the cost of activating coverage through paycheck deductions, for a set period, and may or may not have a copay at the time of service. Paycheck deductions begin once you activate coverage. Once you meet the cost, the deductions are complete. There is a maximum per paycheck amount set by Novant Health in the rare event of multiple activations. The specific amount and number of paycheck deductions for each procedure is available at Join.Surest.com/NovantHealth, access code: Novant2024.

When you receive in-network preventive care, you pay nothing — it’s covered in full! If you need non-preventive care, it works like this:

* If you cover family members in this plan, they must meet their own out-of-pocket maximum until the overall family out-of-pocket limit has been met. See the Plan Comparison for the Surest Plan annual maximums.

Prescription Drugs

When you enroll in a Novant Health medical plan, you automatically receive prescription drug benefits through MedImpact. You may fill covered prescriptions at any pharmacy, but you pay less when using the Novant Health NHRMC Employee Pharmacy or Walgreen’s Retail Pharmacies. You can also save on the cost of maintenance medications for a 90-day supply when you use the mail-order delivery option.

Drug tiers

The cost of your prescription drugs under each medical plan depends on the tier of the medication:

Tier1: Generic
Tier 2: Preferred brands
Tier 3: Non-preferred brands
Tier 4: Specialty generics
Tier 5: Specialty preferred brands
Tier 6: Specialty non-preferred brands.

All prescription carriers have a formulary, or list of drugs based on effectiveness and cost. This list will determine how your prescriptions are covered. Keep in mind that the formulary may change because of regular reviews and updates. See the Pharmacy Benefits for coverage and cost details.

Learn about the drug tiers

Generic drugs

Preferred brands

Non-preferred brands

Specialty generics

Specialty preferred brands

Specialty non-preferred brands

You pay: $

Generic drugs have the same active ingredients as brand-name equivalents and meet the same standards for quality and effectiveness, but usually cost much less.

You pay: $$

Preferred drugs are brand-name medications included on the plan’s formulary and favored by MedImpact.

You pay: $$$

Non-preferred drugs are brand-name medications not preferred by MedImpact. They may still be covered but may require prior authorization and cost more.

You pay: $$$$

Specialty generics are medications to treat certain chronic conditions and must be filled through Novant Health Specialty Pharmacy.

You pay: $$$$$

Specialty preferred drugs are brand-name medications for special or chronic condition; the drugs are included on the plan’s formulary and must be filled through Novant Health Specialty Pharmacy. MedImpact.

You pay: $$$$$$

Non-preferred specialty drugs are brand-name medications not preferred by MedImpact. They may still be covered but may require prior authorization and cost more and must be filled through Novant Health Specialty Pharmacy.

Ask your doctor about generic medications.

They’re generally just as effective as brand-name medications, but typically cost 80-85% less.

Use the mail order feature.

Save time and money on maintenance medication for chronic conditions — such as an allergy, high blood pressure, or diabetes — with the convenient, cost-saving mail order prescription program[s] through NHRMC Team Member Pharmacy.

Free shipping on prescriptions.
No waiting in line at the pharmacy.
Reduced cost for a three-month (90-day) supply.
Convenient, automatic refills.

Prescription programs

Your pharmacy benefits include several programs aimed at ensuring your safety and making sure you receive the most clinically appropriate and cost-effective medication.

Specialty medication

All prescriptions for specialty medication used to treat certain conditions (such as rheumatoid arthritis, multiple sclerosis, or psoriasis) must be filled through the Novant Health Specialty Pharmacy.

Dispense as written (DAW)

If your doctor writes DAW on a brand-name prescription when a generic alternative is available, you will pay the brand cost. Without DAW, you would also pay the price difference between the brand and generic drug.

Prior authorization

Some medications may require prior authorization from your doctor before receiving approval for coverage. This is done to ensure the medication is the best option for you.

Step therapy

Step therapy requires that you try the most cost-effective medications appropriate for your condition before more expensive medications can be approved for coverage.

Pharmacy Benefits

CIGNA Premium and Standard Medical Plans
Pharmacy:	Novant Health and NHRMC Pharmacies and Walgreens Retail Pharmacies 30-and 90-day Supplies	Non-Walgreens Retail Pharmacies 30-Day Supply	NHRMC Employee Pharmacy and Walgreens Prescription Delivery 90- Day Supply
Deductible — Applies to Rx out-of-pocket	None	$150, applies to brand drugs	None
Annual out-of-pocket maximum: $1,600 employee only/$3,200 family ($1,600 out-of-pocket limit for any one member)
Tier 1: Generics	$5 (30 days) / $12 (90 days)	$10	$12
Tier 2: Preferred brands	$25 (30 days) / $65 (90 days)	$30+20% up to $145	$65
Tier 3: Non-preferred brands	$45 (30 days) / $135 (90 days)	$55+40% up to $145	$135
Tier 4: Specialty Generics	$70 (30-day limit)	Not covered	$70 (30-day limit)
Tier 5: Specialty Preferred Brands	$100 (30-day limit)	Not covered	$100 (30-day limit)
Tier 6: Specialty Non-Preferred Brands	$200 (30-day limit)	Not covered	$200 (30-day limit)
Out-of-pocket maximum per claim	N/A	$145	N/A

Surest Plan
Pharmacy:	Novant Health and NHRMC Pharmacies and Walgreens Retail Pharmacies 30-and 90-day Supplies	Non-Walgreens Retail Pharmacies 30-Day Supply	NHRMC Employee Pharmacy and Walgreens Prescription Delivery 90- Day Supply
Deductible — Applies to Rx out-of-pocket	None	None	None
Annual out-of-pocket maximum: $1,600 employee only/$3,200 family ($1,600 out-of-pocket limit for any one member)
Tier 1: Generics	$5 (30 days) / $15 (90 days)	$10	$15
Tier 2: Preferred brands	$25 (30 days) / $65 (90 days)	$30	$65
Tier 3: Non-preferred brands	$100(30 days) / $250(90 days)	$160	$250
Tier 4: Specialty Generics	$200 (30-day limit)	Not covered	$200 (30-day limit)
Tier 5: Specialty Preferred Brands	$250 (30-day limit)	Not covered	$250 (30-day limit)
Tier 6: Specialty Non-Preferred Brands	$300 (30-day limit)	Not covered	$300 (30-day limit)

Mandatory generics with a DAW waiver: The difference between cost of brand and generic is not covered under the copay limit or the out-of-pocket limit.
Infertility drugs: These can be purchased from Walgreens and any other pharmacy but are limited to a 30-day supply each fill. There is a $10,000 lifetime maximum benefit for infertility drugs.
Tiers 4 through 6: These are filled by Novant Health specialty pharmacies unless otherwise noted by the specialty pharmacy. Call Novant Health Specialty Pharmacy toll free at 1-855-307-6868 or NHRMC Employee and Specialty Pharmacy at 1-844-662-7785 for inquires and questions.

Visit www.walgreens.com to download the mobile app to manage your prescriptions, order refills, sign up for home delivery, find care, and more. Get started by creating an online account on the Walgreens website.

Visit Novant Health Pharmacy to manage your prescriptions, order refills, sign up for home delivery, find care, and more. Specialty prescriptions must be filled at a Novant Health Specialty Pharmacy, but you can fill any prescription at a Novant Health pharmacy. Here are the Specialty Pharmacy locations:

Novant Health Specialty Pharmacy: 1381 Westgate Center Dr Winston Salem, NC 27103 Phone: 336-718-1111
Novant Health Pharmacy – University: 8401 University Exec Park Dr, Suite 127 Charlotte, NC 28262 Phone: 704-316-5900
Novant Health Pharmacy – Elizabeth: 125 Queens Rd, Suite 180 Charlotte, NC 28204 Phone: 704-316-4180
NH New Hanover RMC Employee & Specialty Pharmacy: 2250 Shipyard Blvd, Suite 12 Wilmington, NC 28403 Phone: 910-662-7755 Mail Order: 844-662-7785

Virtual Care

The medical plans give you access to telehealth services so that you can access health care anytime, anywhere. Consider using virtual care for non-emergency medical or behavioral health care — it’s available from the comfort of your home or wherever you are.

Virtual care is a great option when:

You don’t feel up to going to the doctor’s office.
You can’t get to your doctor because you’re traveling.
You need care after hours (nights, weekends, holidays).

Doctors can diagnose, treat, and prescribe medication when needed for many common conditions. The cost for a virtual visit varies by medical plan but is typically less than going to an urgent care center.

Find a Provider

Using in-network providers saves you money. Here’s how to find doctors in your medical plan network.

The Premium and Standard plans offered through Cigna include two preferred provider networks: Enhanced Network (Tier 1) and the Preferred Network (Tier 2). Your out-of-pocket costs are lowest when you use Tier 1/Enhanced Network providers. Here’s how to find network providers:

Log in to your Cigna account and click on “Find Care & Costs”
You can search by doctor type, name or health facility
A list of applicable search results will be generated. If provider is in tier 1, you will see a green check mark with “Novant Health Network Tier 1” noted beneath their name in the list.
Please note that advanced practice practitioners (APP) within our Novant Health Medical Group (NHMG) clinics are not included in either search functions, for Cigna or Surest, because they bill under a rendering physician.

The Surest plan includes two preferred provider networks: Novant Health (Tier 1) and Surest UHC Choice Plus (Tier 2). Your out-of-pocket costs are lowest when you use Tier 1/Novant Health providers. Here’s how to find network providers:

Visit benefits.surest.com
Once logged in select the type of care you are searching for, search by your provider’s name or select a provider if you are searching for a new provider.
Novant Health Network providers are listed first with the lowest copay displayed.
Please note that advanced practice practitioners (APP) within our Novant Health Medical Group (NHMG) clinics are not included in either search functions, for Cigna or Surest, because they bill under a rendering physician.