Medical

Overview

You have four options for medical coverage: Novant Health Premier, Standard, Premium or High Deductible Health Plan (HDHP), plans provided through Cigna.

With the Standard, Premium and 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 Cigna.

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 region they benefit from higher coverage levels.

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.

2025 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 Tier 1 providers.

The Cigna Standard, Premium and 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.

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 region they benefit from higher coverage levels.

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*	Cigna HDHP - Enhanced Network	Cigna HDHP - Preferred Network	Cigna HDHP - Non-Preferred Network	Cigna HDHP - Out of Network	Novant Health Premier Plan - Novant Health Plus Network	Novant Health Premier Plan - Alternative Network	Novant Health Premier Plan - Out-of-Network
1. Premier, Standard and Premium annual deductible: Copays do not apply to the deductible; deductibles cross-accumulate. HDHP annual deductible: Includes pharmacy and medical; deductibles cross accumulate.
Employee Only	$900	$1,950	$2,800	$3,850	$1,200	$2,200	$3,200	$4,400	$2,000	$3,000	$4,000	$7,000	$700	$3,200	$7,000
Employee/Child(ren)	$1,800	$3,900	$5,600	$7,700	$2,400	$4,400	$6,400	$8,800	$4,000	$6,000	$8,000	$14,000	$1,400	$6,400	$14,000
Employee/Spouse	$1,800	$3,900	$5,600	$7,700	$2,400	$4,400	$6,400	$8,800	$4,000	$6,000	$8,000	$14,000	$1,400	$6,400	$14,000
Employee/Family	$1,800	$3,900	$5,600	$7,700	$2,400	$4,400	$6,400	$8,800	$4,000	$6,000	$8,000	$14,000	$1,400	$6,400	$14,000
2. Premier, Standard and Premium OOP maximum: Includes deductible, coinsurance, copays; all tiers cross-accumulate. Medical and pharmacy OOP are separate limits. HDHP OOP maximum: Includes medical deductible and coinsurance. Medical and Pharmacy OOP are combined.
Employee Only	$3,200	$5,000	$5,600	$7,200	$4,200	$6,200	$6,800	$9,400	$6,000	$7,500	$8,300	$14,000	$2,500	$6,800	$14,000
Employee/Child(ren)	$6,400	$10,000	$11,200	$15,400	$8,400	$12,400	$13,600	$18,800	$12,000	$15,000	$16,600	$28,000	$5,000	$13,600	$28,000
Employee/Spouse	$6,400	$10,000	$11,200	$15,400	$8,400	$12,400	$13,600	$18,800	$12,000	$15,000	$16,600	$28,000	$5,000	$13,600	$28,000
Employee/Family	$6,400	$10,000	$11,200	$15,400	$8,400	$12,400	$13,600	$18,800	$12,000	$15,000	$16,600	$28,000	$5,000	$13,600	$28,000
Medical OOP limit any one member	$3,200	$5,000	$5,600	$7,200	$4,200	$6,200	$6,800	$9,400	N/A	N/A	N/A	N/A	$2,500	$6,800	$14,000
Medical and Pharmacy OOP limit any one member	$4,800	$6,600	$7,200	$8,800	$5,800	$7,800	$8,400	$11,000	$6,000	$7,500	$8,300	$14,000	$4,100	$8,400	$15,600
Pharmacy out-of-pocket maximum (Individual/Family)	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Health care visits: Your costs All coinsurance amounts in-network and out-of-network are after annual deductible, except where noted.
Preventive care	100%	100%	Tier 2 Benefit applies	50%	100%	100%	Tier 2 Benefit applies	50%	100%	100%	Tier 2 Benefit applies	50%	100%	100%	50%
Hospital inpatient services	10%	25%	40% tier 3 ded/OOP max	50%	15%	25%	40%, tier 3 ded/OOP max	50%	10%	25%	40%, tier 3 ded/OOP max	50%	5%	25%	50%
Hospital outpatient services	10%, no ded	25%	40%, tier 3 ded/OOP max	50%	15%, no ded	25%	40%, tier 3 ded, OOP max	50%	10%	25%	40%, tier 3 ded/OOP max	50%	5%, no ded	25%	50%
Physician inpatient visits	10%	25%	Tier 2 Benefit applies	50%	15%	25%	Tier 2 Benefit applies	50%	10%	25%	Tier 2 Benefit applies	50%	5%	25%	50%
Physician surgery, office	$75	25%	Tier 2 Benefit applies	50%	$85	25%	Tier 2 Benefit applies	50%	10%	25%	Tier 2 Benefit applies	50%	$60	25%	50%
Physician surgery, inpatient and outpatient	$100	25%	Tier 2 Benefit applies	50%	$200	25%	Tier 2 Benefit applies	50%	10%	25%	Tier 2 Benefit applies	50%	$75	25%	50%
Primary Care Physician office visit (excluding surgery)	$20	25%	Tier 2 Benefit applies	50%	$25	25%	Tier 2 Benefit applies	50%	10%	25%	Tier 2 Benefit applies	50%	$10	25%	50%
Specialist office visit (excluding surgery)	$50	25%	Tier 2 Benefit applies	50%	$65	25%	Tier 2 Benefit applies	50%	10%	25%	Tier 2 Benefit applies	50%	$35	25%	50%
Urgent care	$20	25%	40%, tier 3 ded/OOP max	50%	$35	25%	40%, tier 3 ded/OOP max	50%	10%	25%	40%, tier 3 ded/OOP max	50%	$15	25%	50%
Virtual Care primary care/specialist	$20	N/A	N/A	N/C	$25	N/A	N/A	N/C	10%	N/A	N/A	N/C	$10	N/A	N/C
Emergency room	15%	15%	15%, tier 3 ded/OOP max	15%	20%	20%	20%, tier 3 ded/OOP max	20%	10%	10%	10%, Tier 3 ded/OOP max	10%	15%	15%	15%
X-rays, and lab services, including interpretation at office, urgent care	10%, no ded	25%	Tier 2 benefit applies	50%	15%, no ded	25%	Tier 2 benefit applies	50%	10%	25%	Tier 2 benefit applies	50%	5%, no ded	25%	50%
X-rays, and lab services at outpatient hospital or independent facility	10%, no ded	25%	40%, tier 3 ded/OOP max	50%	15%, no ded	25%	40%, tier 3 ded/OOP max	50%	10%	25%	40%, tier 3 ded/OOP max	50%	5%, no ded	25%	50%
Advanced radiology (MRI, PET, CT), office	$125	25%	Tier 2 benefit applies	50%	$200	25%	Tier 2 benefit applies	50%	10%	25%	Tier 2 benefit applies	50%	$100	25%	50%
Advanced radiology (MRI, PET, CT), outpatient hospital	$125	25%	40%, tier 3 ded/OOP max	50%	$200	25%	40%, tier 3 ded/OOP max	50%	10%	25%	40%, tier 3 ded/OOP max	50%	$100	25%	50%
Anesthesia, inpatient	10%	25%	40%, tier 3 ded/OOP max	50%	15%	25%	40%, tier 3 ded/OOP max	50%	10%	25%	40%, tier 3 ded/OOP max	50%	5%	25%	50%
Inpatient mental health and substance abuse	10%	10%, Tier 1 ded/OOP max	10%, Tier 1 ded/OOP max	50%	15%	15%, Tier 1 ded/OOP max	15%, Tier 1 ded/OOP max	50%	10%	10%, Tier 1 ded/OOP max	10%, Tier 1 ded/OOP max	50%	5%	5%, tier 1 ded	50%
Physician office mental health and substance abuse	$20	$20	$20	50%	$25	$25	$25	50%	10%	10%, Tier 1 ded/OOP max	10%, Tier 1 ded/OOP max	50%	$10	$10	50%
Physical therapy (no visit limit)	$20	$35	40%, tier 3 ded/OOP max	50%	$25	$40	40%, tier 3 ded/OOP max	50%	10%	25%, Tier 1 ded/OOP max	40%, tier 3 ded/OOP max	50%	$10	$25	50%
Occupational therapy (no visit limit)	$20	$35	40%, tier 3 ded/OOP max	50%	$25	$40	40%, tier 3 ded/OOP max	50%	10%	25%, Tier 1 ded/OOP max	40%, tier 3 ded/OOP max	50%	$10	$25	50%
Speech therapy (no visit limit)	$20	$35	40%, tier 3 ded/OOP max	50%	$25	$40	40%, tier 3 ded/OOP max	50%	10%	25%, Tier 1 ded/OOP max	40%, tier 3 ded/OOP max	50%	$10	$25	50%
Maternity, hospital	10%	25%	40%, tier 3 ded/OOP max	50%	15%	25%	40%, tier 3 ded/OOP max	50%	10%	25%	40%, tier 3 ded/OOP max	50%	5%	25%	50%
Maternity, Physician Global	$100	25%	Tier 2 benefit applies	50%	$200	25%	Tier 2 benefit applies	50%	10%	25%	Tier 2 benefit applies	50%	$75	25%	50%
Durable medical equipment	10%	10%, Tier 1 ded/OOP max	40%, tier 3 ded/ OOP max applies	50%	15%	15%, Tier 1 ded/OOP max	40%, tier 3 ded/ OOP max applies	50%	10%	10%, Tier 1 ded/OOP max	40%, tier 3 ded/ OOP max applies	50%	5%	5%, tier 1 ded	50%

*Novant Health network tier applies when DME services are obtained through Cigna's DME vendor, eviCore.

Tier 3 coinsurance is after Tier 3 annual deductible and is subject to Tier 3 annual out-of-pocket maximum.
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.
Out-of-network benefits are based on reasonable and customary charges. (MRC 110%)

Novant Health Premier Plan

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 region they benefit from higher coverage levels. The plan provides three tiers of coverage.

Tier 1: Novant Health Plus Network	Tier 2: Alternate Network	Tier 3: Out-of-Network
Most cost-effective This tier includes Novant Health providers, clinics, and facilities, plus select independent providers; and Non-Novant Health providers in the Cigna Open Access Plus Provider Network in each market – greater Charlotte market, greater Winston-Salem market and the coastal region. Please note that this network differs from the Enhanced Network available in other medical plans 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%	Highest cost Includes providers and facilities not in other tiers

* 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 annual maximums.

Standard and Premium Plans

The Standard and 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.

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:

*With the $1,500 Deductible Plan, coinsurance for any person covered under a family plan begins only after the entire family deductible has been met.
**With the $1,500 Deductible Plan, the plan begins to pay 100% for any person covered under a family plan only after the entire family out-of-pocket maximum has been met.

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 Novant Health Premier, Standard and Premium medical plans include an HRA, which can be 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 the Novant Health Premier, Standard and Premium 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			Premier/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
Employee Only	$0	$0	$900	$0	$0
Employee/Child(ren)	$375	$0	$900	$0	$0
Employee/Spouse	$450	$0	$1,175	$0	$0
Employee/Family	$750	$0	$1,175	$0	$0

High Deductible Health Plan (HDHP)

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. This plan 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.

How the HDHP works

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:

* 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 annual maximums.

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 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 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

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 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.

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:

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 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

Novant Health Premier Plan
Pharmacy	Novant Health and NHRMC Pharmacies and Walgreens Retail Pharmacies	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
Tier 1: Generics	$5 (30 days) / $12 (90 days)	$10	$12
Tier 2: Preferred brands	$35 (30 days) / $85 (90 days)	$40+20% up to $150	$85
Tier 3: Non-preferred brands	$60 (30 days) / $180 (90 days)	$85+40% up to $150	$180
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	$150	N/A
Out-of-pocket maximum per Calendar Year	$1,600 Employee Only / $3,200 Family ($1,600 OOP Limit for any one member)

Cigna Standard Plan & Premium Plans
Pharmacy:	Novant Health and NHRMC Pharmacies and Walgreens Retail Pharmacies	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
Tier 1: Generics	$10 (30 days) / $25 (90 days)	$15	$25
Tier 2: Preferred brands	$40 (30 days) / $100 (90 days)	$45+20% up to $250	$100
Tier 3: Non-preferred brands	$80 (30 days) / $240 (90 days)	$100+40% up to $250	$240
Tier 4: Specialty Generics	$100 (30-day limit)	Not covered	$100 (30-day limit)
Tier 5: Specialty Preferred Brands	$150 (30-day limit)	Not covered	$150 (30-day limit)
Tier 6: Specialty Non-Preferred Brands	$400 (30-day limit)	Not covered	$400 (30-day limit)
Out-of-pocket maximum per claim	N/A	$250	N/A
Out-of-pocket maximum per Calendar Year	$1,600 Employee Only / $3,200 Family ($1,600 OOP Limit for any one member)

High Deductible Health Plan
Pharmacy:	Novant Health and NHRMC Pharmacies and Walgreens Retail Pharmacies	Non-Walgreens Retail Pharmacies 30-Day Supply	NHRMC Employee Pharmacy and Walgreens Prescription Delivery 90-Day Supply
Deductible — Applies to Rx out-of-pocket	$2,000/ $4,000	$2,000/ $4,000	$2,000/ $4,000
Tier 1: Generics	Deductible, then 10%	Deductible, then 25%	Deductible, then 10%
Tier 2: Preferred brands	Deductible, then 10%	Deductible, then 25%	Deductible, then 10%
Tier 3: Non-preferred brands	Deductible, then 10%	Deductible, then 25%	Deductible, then 10%
Tier 4: Specialty Generics	Deductible, then 10%	Not covered	Deductible, then 10%
Tier 5: Specialty Preferred Brands	Deductible, then 10%	Not covered	Deductible, then 10%
Tier 6: Specialty Non-Preferred Brands	Deductible, then 10%	Not covered	Deductible, then 10%
Out-of-pocket maximum per claim	N/A	N/A	N/A
Out-of-pocket maximum per Calendar Year	$6,000 Employee Only / $12,000 Family (Combined with Medical)

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, Standard and HDHP 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, because they bill under a rendering physician.

To search for providers or facilities in the Novant Health Premier plan visit Novant Health Plus Network Providers Search to determine if your current providers or facilities fall into the Novant Health Plus (tier 1) network.