Overview of Coverage - Lion Traditional

2024 Lion Traditional Coverage - Faculty & Staff

Details for each Faculty & Staff plan are able to be reviewed within the Summary of Benefit Coverage (SBC) and Coverage Grids below. 

Deductible
Salary Range < = $45,000 $45,001 - $60,000 $60,001 - $90,000 > $90,000
Individual $250 $375 $500 $625
Family $500 $750 $1,000 $1,250
Coinsurance Out-of-Pocket Maximum
Individual $1,250
Family $2,500
Out-of-Pocket Maximum (Deductible + Coinsurance)
Individual $1,500 $1,625 $1,750 $1,875
Family $3,000 $3,250 $3,500 $3,750
Member Coinsurance (after deductible)
Percentage 10%
Services
Preventive Care
Highmark Preventive Schedule		 Covered at 100%
Office Visit $20 copay
Well360 Virtual Health Telemedicine $0 copay
Specialist Visit $30 copay
Urgent Care $30 copay
Emergency Room (waived if admitted) $100 copay
Faculty & Staff Prescription
$2,000 Individual / $8,000 Family Prescription out-of-pocket maximum
Preventive Drugs (lower coinsurance only)
Preventive Drug List
Generic Drugs 10% Coinsurance
Preferred Brand Drugs 20% Coinsurance
Non-Preferred Brand Drugs 40% Coinsurance
Retail (30-day supply)
Generic Drugs 50% Coinsurance
Preferred Brand Drugs 50% Coinsurance
Non-Preferred Brand Drugs 70% Coinsurance
Mail order
Generic Drugs 20% Coinsurance
Preferred Brand Drugs 20% Coinsurance
Non-Preferred Brand Drugs 70% Coinsurance
Specialty Medications
Preferred Brand Drugs 50% Coinsurance, $50 Maximum
Non-Preferred Brand Drugs 70% Coinsurance, $100 Maximum

 

2024 Lion Traditional Coverage - Technical Services

Details for each Technical Services plan are able to be reviewed within the Summary of Benefit Coverage (SBC) and Coverage Grids below:

Deductible
Individual $250
Parent/Child(ren) $250/$375
Family $250/$500
Coinsurance Maximum
Individual $750
Parent/Child(ren) $750/$1,125
Family $750/$1,500
Out-of-Pocket Maximum
Individual $1,000
Parent/Child(ren) $1,000/$1,500
Family $1,000/$2,000
Member Coinsurance
Percentage 10%
Services
Preventive Care
Highmark Preventive Schedule		 Covered at 100%
Office Visit $10 copay
Well360 Virtual Health Telemedicine $10 copay
Specialist Visit $20 copay
Urgent Care $20 copay
Emergency Room (waived if admitted) $100 copay
 
Technical Services Prescription
$1,000 Individual / $6,000 Family Prescription out-of-pocket maximum
Preventive Drugs (lower coinsurance only)
Preventive Drug List
Generic Drugs 10% Coinsurance
Preferred Brand Drugs 20% Coinsurance
Non-Preferred Brand Drugs 40% Coinsurance
Retail (30-day supply)
Generic Drugs 50% Coinsurance
Preferred Brand Drugs 50% Coinsurance
Non-Preferred Brand Drugs 70% Coinsurance
Mail Order (90-day supply)
Generic Drugs 20% Coinsurance
Preferred Brand Drugs 20% Coinsurance
Non-Preferred Brand Drugs 70% Coinsurance
Specialty Medications
Preferred Brand Drugs 50% Coinsurance, $50 Maximum
Non-Preferred Brand Drugs 70% Coinsurance, $100 Maximum