Faculty & Staff - Overview of Coverage
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 - Overview of Coverage
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 |
