2026 Lion Traditional Plan

The Lion Traditional plan is a lower deductible health plan option with a higher employee contribution. Keep in mind that this plan also has a separate prescription out-of-pocket maximum.

Lion Traditional members who have been diagnosed with the following chronic conditions will experience enhanced benefits with the Condition Care Program. This program encourages individuals to manage these health conditions by keeping the individual's out-of-pocket expenses low. With this program, all office visits, lab work and medical supplies related to these conditions are covered at 100% with no co-pays or coinsurance. Enrollment is not required with Highmark; eligible claims will be processed at the 100% level automatically.

  • Diabetes
  • High Cholesterol
  • Hypertension

Members of this plan are also able to enroll in the pre-tax Health Care Flexible Savings Account (FSA) to help with medical expenses and reduce your tax liability.

Below are details regarding the plan design. For more information regarding payroll contributions examples, please visit Premium Comparison or use the Healthcare Calculator.

2026 Lion Traditional - Faculty, Staff, and Postdoctoral Appointees

Highmark Blue Shield continues as the medical services plan administrator.
Deductible In-Network
Salary Range < = $45,000 $45,001 - $60,000 $60,001 - $90,000 > $90,000
Individual $250 $375 $500 $625
Family $500 $750 $1,000 $1,250
Coinsurance Maximum (paid after Deductible)
Individual $2,000
Family $4,000
Out-of-Pocket Maximum (Deductible + Coinsurance Max)
Individual $2,250 $2,375 $2,500 $2,625
Family $4,500 $4,750 $5,000 $5,250
Member Coinsurance (after deductible)
Percentage 10%
In-Network Services
Preventive Care
Highmark Preventive Schedule		 Covered at 100%
Office Visit $20 copay
Well360 Virtual Health Telemedicine $0 copay
Specialist Visit $30 copay
Urgent Care $30 copay
Emergency Room (waived if admitted) $150 copay

Faculty, Staff, and Postdoctoral Appointees Lion Traditional Prescription

CVS Caremark will begin as our prescription coverage administrator beginning January 1, 2026.

With the Lion Traditional plan, there is a separate out-of-pocket maximum for prescriptions. For individual coverage, the prescription out-of-pocket maximum is $2,000. For family coverage, the prescription out-of-pocket maximum is $8,000.

Medication Type Generic Medications Preferred Brand Medications Non-Preferred Brand Medications
Preventive Medications
CVS Preventive Drug List		 10% Coinsurance 20% Coinsurance 40% Coinsurance
Retail Pharmacy
(31-day supply or less, picked up at an in-network retail pharmacy)		 50% Coinsurance 50% Coinsurance 70% Coinsurance
Retail 90
(83-day supply or less, picked up at in-network retail pharmacy)		 50% Coinsurance 50% Coinsurance 70% Coinsurance
Retail 90
(84-day supply up to 90-day supply, picked up at in-network retail pharmacy)		 20% Coinsurance 20% Coinsurance 70% Coinsurance
Mail Order
(90-day or less supply, mailed to home from CVS mail order pharmacy)		 20% Coinsurance 20% Coinsurance 70% Coinsurance
Specialty 50% Coinsurance,
$100 Maximum		 50% Coinsurance,
$100 Maximum		 70% Coinsurance,
$200 Maximum
ACA Preventive Drug List
CVS ACA Preventive Drug List 0% Coinsurance

2026 Lion Traditional - Technical Service

Highmark Blue Shield continues as the medical services plan administrator.

Deductible
Coverage Type Deductible
Individual $250
Parent/Child(ren) $250/$375
Family $250/$500
Coinsurance Maximum (member coinsurance is 10% after deductible)
Coverage Type Coinsurance Maximum
Individual $750
Parent/Child(ren) $750/$1,125
Family $750/$1,500
Out-of-Pocket Maximum
Coverage Type Out-of-Pocket Maximum
Individual $1,000
Parent/Child(ren) $1,000/$1,500
Family $1,000/$2,000
Copay Costs
Service Coverage
Preventive Care
Highmark Preventive Schedule		 Covered at 100%
Office Visit $10 copay
Well360 Virtual Health & Telemedicine $0 copay
Specialist $20 copay
Urgent Care $20 copay
Emergency Room (waived if admitted) $100 copay

Technical Service Lion Traditional Prescription

CVS Caremark will begin as our prescription coverage administrator beginning January 1, 2026.

With the Lion Traditional plan, there is a separate out-of-pocket maximum for prescriptions. For individual coverage, the prescription out-of-pocket maximum is $1,000. For family coverage, the prescription out-of-pocket maximum is $6,000.

Medication Type Generic Medications Preferred Brand Medications Non-Preferred Brand Medications
Preventive Medications
CVS Preventive Drug List		 10% Coinsurance 20% Coinsurance 40% Coinsurance
Retail Pharmacy
(31-day supply or less, picked up at an in-network retail pharmacy)		 50% Coinsurance 50% Coinsurance 70% Coinsurance
Retail 90
(83-day supply or less, picked up at in-network retail pharmacy)		 50% Coinsurance 50% Coinsurance 70% Coinsurance
Retail 90
(84-day supply up to 90-day supply, picked up at in-network retail pharmacy)		 20% Coinsurance 20% Coinsurance 70% Coinsurance
Mail Order
(90-day or less supply, mailed to home from CVS mail order pharmacy)		 20% Coinsurance 20% Coinsurance 70% Coinsurance
Specialty 50% Coinsurance,
$50 Maximum		 50% Coinsurance,
$50 Maximum		 70% Coinsurance,
$100 Maximum
ACA Preventive Drug List
CVS ACA Preventive Drug List  0% Coinsurance