Health Plans
Medical Coverage
Having the right medical plan is essential for both your health and financial well-being. You’ll have the same medical plan options to choose from in 2025, and there are no changes to these plans:
- CareFirst Core PPO Plan, a preferred provider organization
- LiUNA BU CareFirst Network Only Plan, an exclusive provider organization (EPO)
- Kaiser Permanente HMO Plan, a health maintenance organization (HMO)
All three plans cover preventive care, emergency care, prescriptions, and limit the amount you will pay out of pocket each year. Their differences include their networks of providers (doctors, hospitals, etc.) and how the plans pay for medical expenses.
The two CareFirst medical plans also come with convenient telehealth visits via MDLIVE with a minimal copay and expert support through Quantum Health, your dedicated advocate for answering your medical questions, big or small.
Here’s a comparison of key plan features:
| In-Network Benefits (unless otherwise labeled)* | CareFirst Core PPO Plan | LiUNA BU CareFirst Network Only Plan | Kaiser Permanente HMO Plan |
|---|---|---|---|
| Provider network | BlueChoice Advantage PPO network (through CareFirst) | BlueChoice Advantage network (through CareFirst) | Kaiser Permanente |
| Access to Quantum Health advocacy service | Yes | Yes | No |
| Annual deductible (what you pay for medical and mental health services before the plan pays benefits) |
In-network: $500 individual $1,500 family Out-of-network: $1,000 individual $3,000 family |
In-network: None Out-of-network: Not covered |
In-network: None Out-of-network: Not covered |
| Out-of-pocket maximum (the most you'll pay in a year for medical, mental health, and prescription drugs) |
In-network: $2,000 individual $6,000 family Out-of-network: $4,000 individual $8,000 family |
In-network: $1,500 individual $4,500 family Out-of-network: Not covered |
In-network: $3,500 individual $9,400 family Out-of-network: Not covered |
| Coinsurance (what you pay for most services after the deductible is met) |
In-network: 20% Out-of-network: 30% |
In-network: None Out-of-network: Not covered |
In-network: None Out-of-network: Not covered |
| Health Care Flexible Spending Account (FSA) eligible | Yes | Yes | Yes |
| Preventive care | 100% covered, no deductible | 100% covered, no deductible | 100% covered, no deductible |
| Office visit (primary and specialist) |
You pay 20% of the cost after deductible is met | $15 / $30 copay | $15 / $30 copay |
| Diagnostic, X-ray, MRI, CAT scan | You pay 20% of the cost after deductible is met | 100% covered | 100% covered |
| Urgent care | $50 copay | $25 copay | $30 copay |
| Emergency room | $150 copay (waived if admitted) |
$50 copay (waived if admitted) |
$50 copay (waived if admitted) |
| Outpatient surgery (medical and mental health services) |
You pay 20% of the cost after deductible is met | $60 copay | $50 copay |
| Hospitalization (medical and mental health services) |
$250 copay + you pay 20% of the cost after deductible is met | $100 copay | $100 copay |
| Mental Health & Substance Abuse - outpatient | You pay 20% of the cost after deductible is met | $15 copay -office visit; 100% outpatient covered | $15 copay |
| Mental Health & Substance Abuse – inpatient | $250 copay + you pay 20% of the cost after deductible is met | $100 copay | $250 copay |
| Occupation/Physical/Speech Therapy (limited to a combined 90 days per illness or injury per calendar year) | You pay 20% of the cost after deductible is met | $30 copay | $30/visit, limit combined 30 visits per illness/injury per year |
| Artificial Insemination (AI) and Intra-Uterine Insemination (IUI) | You pay 20% of the cost after deductible is met limited to six (6) attempts per live birth and up to a lifetime maximum benefit of $100,000 combined with IVF and Prescription Drugs. |
You pay 50% of cost limited to six (6) attempts per live birth and up to a lifetime maximum benefit of $100,000 combined with IVF and Prescription Drugs. |
You pay 50% |
| In-Vitro Fertilization (IVF) | You pay 20% of the cost after deductible is met limited to three (3) attempts per live birth; and a lifetime maximum of $100,000 combined with AI/IUI and Prescription Drugs. |
You pay 50% of cost limited to three (3) attempts per live birth; and a lifetime maximum of $100,000 combined with AI/IUI and Prescription Drugs. |
You pay 50% limited to three (3) attempts per live birth; and a lifetime maximum of $100,000 |
| Pre- and Post-Natal Care- routine | 100% covered, no deductible | 100% covered | 100% covered, after the initial visit |
| Gender Affirming Care | Benefits are available to the same extent as benefits provided for other inpatient and outpatient services. Click here for an overview | Covered at the applicable copay for members 18 or older. Coverage requires medically necessary review in accordance with Kaiser Medical Policy. | |
| Vision Care | Adult biennial eye exam covered 100% through Wilmer; must call 410-955- 5080 to
schedule Eyeglasses, new contact lenses, and dispensing of contact lenses not included |
Adult – annual eye exam at a Kaiser Permanente provider and $75 allowance on lenses/frames purchased at
Kaiser Permanente Child up to age 19 – annual eye exam and 1 pair of glasses per year. |
|
| Telemedicine | MDLIVE $20 copay | MDLIVE $15 copay | 100% covered |
| Prescription drugs managed by | Capital Rx | Capital Rx | Kaiser Permanente |
| Prescription drugs: retail (up to 30-day supply) |
Generic: $10 copay Formulary brand name: You pay 20% of the cost ($30 min / $45 max) Non-formulary brand: You pay 25% of the cost ($60 min / $100 max) |
Generic: $10 copay Formulary brand name: You pay 20% of the cost ($30 min / $45 max) Non-formulary brand: You pay 25% of the cost ($60 min / $100 max) |
Generic: $7 / $10 copay (Kaiser / community pharmacies) Formulary brand name: $15 / $20 copay (Kaiser / community pharmacies) Non-formulary brand: $30 / $35 copay (Kaiser / community pharmacies) |
| Prescription drugs: mail order (up to 90-day supply) **You also can fill prescriptions through one of the Johns Hopkins Outpatient Pharmacies or use their mail-order services. |
Generic: $25 copay Formulary brand name: $75 copay Non-formulary brand: $150 copay |
Generic: $25 copay Formulary brand name: $75 copay Non-formulary brand: $150 copay |
Generic: $14 copay Formulary brand name: $30 copay Non-formulary brand: $60 copay |
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Family includes two or more individuals.
*If you select the CareFirst Core PPO Plan, you’ll have the option to use out-of-network providers. However, the plan pays less for out-of-network services, and there is a separate deductible and out-of-pocket maximum. Certain services may not be covered. See the Summary of Benefits and Coverage for details. Out-of-network providers are not covered in the LiUNA BU CareFirst Network Only Plan and Kaiser Permanente HMO Plan, unless you receive urgent care (Kaiser Permanente HMO Plan only: $30 copay) and emergency room services (both LiUNA BU CareFirst Network Only Plan and Kaiser Permanente HMO Plan: $50 copays) outside the network service area. |
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*If you select the CareFirst Core PPO Plan, you’ll have the option to use out-of-network providers.
However, the plan pays less for out-of-network services, and there is a separate deductible and
out-of-pocket maximum. Certain services may not be covered. See the Summary of Benefits and Coverage
for details. Out-of-network providers are not covered in the LiUNA BU CareFirst Network Only Plan
and Kaiser Permanente HMO Plan unless you receive urgent care (Kaiser Permanente HMO Plan only: $30
copay) and emergency room services (both LiUNA BU CareFirst Network Only Plan and Kaiser Permanente
HMO Plan: $50 copays) outside the network service area.
All prescription drug managers (including JHU’s pharmacy benefits manager, Capital Rx) have a formulary—a list of drugs covered by the plan. JHU’s plan covers both formulary and non-formulary drugs. However, you’ll pay more for non-formulary drugs. |
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Dental Coverage
Comparing your JHU dental plan options
Both dental plan options feature the Delta Dental PPO network of providers. Both options will pay benefits for out-of-network providers, but you’ll pay more if you go out-of-network.
| Plan Features | Delta Dental Core (no orthodontia) |
Delta Dental Enhanced (with orthodontia) |
|---|---|---|
| Annual deductible* | Single: $75 Family: $150 |
Single: $50 Family: $100 |
| Preventive care (plan pays) | 100% in-network, no deductible | 100% in-network, no deductible |
| Basic services | You pay 30% of cost after deductible is met | You pay 10% of cost after deductible is met |
| Major services, implants | You pay 50% of cost after deductible is met | You pay 40% of cost after deductible is met |
| Orthodontia (child and adult) | Not covered | You pay 50% of cost after deductible is met |
| Annual maximum benefit (excludes orthodontia) | $1,000 | $2,000 |
| Lifetime maximum benefit for orthodontia (per covered member) | Not covered | $2,000 |
*A deductible is the annual amount you must pay for services before the plan pays benefits. The deductible only applies to basic and major services; there is no deductible for preventive care.
To view dental providers:
- Go to deltadentalins.com/jhu, or call 800-932-0783 from 8 a.m. to 8 p.m. ET, Monday through Friday.
- Click the Find a Dentist tool on the right. Enter a location (address, ZIP code, or city and state).
- Select the Delta Dental PPO or Delta Dental Premier network from the drop-down menu:
- Delta Dental PPO: These dentists have agreed to reduced fees, so you won’t get charged more than your expected share of the bill.
- Delta Dental Premier: If you can’t find a PPO dentist, Delta Dental Premier dentists offer the next best opportunity to save, as these dentists have agreed to set fees.
- For a more targeted search, you can enter the name of your dental office.
Vision Coverage
Vision coverage is provided through EyeMed. Here are some of the highlights of the EyeMed Vision Plan:
| Plan Features | EyeMed Vision Plan (In-Network Cost) |
EyeMed Vision Plan (Out-of-Network Reimbursement) |
|---|---|---|
| Eye exam (every 12 months) | You pay $10 copay | Plan reimburses you up to $40 |
| Lenses (every 12 months in lieu of contact lenses)
Single-vision Lined bifocal Lined trifocal Lenticular |
You pay $20 copay | Plan reimburses you up to:
$40 $60 $80 $80 |
| Frames (every 12 months) | $150 allowance, $0 copay; you get 20% off balance over $150 | Plan reimburses you up to $66 |
| Contact lenses (every 12 months in lieu of lenses)
Conventional Disposable Medically necessary contact lenses |
$0 copay, $150 allowance (once yearly); you get 15% off balance over $150 $0 copay, $150 allowance; plus balance over $150 $0 copay; covered by plan |
Plan reimburses you up to:
$150 $150 $210 |
| Laser vision correction | 15% off the retail price or 5% off the promotional price | N/A |
To find out if your provider participates in the EyeMed network, go to eyemed.com.
Free biennial adult eye examination
You and your eligible dependents age 18 and older who are enrolled in the CareFirst Core PPO Plan or the CareFirst Enhanced PPO Plan are eligible for a free eye exam every two years by a selected School of Medicine Wilmer Eye Institute provider in the Baltimore area. The comprehensive eye exam will consist of a routine eye exam and complete visual system exam. Call 410-955-5080 to schedule an appointment.
Note: Eyeglasses and fitting or dispensing new contact lenses are not included in the routine eye exam and are not covered by the university medical plans; however, you may enroll in the EyeMed Vision Plan.