2025 Lion Traditional Plan

The Lion Traditional plan is a lower deductible health plan option with a higher employee contribution. Keep in mind that this plan also has a separate prescription out-of-pocket maximum.

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; eligible claims will process at the 100% level automatically.

  • Diabetes
  • High Cholesterol
  • Hypertension

Members of this plan are also able to enroll in the pre-tax Health Care Flexible Savings Account (FSA) to help with medical expenses and reduce your tax liability. 

For more information regarding payroll contributions examples, please visit the Premium Comparison page with Health Care Contribution Calculator.

Faculty & Staff: Deductible, Coinsurance, Out-of-Pocket Max, & Copay Costs

Deductible
Salary Range Individual Coverage Family Coverage
= < $45,000 $250 $500
$45,001 - $60,000 $375 $750
$60,001 - $90,000 $500 $1,000
>$90,000 $625 $1,250
Coinsurance Out-of-Pocket Maximum
Individual Coverage Family Coverage
$1,250 $2,500
Member coinsurance after Deductible is 10% Member coinsurance after Deductible is 10%
Out-of-Pocket Maximum (Deductible + Coinsurance)
Salary Range Individual Coverage Family Coverage
= < $45,000 $1,500 $3,000
$45,001 - $60,000 $1,625 $3,250
$60,001 - $90,000 $1,750 $3,500
>$90,000 $1,875 $3,750
Copay Costs
Service Coverage
Preventive Care Covered at 100%
Office Visit $20 copay
Well360 Virtual Health Telemedicine $0 copay
Specialist $30 copay
Urgent Care $30 copay
Emergency Room (waive if admitted) $100 copay

 

Faculty & Staff: Prescription Coverage

With the Lion Traditional plan, there is a separate out-of-pocket maximum for prescriptions. For individual coverage, the prescription out-of-pocket maximum is $2,000. For family coverage, the prescription out-of-pocket maximum is $8,000.

Medication Type Generic Medications Preferred Brand Medications Non-Preferred Brand Medications
Preventive Medications 10% Coinsurance 20% Coinsurance 40% Coinsurance
Retail (30-day supply) 50% Coinsurance 50% Coinsurance 70% Coinsurance
Mail (90-day supply) 20% Coinsurance 20% Coinsurance 70% Coinsurance
Specialty Medications
Preferred Brand Medications 50% Coinsurance, $50 Maximum
Non-Preferred Brand Medications 70% Coinsurance, $100 Maxmimum

Technical Service: Deductible, Coinsurance, Out-of-Pocket Max, & Copay Costs

Deductible
Coverage Type Deductible
Individual $250
Parent/Child(ren) $250/$375
Family $250/$500
Coinsurance Maximum (member coinsurance is 10% after deductible)
Coverage Type Coinsurance Maximum
Individual $750
Parent/Child(ren) $750/$1,125
Family $750/$1,500
Out-of-Pocket Maximum
Coverage Type Out-of-Pocket Maximum
Individual $1,000
Parent/Child(ren) $1,000/$1,500
Family $1,000/$2,000
Copay Costs
Service Coverage
Preventive Care Covered at 100%
Office Visit $10 copay
Well360 Virtual Health Telemedicine $0 copay
Specialist $20 copay
Urgent Care $20 copay
Emergency Room (waived if admitted) $100 copay

 

Technical Service: Prescription Coverage

With the Lion Traditional plan, there is a separate out-of-pocket maximum for prescriptions. For individual coverage, the prescription out-of-pocket maximum is $1,000. For family coverage, the prescription out-of-pocket maximum is $6,000.

Medication Type Generic Medications Preferred Brand Medications Non-Preferred Brand Medications
Preventive Medications 10% Coinsurance 20% Coinsurance 40% Coinsurance
Retail (30-day supply) 50% Coinsurance 50% Coinsurance 70% Coinsurance
Mail (90-day supply) 20% Coinsurance 20% Coinsurance 70% Coinsurance
Specialty Medications
Preferred Brand Medications 50% Coinsurance, $50 Maximum
Non-Preferred Brand Medications 70% Coinsurance, $100 Maxmimum