2026 Benefits Open Enrollment FAQs

Full-time employees enrolling in Penn State’s health plans will be able to choose from the same plan options as are currently available: Lion Traditional and Lion Advantage.

Highmark Blue Shield will remain the University’s third-party administrator for medical services.

Penn State is contracting with CVS Caremark, which will replace Express Scripts and Accredo as the University’s pharmacy provider beginning Jan. 1, 2026.

As health care costs across the country continue to rise, Penn State projects its health care costs will increase by $30 million for 2026, continuing an annual trend of significant cost growth for the University. As a result, all employees will see a slight increase in payroll contributions for 2026.

Payroll contributions for enrolled faculty and staff are based on a specific percentage of their annual base salary as of Sept. 30 each year (ARL employees as of Oct. 1; employees covered by a collective bargaining agreement should refer to their applicable contract).

All employees can estimate their payroll contributions for each plan type and coverage tier by downloading Penn State Human Resources’ health care payroll contribution calculator. A chart of the plan design, including deductibles, coinsurance and out-of-pocket costs is available for review.

Out-of-pocket maximums (OOPM) also will be increasing for employees by varying amounts, depending on whether employees are enrolled in the Lion Traditional or Lion Advantage plans and if they are enrolled as individuals or as a family.

An example of 2026 payroll contributions, OOPMs, and deductibles for an employee earning $75,000 annually:

• Lion Traditional
  • Individual: $110.63
  • Family: $344.38
  • Individual Deductible: $500
  • Family Deductible: $1,000
  • OOPM (Individual): $2,000
  • OOPM (Family): $4,000
• Lion Advantage HSA / Lion Advantage Flex
  • Individual: $57.50
  • Family: $176.88
  • Individual Deductible: $1,700 (per IRS minimum)
  • Family Deductible: $3,400 (per IRS minimum)
  • OOPM (Individual): $3,675
  • OOPM (Family): $7,350

Analysis of industry trends revealed the out-of-pocket maximums for Penn State plans were below the industry average, and adjustments were necessary in the face of rising health care costs nationwide. Increases of out-of-pocket maximums will vary, depending on whether employees are enrolled in the Lion Traditional or Lion Advantage plans.

External market forces across the nation are causing health care costs to rise – for example, provider rate increases, rising supply costs, workforce shortages, health care worker burnout, hospital consolidations, and continued advancements with certain medications all drive up cost for employers and employees. These challenges are not unique to Penn State. The University projects our total health care costs will rise by $30 million in 2026.

Analysis of industry trends revealed the out-of-pocket maximums for Penn State plans were below the industry average, and adjustments were necessary in the face of rising health care costs nationwide. Increases of out-of-pocket maximums will vary, depending on whether employees are enrolled in the Lion Traditional or Lion Advantage plans.

Most employees do not reach the out-of-pocket maximums – for the Lion Traditional plan, only about 7% of employees with individual coverage and only about 3% with family coverage reached the OOPM in 2024. For the Lion Advantage plan, about 10% of employees with individual coverage and about 9% of employees with family coverage reached the OOPM in 2024.

Yes. While it isn’t possible to predict exact numbers for 2027 and beyond, Penn State does anticipate annual growth in health care expenses for the foreseeable future. The reality is that health care costs continue to rise across the country, a trend that also impacts our University. In 2025 we project total health care costs will rise by about $30 million. We remain committed to providing our faculty, staff and their families with competitive, affordable, high-quality health care, and University leaders will maintain the current 75% University / 25% employee cost sharing principle.

Yes. Penn State continually reviews its benefits package to remain competitive with both peer universities and national standards. Our health care plans offer high-quality coverage, full preventive care and a cost-sharing model (75% University / 25% employee) that is favorable compared with many higher education institutions and national employers. While rising health care costs are a nationwide challenge, Penn State’s self-insured model and ongoing partnerships with Highmark and CVS Caremark help us manage costs while maintaining strong coverage options for employees and their families.

In addition, in the recent ModernThink staff satisfaction survey, more than 80% of Penn State staff members said they were “very satisfied” when asked about their overall satisfaction with the University’s benefits.

Penn State understands the importance and impact of health care on its employees and their families, and continues to work closely with benefits plan partners to continue offering affordable, high-quality care. To help keep costs in check, the University is self-insured, compared to other employers who pay significantly more through a private insurer.

As employees prepare for 2026 benefits open enrollment, Penn State encourages employees to be smart consumers of health care. Employees can use the Benefits Mentor tool to help determine which health care plan may be best for them and their families.

The University also offers a number of programs and resources to help employees manage their health care costs, including:

CVS Caremark Enhancements: Starting in January, employees can take advantage of one of several enhancements offered for prescription costs; Retail 90, Specialty Starter Fill, ScriptSync, Caremark Cost Saver, Rx Savings Plus for Non-Covered Drugs (PENCD). Review more information on the HR website.

Quest or LabCorp facilities for nonurgent tests: Employees using Quest, LabCorp, or other freestanding laboratories can garner significant cost savings when conducting lab tests such as blood work and cultures

Highmark’s Well360 Virtual Health Telemedicine: For both Lion Traditional and Lion Advantage (HSA and Flex) members, telemedicine is a $0 cost share alternative that may be a cost-effective option versus visiting an urgent care or emergency room.

Condition Care Program: For employees in the Lion Traditional plan and diagnosed with certain chronic conditions, this program keeps out-of-pocket expenses low by covering all office visits, lab work and medical supplies related to these conditions with no copays or coinsurance.

Scripta and Hinge: Both benefits are available at no cost to faculty and staff and their dependents enrolled in a Penn State medical plan. Scripta provides participants with options and pricing information to help patients save on prescription drugs. Hinge is a virtual physical therapy benefit and an alternative to traditional physical therapy designed to address muscle and joint pain.

If you are retiring on Dec. 31, 2025, you do not need to complete the 2026 Open Enrollment.

If you are not certain of a Dec. 31 retirement date, you should complete the 2026 Open Enrollment for any changes you may want in 2026.

Please be sure to attend a Preparing for Retirement session for more important information.

While Hinge Health and Scripta Prescription Savings Plan became available to employees starting September 1, 2025, these plans are “new” and will be reviewed during open enrollment webinars.

Any other benefit plan changes will be outlined as well and found within other 2026 Benefits Open Enrollment web content.

Penn State continually reviews employee benefits to provide faculty and staff with the highest quality and most affordable health care possible. While Highmark Blue Shield will remain the University’s third-party administrator for medical services, CVS Caremark will replace Express Scripts and Accredo as the University’s pharmacy provider. CVS Caremark’s partnerships in Pennsylvania and throughout the United States are strong, resulting in the overall lower total cost of care and positive prescription cost and refill experiences.

CVS Caremark is the largest pharmacy benefit manager (PBM) in the United States, with a national network of over 60,000 in-network pharmacies, which includes many chain and independent.

Highmark and CVS Caremark will coordinate benefits to ensure accuracy of any plan deductibles that include both medical and prescription claims.

CVS Caremark has a national network of over 60,000 in-network pharmacies, including many chains and independent locations. This broad network will assist Penn State in continuing its effort to provide employees with the highest quality and most affordable health care possible. This partnership offers enhancements including Retail 90, Specialty Starter Fill, ScriptSync, Caremark Cost Saver, Rx Savings Plus for Non-Covered Drugs (PENCD). 

You should not need a new pharmacy in most cases. As long as your current pharmacy is participating with CVS Caremark, you will simply need to present your new CVS Caremark ID card for your prescription to be processed correctly under your medical plan. 

Members age 18 or older who will experience any formulary changes or details regarding prior authorizations will receive a customized notification letter from CVS Caremark in late November. CVS Caremark will be sending all employees a welcome kit including more information regarding CVS resources and ID cards in late December 2025. Also starting in December, employees will be able to call a dedicated phone number for prescription-related questions, and additional information will be shared online. 

Yes. University Health Services pharmacy will continue to be available for short-term and maintenance prescriptions. You will simply need to present your new CVS Caremark ID card for your prescription to be processed correctly under your medical plan. In most cases you will not need a new prescription to remain with University Health Services pharmacy. 

Penn State is working closely with CVS Caremark to promote a smooth transition for employees. Every pharmacy benefit provider has its own drug formularies, and CVS Caremark’s prescription formulary may be different than Express Scripts and Accredo.  

Members age 18 or older who will experience any formulary changes or details regarding prior authorizations will receive a customized notification letter from CVS Caremark in late November. CVS Caremark will be sending all employees a welcome kit including more information regarding CVS resources and ID cards in late December 2025. Also starting in December, employees will be able to call a dedicated phone number for prescription-related questions, and additional information will be shared online. 

Employees’ medications with prior authorizations will be honored with CVS Caremark. Prescriptions with available refills at retail pharmacies and/or University Health Services can be refilled after Jan. 1, 2026; just present your new CVS Caremark ID card. Refills through Express Scripts by mail and Accredo Specialty will be transferred to CVS Caremark or CVS Specialty; available for refill upon normal refill date on or after Jan. 1, 2026.

No. Scripta will work with CVS Caremark beginning Jan. 1, 2026, to continue offering review of your prescriptions for any lower cost options or alternatives that may be available.

Medication prior authorizations (PAs) with Highmark that expire after Dec. 31, 2025, will be honored with CVS Caremark. Once your prior authorization has expired, you will need to work with your doctor for a new PA to be submitted to CVS Caremark. 

The University places the highest priority in safeguarding employee information, and all information is handled securely in accordance with the federal Health Insurance Portability and Accountability Act (HIPAA).  

As the University strives to offer its employees access to affordable, high-quality health care, Penn State continually reviews its employee benefits in an effort to keep costs low for employees and their families. Any time there is a change in providers, Penn State Human Resources works to minimize any potential impacts on the services and care employees and their dependents receive. 

Starting at the end of November 2025, CVS Caremark will be sending out letters to impacted members regarding changes in formulary status for the medications that they are currently taking. Once that letter is mailed to you, there will also be a follow up phone call from CVS Caremark to discuss with you the next actions needed regarding your medication.