2025 Medical Plan Comparison
Highmark 2025 Plan Design Tutorial
Below is a side-by-side comparison of costs and coverages for each medical plan option.
| Plan Component | Lion Traditional Plan Per employee type as listed |
Lion Advantage HSA Faculty, Staff, & Technical Service |
Lion Advantage Flex Faculty and Staff ONLY |
|---|---|---|---|
| Deductible | Faculty & Staff $250-$625 Individual (based on salary) $500-$1,250 Family (based on salary) Technical Service $250 Individual $250 / $375 Parent + Child(ren) $250 / $500 Family |
$1,650 Individual / $3,300 Family | $1,650 Individual / $3,300 Family |
| Coinsurance Percentage | Faculty, Staff, & Technical Service 10% member / 90% University |
10% member / 90% University | 10% member / 90% University |
| Coinsurance Maximum | Faculty & Staff $1,250 Individual / $2,500 Family Technical Service $750 Individual $750 / $1,125 Parent + Child(ren) $750 / $1,500 Family |
$1,975 Individual / $3,950 Family | $1,975 Individual / $3,950 Family |
| Out-of-Pocket Maximum | Faculty & Staff $1,500-$1,875 Individual (based on salary) $3,000-$3,750 Family (based on salary) Technical Service $1,000 Individual $1,000 / $1,500 Parent + Child(ren) $1,000 / $2,000 Family |
$3,625 Individual / $7,250 Family | $3,625 Individual / $7,250 Family |
| Preventive Care | Faculty, Staff, & Technical Service 100% coverage, copay/deductible does not apply |
100% coverage, deductible does not apply | 100% coverage, deductible does not apply |
| Primary Care Visit | Faculty & Staff $20 copay Technical Service $10 copay |
10% coinsurance after deductible | 10% coinsurance after deductible |
| Well360 Virtual Health Telemedicine Visit | Faculty, Staff, & Technical Service $0 copay |
$0 cost share after deductible | $0 cost share after deductible |
| Specialist Visit | Faculty & Staff $30 copay Technical Service $20 copay |
10% coinsurance after deductible | 10% coinsurance after deductible |
| Urgent Care Visit | Faculty & Staff $30 copay Technical Service $20 copay |
10% coinsurance after deductible | 10% coinsurance after deductible |
| Emergency Room Visit | Faculty, Staff, & Technical Service $100 copay (waived if admitted) |
10% coinsurance after deductible | 10% coinsurance after deductible |
| Plan Deductible and Coinsurance Information | Deductible applies to: Lab tests, x-rays, surgery, in-patient admissions, out-patient services, and durable medical equipment. Once deductible is met, coinsurance is applicable on these services. Once deductible and coinsurance is met, coverage for these services will be paid by the University at 100%. Deductible DOES NOT include: copays or prescriptions |
Deductible applies to: ALL medical and prescription services are applied to deductible and then coinsurance. Once deductible and coinsurance is met, coverage will be paid by University at 100%. | Deductible applies to: ALL medical and prescription services are applied to deductible and then coinsurance. Once deductible and coinsurance is met, coverage will be paid by University at 100%. |
Medical Plan Summaries
| Lion Traditional Plan | Lion Advantage HSA | Lion Advantage Flex (Faculty and Staff ONLY) |
|---|---|---|
| This is a traditional Preferred Provider Organization (PPO) plan that has freedom of choice with a large, national provider network: | This is a High Deductible Health Plan (HDHP) that has freedom of choice with a large, national provider network. It is automatically paired with a pre-tax Health Savings Account (HSA). To be eligible, the employee must meet the following: | This is a High Deductible Health Plan (HDHP) that has freedom of choice with a large, national provider network. This new health plan option DOES NOT pair with a pre-tax Health Savings Account (HSA), therefore will receive no employer seed funding. |
| May be used in conjunction with other non-HDHP plans; multiple plans will follow Coordination of Benefits between plan carriers to determine primary versus secondary payer | Cannot have other health insurance coverage (including Medicare or Tricare) | Primarily intended for those employee who are or may become Medicare eligible, but still want a lower payroll contribution with higher deductible. |
| May choose to also participate in the Health Care Flexible Spending Account (FSA), but this is not required; the Health Care FSA is not available for Postdoctoral Fellows | The employee nor spouse can have a balance in a Health Care Flexible Spending Account (FSA) from another employer plan
|
May be used in conjunction with other health insurance coverage; mulitple plans will follow Coordination of Benefits between plan carriers to determine primary versus secondary payer |
| Available to all visa types; may be the only option presented depending on visa type listed in Workday | Cannot have a J or F visa type | May choose to also participate in the Health Care Flexible Spending Account (FSA), but this is not required; the Health Care FSA is not available for Postdoctoral Fellows |
| Is the only plan option available to Postdoctoral Fellows | Cannot be classified as a Postdoctoral Fellow | Cannot have a J or F visa type |
Participants in Lion Traditional are eligible for the Condition Care Program. This program provides lower cost-sharing on high value services for employees, spouses, and children with one or more of the following conditions:
|
Participants in Lion Advantage HSA are not eligible for the Condition Care Program (CCP) | Participants in Lion Advantage Flex are not eligible for the Condition Care Program (CCP) |
Try the Benefits Mentor tool to see which plan might be best for you.