How the medical plans work

Below are examples of how the medical work. Comparing the Lion Advantage HSA, Lion Advantage Flex, and the Lion Traditional plans.

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Lion Advantage: "1 bucket" of costs

"Bucket 1"

ALL services toward deductible

Office visits, X-ray/Lab, Inpatient and Outpatient, Prescription Medications

Deductible

  • $1,650 Individual
  • $3,300 Family

Coinsurance

  • 10% / 90% for medical services

Coinsurance Maximum

  • $1,975 Individual
  • $3,950 Family

Max Out-of-Pocket: (Deductible + Coinsurance)

  • $3,625 Individual 
  • $7.250 Family

Prescription

  • Medication Categories
    • Generic
    • Formulary Brand
    • Non-Formulary Brand

Lion Advantage: Highlights

"Bucket 1" Highlights

  • Lion Advantage HSA and Lion Advantage Flex plans have “1 bucket” where medical services and prescription costs apply
  • All employee medical services and prescription go toward deductible first
  • After deductible is met, all medical services will apply to the coinsurance maximum
  • Once the maximum out-of-pocket amounts have been met, the plan pays 100%

Lion Traditional: "3 Buckets" of costs

"Bucket 1"

Deductible

  • Faculty & Staff - Deductible per salary
  • Technical Service - Deductible per CBA

Coinsurance

  • 10% / 90% for medical services

Coinsurance Maximum

  • Faculty / Staff = $1,250 Individual, $2,500 Family
  • Tech Service = $750 to $1,500 based on enrollment tier

Max Out-of-Pocket: (Deductible + Coinsurance)

  • Faculty / Staff = $1,500 to $3,750 depending on deductible and coverage tier
  • Tech Service = $1,000 to $2,000 depending on deductible and coverage tier

"Bucket 2"

Copays

  • No maximums; not part of deductible or coinsurance
  • Office visit = $20 Faculty/Staff; $10 Technical Service
  • Specialist visit = $30 Faculty/Staff; $20 Technical Service
  • Urgent Care = $30 Faculty/Staff; $20 Technical Service
  • Emergency Room = $100 Faculty/Staff/Technical Service
    • Emergency Room copay waived if admitted

"Bucket 3"

Prescriptions

  • Faculty/Staff Maximum; $2,000 individual, $8,000 Family
  • Technical Service Maximum; $1,000 individual, $6,000 Family
  • Medication Categories:
    • Generic
    • Formulary Brand
    • Non-Formulary Brand

Lion Traditional: Highlights

"Bucket 1" Highlights

  • Lion Traditional plan has “3 buckets” where medical services apply
  • All employee medical services go toward deductible first
  • After deductible is met, all medical services will apply to the coinsurance maximum
  • Once the maximum out-of-pocket amounts have been met, the plan pays 100%

 

 

 

 

 

 

 

 

 

 

"Bucket 2" Highlights

  • Copays are separate from Deductible and Coinsurance; there is no maximum for the accrual of copay amounts

 

 

 

"Bucket 3" Highlights

  • Prescription costs are separate from Deductible and Coinsurance with their own out-of-pocket maximum