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.

See Cost Scenario Examples

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Lion Traditional Plan

Lion Traditional plan has “3 buckets”. Each portion of medical services, administered by Highmark Blue Shield, or prescription coverage, administered by CVS Caremark, will apply.

Bucket #1	Bucket #1 Highlights
DEDUCTIBLE • Faculty & Staff - Deductible per salary • Technical Service - Deductible per CBA COINSURANCE AND COINSURANCE MAXIMUM • 10% / 90% for medical services • Faculty / Staff = $2,000 Individual, $4,000 Family • Tech Service = $750 to $1,500 based on enrollment tier MAX OUT-OF-POCKET: (DEDUCTIBLE + COINSURANCE) • Faculty / Staff = $2,250 to $2,250 depending on deductible and coverage tier • Tech Service = $1,000 to $2,000 depending on deductible and coverage tier	All employee medical services first apply to the deductible. After the deductible is met, all medical services will apply the coinsurance amount toward the coinsurance maximum. Once the max out-of-pocket (deductible + coinsurance maximum) has been met, the plan pays 100%.

Bucket #1

Bucket #1 Highlights

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

COINSURANCE AND COINSURANCE MAXIMUM
•   10% / 90% for medical services
•   Faculty / Staff = $2,000 Individual, $4,000 Family
•   Tech Service = $750 to $1,500 based on enrollment tier

MAX OUT-OF-POCKET: (DEDUCTIBLE + COINSURANCE)
•   Faculty / Staff = $2,250 to $2,250 depending on deductible and coverage tier
•   Tech Service = $1,000 to $2,000 depending on deductible and coverage tier

All employee medical services first apply to the deductible.

After the deductible is met, all medical services will apply the coinsurance amount toward the coinsurance maximum.

Once the max out-of-pocket (deductible + coinsurance maximum) has been met, the plan pays 100%.

Bucket #2	Bucket #2 Highlights
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 = $150 Faculty/Staff; $100 Technical Service * Emergency Room copay waived if admitted	Copays are separate from medical services under the deductible and coinsurance; there is no maximum for the accrual of copay amounts.

Bucket #3	Bucket #3 Highlights
PRESCRIPTION • Medication Categories * Generic * Formulary Brand * Non-Formulary Brand	Prescription costs are separate from the Highmark administered medical deductible, coinsurance, and copays. CVS Caremark will administer prescription benefits starting January 1, 2026. Prescription costs under the Lion Traditional plan carry their own out-of-pocket maximum.

Lion Advantage HSA and Lion Advantage Flex

Lion Advantage HSA and Lion Advantage Flex plans have “1 bucket” where medical services and prescription costs apply. Highmark Blue Shield will continue to administer medical services while CVS Caremark will administer prescription benefits starting January 1, 2026.

Bucket #1	Bucket #1 Highlights
DEDUCTIBLE • $1,700 Individual • $3,400 Family COINSURANCE AND COINSURANCE MAXIMUM • 10% / 90% for medical services • $1,975 Individual • $3,950 Family MAX OUT-OF-POCKET: (DEDUCTIBLE + COINSURANCE) • $3,675 Individual • $7,350 Family PRESCRIPTION • Medication Categories * Generic * Formulary Brand * Non-Formulary Brand	All employee medical services and prescription costs first apply to the deductible. Office visits, x-rays, lab work, inpatient and/or outpatient services, and prescription medications. After deductible is met, all medical services will apply the coinsurance amount medical services and prescription costs until the coinsurance maximum is met. Once the max out-of-pocket (deductible + coinsurance maximum) has been met, the plan pays 100%.

Bucket #1

Bucket #1 Highlights

DEDUCTIBLE
•   $1,700 Individual
•   $3,400 Family

COINSURANCE AND COINSURANCE MAXIMUM
•   10% / 90% for medical services
•   $1,975 Individual
•   $3,950 Family

MAX OUT-OF-POCKET: (DEDUCTIBLE + COINSURANCE)
•   $3,675 Individual
•   $7,350 Family

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

All employee medical services and prescription costs first apply to the deductible. Office visits, x-rays, lab work, inpatient and/or outpatient services, and prescription medications.

After deductible is met, all medical services will apply the coinsurance amount medical services and prescription costs until the coinsurance maximum is met.

Once the max out-of-pocket (deductible + coinsurance maximum) has been met, the plan pays 100%.