Lion Advantage HSA Plan
Below are details regarding the plan design.
Deductible, Coinsurance, Out-of-Pocket Maximum, & Cost Sharing
Deductible
| Individual Coverage | Family Coverage | |
|---|---|---|
| Deductible | $1,650 | $3,300 |
Coinsurance Out-of-Pocket Maximum
| Individual Coverage | Family Coverage | |
|---|---|---|
| Coinsurance Maximum | $1,975 | $3,950 |
| Member Coinsurance (after deductible) | 10% | 10% |
Total Out-of-Pocket Maximum
| Individual Coverage | Family Coverage | |
|---|---|---|
| Total Out-of-Pocket Maximum | $3,625 | $7,250 |
Cost Sharing
| Coverage | |
|---|---|
| Preventive Care | Covered at 100% |
| Office Visit | Deductible and Coinsurance apply |
| Well360 Virtual Health Telemedicine | $0 after Deductible |
| Specialist | Deductible and Coinsurance apply |
| Urgent Care | Deductible and Coinsurance apply |
| Emergency Room (waive if admitted) | Deductible and Coinsurance apply |
Prescription Coverage
| Medication Type | Generic Medications | Preferred Brand Medications | Non-Preferred Brand Medications |
|---|---|---|---|
| Preventive Medications | 10% Coinsurance | 20% Coinsurance | 40% Coinsurance |
| Retail (30-day supply) | 10% Coinsurance | 20% Coinsurance | 40% Coinsurance |
| Mail (90-day supply) | 10% Coinsurance | 20% Coinsurance | 40% Coinsurance |
| Preferred Brand Medications | 20% Coinsurance, $65 Minimum |
|---|---|
| Non-Preferred Brand Medications | 40% Coinsurance, $100 Minimum |
| Preferred Brand Medications | Integrated with Medical |