Editor’s note: This story is part of a series of articles designed to help employees better understand and navigate their benefits.
UNIVERSITY PARK, Pa. — Benefits open enrollment for 2026 has come and gone, and most Penn State employees have chosen between the Lion Traditional, Lion Advantage HSA and Lion Advantage Flex Plans. With deductibles resetting to start the new calendar year, employees may have questions about how their plans work, such as which costs apply to their deductibles and how much they need to pay before hitting their out-of-pocket maximum.
Penn State Human Resources is providing the following breakdown of each health plan to help employees better understand the plans they chose for 2026.
What are the plans?
Penn State has three health care plan options, administered through Highmark, for employees to choose from, based on their employee eligibility status: Lion Traditional, Lion Advantage HSA and the Lion Advantage Flex plans.
- The Lion Traditional plan is a lower-deductible health plan option with a higher employee contribution.
- The Lion Advantage HSA plan is a High-Deductible Health Plan (HDHP) option with a lower employee contribution, paired with a Health Savings Account (HSA).
- The Lion Advantage Flex Plan is specifically for faculty, staff and postdoctoral appointees who may already be enrolled in Medicare, or employees enrolled in Tricare or other health insurance.
How do the health care plans work?
All of Penn State’s medical plans are self-insured, meaning that for each portion of the plan paid by the employee, the University is billed for and pays the remaining portion of the claim. The University and employees share the cost of coverage, with Penn State paying 75% and employees paying 25%. After the deductible and co-insurance maximums have been met, medical services that fall in this bucket would be paid at 100% by Penn State.
What costs apply to your deductible depends on which health care plan you choose.
The Lion Traditional plan has three buckets where costs will accrue:
- Medical services — Any medical services, such as X-rays, bloodwork, surgeries, MRIs and hospital stays will apply to this bucket until the out-of-pocket maximum has been reached.
- Copays — Copayments for office visits, urgent care visits or emergency room visits do not count toward the medical deductible and coinsurance.
- Prescription costs — Prescription costs are separate from the Highmark administered medical deductible, coinsurance and copays. As of Jan. 1, prescription benefits are administered by CVS Caremark and costs carry their own out-of-pocket maximum. The plan will pay the applicable coinsurance portion up to $2,000 per person and $8,000 for a family.
Under the Lion Advantage HSA and Lion Advantage Flex plans, there is only one bucket where all medical services administered by Highmark Blue Shield and prescription services administered by CVS Caremark apply. Doctor appointments, X-rays, bloodwork, surgeries, MRIs, hospital admissions and prescription costs will apply to this single bucket until the out-of-pocket maximum has been reached.
Are copays a part of all the plans?
Copays are only a part of the Lion Traditional plan design. A copay is a fixed amount a plan holder is responsible for paying for a particular service at the time of the appointment or procedure. The cost of copays does not count toward the medical deductible and coinsurance. There is no maximum for the accrual of copay amounts.
There is generally no payment due at the time of service under the Lion Advantage and Advantage Flex plans. However, the subscriber will receive a bill from their provider. The subscriber may then choose to pay the bill from their Health Savings Account (HSA) or another personal account.
Once the deductible is met, what does the coinsurance cover?
After the deductible is reached, the health care plans will begin to cover a portion of the cost for eligible health care. For Penn State employees, the health plan covers 90% of all in-network care after the deductible is reached. Employees pay 10% for most services until reaching the applicable out-of-pocket maximum.
The deductible resets at the beginning of each year.
When is the out-of-pocket maximum reached?
The out-of-pocket maximum includes the deductible and coinsurance and is the most a plan holder will pay for certain health care expenses in a calendar year. Once a plan holder reaches their out-of-pocket maximum, expenses are covered by Penn State at 100% for the remainder of the benefit year.
The dollar value for the deductibles and out-of-pocket maximums for each plan can be found on the Penn State Human Resources website.
Where can I learn more about my health insurance plan?
Information on each of the plans can be found by visiting the Human Resources website. During open enrollment, employees can also attend webinars and take advantage of the Benefits Mentor tool in Workday to calculate which option is best for them based on their prior and current claims. The Health Care Costs Calculator can also help employees compare specific health care contributions for each plan. The calculator can also help employees compare specific health care contributions for each plan.
Any questions about health benefits can be directed to HR Services at 814-865-1473. Employees covered by a collective bargaining agreement should refer to that agreement for information on their health care.