Medical

You have four options for medical coverage: Novant Health Premier, Blue Standard, Blue Premium or Blue High-Deductible Health Plan (HDHP), plans provided through Blue Cross Blue Shield of North Carolina (Blue Cross NC).

All team members, enrolled in a Novant Health medical plan will have access to the Blue Options^® PPO network.

The Novant Health Premier Plan prioritizes care within our service areas and market. When team members prioritize seeking care from Novant Health providers and facilities within the greater Charlotte and Winston-Salem markets and in the Coastal regions they benefit from higher coverage levels.

With the Blue Standard, Blue Premium and Blue HDHP 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 Enhanced network. These plans also feature a preferred provider network through Blue Cross NC.

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

Key features

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 Capital Rx.

Financial protection

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

2026 medical plans

Novant Health Premier Plan

The Novant Health Premier Plan prioritizes care within the Novant Health Plus Network to provide excellent care and the lowest deductibles, out-of-pocket maximums and premiums of all our plans. This plan includes a Health Reimbursement Account (HRA), funded by Novant Health through well-being activities.

Details

Blue Standard Plan

This plan has higher deductibles, copays, out-of-pocket maximums and premiums than the Novant Health Premier Plan, but lower premiums than the Premium Plan. The Standard plan also includes an HRA, funded by Novant Health through well-being activities.

Details

Blue Premium Plan

If you choose this plan, you’ll pay the highest premiums. In exchange, when you receive care you’ll benefit from lower deductibles, copays and coinsurance. This plan includes a Health Reimbursement Account (HRA), funded by Novant Health through well-being activities.

Details

High Deductible Health Plan

This plan has the highest deductibles and lower premiums. This plan does not have copays, and you pay 100% of your medical expenses until you meet your deductible, then you’ll pay coinsurance. You can use money from your Health Savings Account (HSA) to cover eligible expense.

Details

How much does Novant Health medical coverage cost?

Novant Health pays a generous portion of the cost of your medical coverage. You’ll pay the remaining amount through pre-tax premiums from your paycheck. The amount you pay will depend on which plan you choose and whether you cover just yourself or family members, too. The Premium plan requires the highest premiums of all four medical plan options, followed by the HDHP, Standard and the Novant Health Premier Plan requiring the lowest premiums.

You can view your plan costs here.

Tobacco-user surcharge

Tobacco-user surcharge

As part of our ongoing efforts to promote a healthier lifestyle, Novant Health has implemented a tobacco-user surcharge.

Definition of tobacco-free

Tobacco-free is defined as a team member or spouse who has not used any form of tobacco products within 30 days prior to their benefits election date.

Tobacco products are defined as any tobacco-derived or tobacco-containing products, nicotine-based products (such as synthetic nicotine), and/or plant-based products including, but not limited to cigarettes, cigars, pipe tobacco, snuff, chewing tobacco, other smokeless products, vape products, electronic cigarettes and other nicotine delivery systems (ENDS).

Nicotine replacement therapies are not considered tobacco products.

Steps for tobacco users to take to avoid the tobacco-user surcharge

Novant Health offers team members and/or their covered spouses an annual opportunity to remove the tobacco-user surcharge by completing the reasonable alternative standards (RAS) outlined below.

If you and/or your covered spouse want to avoid the tobacco-user surcharge:

• Confirm during the enrollment process that you have been tobacco-free for 30 days prior to your benefits election date.

OR, if you and/or your covered spouse are tobacco users and wish to avoid the tobacco-user surcharge, you must complete one of the following RAS, by Oct. 31, 2026:

• Enroll in and complete the Quitting Tobacco video course in the Novant Health well-being portal.

OR

• Obtain documentation from your primary care provider (PCP) stating you have completed a cessation program directed by them.

Once you have completed one of the RAS listed above, submit a screenshot verifying completion of the Quitting Tobacco video course or documentation from your PCP to the Human Resources Solution Center (HRSC) via a ServiceNow HR Inquiry. Under the Category, select Benefits, and use the field to add attachments. You will receive a ServiceNow notification once the RAS documentation has been appropriately validated.

If all covered tobacco users in your family successfully complete the RAS requirements, the tobacco-user surcharge will no longer be charged. You will be refunded the tobacco-user surcharges you paid. It may take up to three pay periods for the surcharge to be refunded.

If the RAS requirement is not completed by Oct. 31, 2026, the tobacco-user surcharge will remain in effect for the remainder of the year.

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 Tier 1 providers.

The Novant Health Premier Plan offers three tiers of benefits. When team members prioritize seeking care from Novant Health providers and facilities within the greater Charlotte and Winston-Salem markets and in the Coastal North Carolina and South Carolina regions they benefit from higher coverage levels.

The Blue Standard, Blue Premium and Blue HDHP 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 Capital Rx. See Prescription Drugs for information about these benefits.

The Novant Health Premier Plan offers the lowest deductibles, out-of-pocket maximums and premiums of all the medical plan options. When team members prioritize seeking care from Novant Health providers and facilities within the greater Charlotte and Winston-Salem markets and in the Coastal North Carolina and South Carolina regions they benefit from higher coverage levels. The plan provides three tiers of coverage.

The Blue Standard and Blue Premium plans 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.

Novant Health offers Blue Standard and Blue Premium plans for out of area team members. These plans offer varying degrees of coverage and cost to you. There are three tiers. Out of area plans are available to team members who live beyond a 50 mile radius of a Novant Health hospital. If you qualify for these plans, they will be included in your medical plan options when you enroll. See the benefit enrollment guide for more information.

The Novant Health Premier, Blue Standard and Blue Premium medical plans include an HRA, which can be funded by Novant Health. In the Blue 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 the Novant Health Premier, Blue Standard and Blue Premium plans, you can earn Novant Health HRA contributions for completing well-being activities through the Novant Health well-being portal.

Here are the Novant Health HRA contributions available:

This plan gives you control over your money and rewards you for making healthy, cost-conscious choices. You pay 100% of your medical and prescription costs until you meet the annual deductible. Once you meet your deductible, you will share the cost of covered medical care and prescriptions, with the plan paying the majority. The Blue HDHP also includes an HSA through Wex. As an added bonus, Novant Health will contribute to your HSA — $750 for employee-only coverage or $1,500 if you cover dependents. 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.

"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 a Novant Health medical plan 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 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 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.

You automatically receive prescription drug benefits when you enroll in a Novant Health medical plan through Capital Rx. However, each plan covers prescription drug benefits differently.

You may fill covered prescriptions at any pharmacy, but you pay less when using the 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.

You can call Capital Rx toll-free at 866-622-2779 with any questions.

Drug tiers

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

Tier 1: 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 Capital Rx.

You pay: $$$

Non-preferred drugs are brand-name medications not preferred by Capital Rx. 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. Capital Rx.

You pay: $$$$$$

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

Pay less for your prescriptions

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 Team Member Pharmacy.

Why use the mail order program?

• 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

• 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.
• The Blue High Deductible Health Plan has a combined medical and pharmacy out-of-pocket maximum per calendar year:
  • $6,000 — Employee Only
  • $12,000 — Family ($6,000 out-of-pocket maximum for any one member)

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).

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