Major Medical/Rx Plans
Clario offers three medical plans through Highmark BCBS: two High Deductible Health Plans with a Health Savings Account and a PPO plan. Each plan utilize the national PPO network of physicians, hospitals, and other health care providers. With each plan, you have the freedom to seek services from providers who do not participate in the PPO network; however, you will typically have more out-of-pocket costs for covered services, and you will need to file claims for reimbursement
Elections you make during Open Enrollment will be effective January 1, 2026 and remain in effect until December 31, 2026 unless you experience a Qualified Life Event.
Plan 1: PPO $1,000 (individual) / $2,000 (family)
The PPO plan has an aggregate deductible and out-of-pocket maximum. Each member accumulates towards the entire deductible and out-of-pocket maximum collectively.
Plan 2: HDHP $2,000 (individual) / $4,000 (family)
The HDHP plan has an aggregate deductible with an embedded out-of-pocket maximum. This means that each member has their own deductible to meet, but all accumulate towards the overall out-of-pocket maximum.
Plan 3: Saver HDHP $5,000 (individual) / $10,000 (family)
The Saver HDHP plan has an aggregate deductible and out-of-pocket maximum. Each member accumulates towards the entire deductible and out-of-pocket maximum collectively.
A comparison chart of the plans is shown below.
Medical Plan Benefits
1 Deductible waived
2 After deductible
3 There is an aggregate deductible for family coverage. The entire family deductible must be met before copayments or coinsurance are applied for an individual family member
4 When you seek care at an out of network provider you will be responsible for balance billing.
Your cost share for Diagnostic Testing is dependent on the place of service. Diagnostic Testing for Professional Provider's Offices are only covered at 100% after office visit copay, if billed in conjunction with an office visit code, on the same date of service. If you go to an independent lab (Labcorp, Quest, etc), then you will be charged deductible and 80% coinsurance.
Please contact Quantum Health for coordination and full details of your benefits coverage.
Your cost share for Diagnostic Testing is dependent on the place of service. Diagnostic Testing for Professional Provider's Offices are only covered at 100% after office visit copay, if billed in conjunction with an office visit code, on the same date of service. If you go to an independent lab (Labcorp, Quest, etc), then you will be charged deductible and 80% coinsurance.
Please contact Quantum Health for coordination and full details of your benefits coverage.
Prescription Drug Benefits ⊕
Medical Plan Documents
Consider a Participating Provider Organization (PPO) plan if:
- You want access to both in-and out-of-network providers
- You want a lower deductible and out-of-pocket maximums
- You are willing to pay more in premiums
Consider a High Deductible Health Plan (HDHP) if:
- You want to be able to see any provider, even a specialist, without a referral
- You want tax-free savings on your healthcare costs
- You want to build a savings account for future healthcare costs for you and your eligible family members
- You want an extra way to add to your retirement savings
PrudentRx - Reduce Out-of-Pocket Costs on your Specialty Medications
PrudentRx is available for the Medical PPO and HDHP plans
CVS Caremark has collaborated with PrudentRx exclusively for a program that may save you money when you fill eligible specialty medications.
How It Works
Participating members will have a $0 out-of-pocket cost on eligible specialty medications. You will be able to obtain non-need based manufacturer assistance where applicable. Not all specialty prescriptions offer manufacturer assistance.
Members enrolled in the HDHP plan must fully satisfy their deductible before they are eligible for a final $0 out-of-pocket cost.
Highmark Programs
Lantern
Today, more than ever, having surgery can be complicated and costly. Lantern is a surgery and medical benefit that makes it easier, more comfortable, and less expensive to get the highest-quality health care for a variety of procedures, including knee, hip, shoulder, spine, heart, weight loss surgeries, cancer care, and more.
Beginning January 1, 2026, anyone enrolled the Highmark medical plans and in need of bariatric surgery will be required to go through Lantern. All other surgeries with Lantern are optional. If you get the bariatric surgery outside of Lantern, it will not be covered.
Your personal care specialist makes sure you have a simplified care experience. Lantern helps with all planning and paperwork, allowing you to focus on your health. If you need to travel for care, your personal care specialist will make your travel arrangements and Lantern will cover the costs for you and a companion.
Total Support
Your personal care specialist makes sure you have a simplified care experience. Lantern helps with all planning and paperwork, allowing you to focus on your health. Quantum Health can also help you every step of the way!
How It Works
- Register for Lantern.
- Call Lantern or Quantum before scheduling care. A dedicated Care Advocate learns about your needs and explains your personalized options.
- Meet your care specialist. A dedicated care specialist will be with you every step of the way to answer your questions, gather information you need, and schedule an initial consultation.
- See how much you will save compared to your traditional insurance plan.
- Receive world-class care.
How Does Lantern Administer Travel Benefits?
When Lantern manages travel on behalf of your health plan, we pay most travel expenses directly to the vendor. The only funds Lantern pay directly to members are for per diem and mileage reimbursement. These funds are issued via a preloaded debit card.
- Hotel cap: $225 per night
- Flight cap: $500 round trip (economy only)
- Travel includes one required companion (must check in for surgery)
Minimum distances for coverage
- Hotels: Over 100 miles from home
- Flight: Over 200 miles from home
Lodging Durations:
- Outpatient Care: 3 nights
- Inpatient Care: 5 nights
- Consult and Surgery (rare occurrence): 7 nights
Costs
PPO: There is no out of pocket cost for a procedure when you use Lantern
HDHP: You must meet your deductible amount before the cost are fully covered
