Condition Care Program
Condition Care Program
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 or CVS Caremark; eligible claims will process at the 100% level automatically.
You may contact Highmark at (844) 945-5509 or CVS Caremark at (833) 298-7175 with any questions regarding coverage under the Condition Care Program.
- Diabetes (Type 1 or Type 2)
- High Cholesterol
- Hypertension
Insulin use is a key criterion for prior approval of a Continuous Glucose Monitoring (CGM) for a Diabetes diagnosis. If an individual is using a CGM for treatment of Type 2 Diabetes, but not currently using insulin, you may wish to speak with your doctor about other over the counter (OTC) options, such as the CGM examples below, that are currently available. While these OTC options are not able to be submitted to your medical plan, you may use your Health Savings Account (HSA) or Health Care Flexible Spending Account (FSA) funds to pay for these options.
- Dexcom Stelo: $99 per month subscription (discounted if you have longer subscriptions) for the sensors.
- Abbott Lingo: There are options to get it every 2 weeks, every 4 weeks or every 12 weeks.
Additionally, if you are a member unable to fill a CGM due to the insulin dependent criteria, there are regular, finger-stick glucose monitor brands that are covered alternatives under the plan.