2023 Lion Advantage (formerly PPO Savings plan)
| Health Savings Account Seed Money | ||||
|---|---|---|---|---|
| Salary Range | < = $45,000 | $45,001 - $60,000 | $60,001 - $90,000 | >$90,000 |
| Individual | $800 | $600 | $400 | $200 |
| Family | $1,600 | $1,200 | $800 | $400 |
| Deductible | ||||
| Individual | $1,600 | |||
| Family | $3,200 | |||
| Coinsurance Maximum | ||||
| Individual | $1,975 | |||
| Family | $3,950 | |||
| Member Coinsurance (after deductible) | ||||
| Percentage | 10% | |||
| Services | ||||
|
Preventive Care |
Covered at 100% | |||
| Office Visits | Deductible and Coinsurance | |||
| Specialist | Deductible and Coinsurance | |||
| Urgent Care | Deductible and Coinsurance | |||
| Emergency Room (waived if admitted) | Deductible and Coinsurance | |||
| Prescription (after deductible) | ||||
| Preventive drugs | ||||
| Generic Drugs | 10% Coinsurance | |||
| Preferred Brand Drugs | 20% Coinsurance | |||
| Non-Preferred Brand Drugs | 40% Coinsurance | |||
| Retail (30-day supply) | ||||
| Generic Drugs | 10% Coinsurance | |||
| Preferred Brand Drugs | 20% Coinsurance | |||
| Non-Preferred Brand Drugs | 40% Coinsurance | |||
| mail (90-day supply) | ||||
| Generic Drugs | 10% Coinsurance | |||
| Preferred Brand Drugs | 20% Coinsurance | |||
| Non-Preferred Brand Drugs | 40% Coinsurance | |||
| Specialty Medications | ||||
| Preferred Brand Drugs | 20% Coinsurance, $65 Minimum | |||
| Non-Preferred Brand Medications | 40% Coinsurance, $100 Minimum | |||
| Out-of-Pocket Maximums | Integrated with Medical | |||