2025 Medical

Before you choose the Green Plan or Blue Plan, you may want to think about the following:

• How much did you spend on health care last year? (premiums, annual deductible, out-of-pocket expenses)
• How well did your health care budget and actual costs match?
• Who do you need to cover during the year?
• Is your doctor(s) in network?
• Do you take any long-term medications and/or specialty drugs?
• Is there any future medical care that you may need?

Here are some tips for electing the right Lennox medical plan:

• Call Quantum Health for personalized 1-on-1 help understanding your options.
• Review the 2025 Lennox medical plan documents.
• Budget your 2025 per paycheck costs.
• Save pre-tax money in a Flexible Spending Account (FSA) to lower your expenses.
• Avoid extra monthly surcharges by taking these actions each year:
  • Certifying Working Spouse Status
  • Confirming Tobacco Use
  • Completing a free annual health screening through the LIIveWell program.

Adding a new dependent under your medical plan?
Within 60 days of enrolling a new dependent in Lennox health coverage, you MUST upload dependent verification documents (marriage certificate, birth certificate, adoption papers) in BenefitSource. Call (800) 284-4549 to check the status as dependent coverage will not be effective until eligibility is confirmed

It is important to understand how your health insurance plan works if you want to avoid unexpected medical bills and out-of-pocket costs.

The Green Plan and Blue Plan both allow you to see any medical provider you want. However, you will be guaranteed the greatest savings with an in-network provider. Finding a nearby in-network doctor is easy with Quantum Health.

There are three steps to both Lennox medical plans:

1. Meet Your
   Annual DeductibleThe amount you must pay before the plan begins to pay.
   
   In order for your Lennox medical plan to start paying, you must meet the annual deductible (costs for most in-network and out-of-network services and prescription drugs). Remember, in-network preventive care is always covered at 100% and is not subject to the deductible.
   
   

   Annual Deductible	Green Plan		Blue Plan
   	In-Network	Out-of-Network	In-Network	Out-of-Network
   Individual	$1,500	$3,000	$850	$1,700
   Family	$4,500	$9,000	$2,550	$5,100

   
   
2. Share the Cost
   Once you meet the annual deductible, you and the plan share the cost of medical care, called
   coinsuranceCoinsurance is an insured individual’s share of the costs of a covered expense.
   . Your Lennox medical plan will cover 80% of the total cost for most in-network medical services. You will be responsible for the remaining 20% amount.
   
   

   Coinsurance	Green Plan		Blue Plan
   	In-Network	Out-of-Network	In-Network	Out-of-Network
   Medical Plan Pays	80%	60%	80%	60%
   You Pay	20%	40%	20%	40%

   
   
3. Reach Your
   Annual Out-of-Pocket Maximum The maximum amount you will have to pay out of pocket for the plan year. If you reach this limit, the plan will pay 100% of your eligible expenses for the rest of the year.
   
   If you meet the annual out-of-pocket maximum before the plan year ends, your Lennox medical plan will pay 100% of your medical care and prescription drug costs for the rest of the plan year.
   
   

   Annual Out-of-Pocket Maximum	Green Plan		Blue Plan
   	In-Network	Out-of-Network	In-Network	Out-of-Network
   Individual	$8,375	$16,750	$7,825	$15,650
   Family	$16,750	$33,500	$15,650	$31,300

The Green Plan and Blue Plan differ in their per paycheck premiums, annual deductibles, and out-of-pocket maximums, but both plans offer the same services, copays, and coinsurance.

Both plans also offer prescription coverage through OptumRx and VIVIO.

An overview of each plan’s coverage is provided below. For more details, view the plan documents.

Plan Features	Green Plan		Blue Plan
	In-Network	Out-of-Network	In-Network	Out-of-Network
Annual Deductible (The amount you must pay before the plan will pay for non-preventive care.)
Individual	$1,500	$3,000	$850	$1,700
Family	$4,500	$9,000	$2,550	$5,100
Annual Out-of-Pocket Maximum 1 (The maximum amount you will have to pay out-of-pocket for the plan year.)
Individual	$8,375	$16,750	$7,825	$15,650
Family	$16,750	$33,500	$15,650	$31,300
What You Pay After the Annual Deductible Is Met
Preventative Care	$0 (no deductible)	Not covered	$0 (no deductible)	Not covered
Physician Office Visit	20%	40%	20%	40%
Outpatient Lab and X-ray Services 2	$0 (no deductible)	40%	$0 (no deductible)	40%
Hospital Services	20%	40%	20%	40%
Urgent Care	20%	40%	20%	40%
Emergency Room 3	$300 + 20% ($300 waived if admitted within 24 hours)		$300 + 20% ($300 waived if admitted within 24 hours)
Ambulance Services	20%		20%
Outpatient Therapy 4	20%	40%	20%	40%
Chiropractic Services	20%	40%	20%	40%
Behavioral Health / Substance Abuse	20%	40%	20%	40%

Starting January 1, 2025, both Green Plan and Blue Plan members will be able to take advantage of the following new benefits and program enhancements.

New For 2025!

Unlimited $0 Virtual Care Visits
Lennox will waive all employee costs associated with Doctor on Demand by Included Health, giving medical plan members unlimited access to virtual care for FREE. Whether you’re at home or on the go, you can connect with a board-certified medical doctor or licensed behavioral health therapist for medical or mental health care.

GRAIL Early Cancer Detection
Combined with recommended health screenings, GRAIL can help detect 50+ types of cancer signals before symptoms appear. To be eligible for the free GRAIL Galleri multi-cancer early detection blood test benefit, medical plan members must be age 50+ or between ages 40-49 and considered high-risk by a physician.

Carrum Health Cancer Support
In case of a cancer diagnosis, Carrum Health provides eligible medical plan members with 1-on-1 expert cancer guidance including specialized oncologist reviews and 24/7 access to oncology-certified nurse support during diagnosis and treatment.

Omada For Prevention
Stay on track with healthy routines. Eligible medical plan members will be able to maintain healthy weight and reduce their risk of chronic diseases with Omada for Prevention, a digital lifestyle change program. The program includes 1-on-1 personalized support and free smart health devices.

Lantern (formerly known as SurgeryPlus)
SurgeryPlus will change its name to Lantern in 2025. Eligible medical plan members will receive the same trusted surgical care and $0 approved procedures. In 2025, a pre-surgery phone consultation with Lantern will be required for all joint and spine procedures (regardless of whether a Lantern surgeon is used). Unless this prior-authorization step is completed, any joint and spine surgery performed by a non-Lantern surgeon will not be covered.

Current programs that will continue to be free…

Second Medical Opinions
When you receive a new diagnosis or a recommended treatment plan, you want to know that it’s accurate and in your best interest. With Expert Medical Opinions by Included Health, you can get a second medical opinion for free to help you make more informed decisions about your health.

Hinge Health Virtual Physical Therapy
Hinge Health offers you access to a virtual physical therapy program that targets muscle and joint pain in the back, knee, hip, shoulder, and other areas, as well as women’s pelvic health – no referral required. Eligible participants receive a personal coach, a physical therapist, and a wearable sensor for live feedback.

Oshi Health Virtual Digestive Care
Oshi Health virtually connects you with a team of top gastroenterologists who can treat common digestive symptoms, help manage chronic gastrointestinal (GI) conditions, and provide health coaching – no referral required. Eligible participants can also use this benefit between visits to their primary GI doctor.

Diabetes Management
A personalized coaching program is available at Omada Health to help you lead a healthier lifestyle and better manage your symptoms of pre-diabetes or diabetes. Virta Health’s research-backed, provider-led treatment program can help you reverse Type 2 diabetes without medication or surgery. Eligibility requirements must be met to register for these programs. Free smart devices are included.

Hypertension Management
Managing and lowering your high blood pressure can be easier with Omada Health’s lifestyle coaching benefit. Eligibility requirements must be met to register for this program. Free smart devices are included.

Quantum Health’s One-on-One Support & $0 Copay Prescription Program
Through Quantum Health’s One-on-One Support Program, all medical plan members can receive free 24/7 nurse support for specific chronic conditions such as asthma, diabetes, coronary artery disease (CAD), congestive heart failure (CHF), and chronic obstructive pulmonary disease (COPD). You may even qualify for FREE chronic condition-specific medications through the $0 Copay Prescription Program.

Tobacco Cessation Program
With Quantum Health, you and/or your covered spouse can quit tobacco using free nicotine replacement aids and 5 quit counseling sessions. The Tobacco Use monthly surcharge can be stopped and surcharges for the current year refunded if you (or your covered spouse) complete 5 counseling sessions.

Whether you enroll in the Green Plan or Blue Plan, you must complete these mandatory steps each year to avoid extra charges and maximize savings:

Certify Working Spouse Status

A $100 monthly Working Spouse surcharge will apply if you enroll a working spouse who is offered health coverage through their employer. If this does not apply and you wish to avoid the surcharge, be sure to answer “No” on the Working Spouse Status question in BenefitSource during Open Enrollment every year.

NOTE: If your status changes, call (800) 284-4549 and submit a Working Spouse Status affidavit.

Confirm Tobacco Use

A $150 per person monthly Tobacco Use surcharge will apply if you and/or your covered spouse uses tobacco and enrolls in a Lennox medical plan. If this does not apply and you wish to avoid the surcharge, be sure to answer “No” on the Tobacco Use question in BenefitSource during Open Enrollment every year.

NOTE: If you/your spouse’s status changes during the year, call (800) 284-4549 and submit a Tobacco Use affidavit.

Complete an Annual Health Screening

A $75 per person monthly Wellness surcharge will apply if you and/or your covered spouse do not complete an annual health screening every year, and meet or improve 3 out of 5 measured health metrics by the next set deadline. To avoid this surcharge, visit LIIveWell for the latest information and deadlines. First time users will have to register.

NOTE: In the case of a medical condition or pregnancy, a screening waiver can be submitted.

If you retire before age 65 and become entitled to Medicare after you’ve signed up for COBRA, your COBRA benefits cease. COBRA will cover your spouse and/or dependent children, if they are already enrolled in coverage, for up to 36 months.

If you retire after age 65 and are enrolled in Medicare (Parts A & B), you can continue COBRA coverage, as well as having Medicare. Medicare coverage will be primary. However, there are often more cost-effective insurance products for you to use with your Medicare that cost less than your COBRA, so please review your options carefully.

If you continue working for Lennox after age 65, Lennox’s medical coverage will remain primary.

If you need a Medicare form completed, please reach out to April Williams at April.Williams@lennox.com.