The Lion Advantage plan is a Qualified High-Deductible Health Plan (QHDHP). It has a lower payroll contribution but a higher deductible than the Lion Traditional plan.
Following are some features of the Lion Advantage plan:
- Medical coverage is the same as for the Lion Traditional plan
- Physician network is the same as for the Lion Traditional plan
- Drug formulary is the same as for the Lion Traditional plan
- In-network preventive care is covered at 100% with no deductible or coinsurance
- Includes a Health Savings Account (HSA) that allows subscribers to use pre-tax funds to pay for future and current health care expenses
Paying for Out-of-Pocket Medical Expenses
With the Lion Advantage plan, there is generally no payment due at the time of service; however, the subscriber will receive a bill from their provider. The subscriber may then choose to pay the bill from a Health Savings Account (HSA) or from other personal accounts. If the bill is paid from a Health Savings account, the subscriber may use the Health Equity debit card, or may pay the provider directly through the claims portal.
With the HSA, there is no requirement to substantiate funds; however, it is recommended that for tax purposes, subscribers keep a record of their payments.
See Health Savings Account for more information about employer contributions to the HSA, maximum allowable annual contributions to the HSA, and how this type of account may be used to pay for medical expenses throughout the life span.
Eligibility Limitations for the Lion Advantage plan with the Health Savings Account (HSA)
While all full-time, benefits-eligible employees are eligible, the EMPLOYEE:
- CANNOT be enrolled in Medicare or be collecting Social Security benefits. It is recommended that employees who are returning from retirement consult with their financial advisor regarding implications of dis-enrolling from Medicare in order to be eligible for the HSA, as they will not be able to collect Social Security benefits unless they are enrolled in Medicare. Once an individual dis-enrolls from Medicare, that person is able to contribute to the HSA.
- CANNOT be enrolled in another health plan.
- CANNOT have a balance in a HEALTH CARE Flexible Spending Account (FSA).
- Due to IRS regulations governing HSA plans, Lion Advantage plan members are not eligible to enroll in the Health Care Flexible Spending Account (FSA). If an employee currently has money in an FSA - either through themselves or through a spouse - that person must use all the money in the FSA before enrolling in the Lion Advantage Plan.
- If two Penn State employees are married and have elected a FAMILY coverage under the Lion Advantage with HSA, a Health Care FSA cannot be opened under either employee. In addition, if you are the Penn State employee and your spouse is employed elsewhere and enrolled in a high-deductible health plan with an HSA, a Health Care FSA cannot be opened by either employee. The IRS does not permit use of a Health Care FSA when contributing to an HSA.
- The Dependent Care FSA is available regardless of medical plan participation up to the IRS limits.
- CANNOT have a J1 Visa; J1 Visa holders are eligible for the PPO plan only.
- CANNOT be classified as a Posdoctoral Fellow; Postdoctoral Fellows are eligible for the Lion Traditional Plan only.