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
- CareFirst Enhanced PPO Plan
- CareFirst High Deductible Health Plan (HDHP)
Note: If you’re currently enrolled in the Kaiser Permanente HMO Plan, you can keep that plan for 2025, but it is closed to new enrollments.
All the CareFirst plans offer a national network and provide coverage for the same broad range of services, including:
- Eligible preventive care (covered at 100%)
- Prescription drug coverage
- Convenient telehealth visits
- Expert support through Quantum Health, your dedicated advocate for navigating any medical questions, big or small.
All plans feature prescription drug benefits and convenient telehealth visits via MDLIVE, with a minimal copay.
Quantum Health
Quantum Health is your full-time health care benefits resource and advocate. They offer live, personalized support that can save you time and maybe save you some out-of-pocket expenses.
Connect with Ouantum Health to get answers about your health benefits during annual enrollment. No need to deal with multiple entities or websites. Everything can be addressed by calling Quantum Health or accessing the member portal.
Learn more about each CareFirst medical plan. Here’s a comparison of key plan features:
| In-Network Benefits (unless otherwise labeled)* | CareFirst High Deductible Health Plan (HDHP) | CareFirst Core PPO Plan | CareFirst Enhanced PPO Plan |
|---|---|---|---|
| Provider network | BlueChoice Advantage PPO network (through CareFirst) | BlueChoice Advantage PPO network (through CareFirst) | BlueChoice Advantage PPO network (through CareFirst) |
| Access to Quantum Health advocacy service | Yes | Yes | Yes |
| Annual deductible (what you pay for medical and mental health services before the plan pays benefits) |
In-network: $1,750 individual $3,500 family** Out-of-network: $3,500 individual $7,000 family |
In-network: $500 individual $1,500 family Out-of-network: $1,000 individual $3,000 family |
In-network: $250 individual $750 family Out-of-network: $500 individual $1,500 family |
| Out-of-pocket maximum (the most you'll pay in a year for medical, mental health, and prescription drugs) |
In-network: $3,500 individual $7,000 family Out-of-network: $7,000 individual $14,000 family |
In-network: $2,000 individual $6,000 family Out-of-network: $4,000 individual $8,000 family |
In-network: $1,000 individual $3,000 family Out-of-network: $2,000 individual $6,000 family |
| Coinsurance (what you pay for most services after the deductible is met) |
In-network: 20% Out-of-network: 40% |
In-network: 20% Out-of-network: 30% |
In-network: 10% Out-of-network: 30% |
| Health Savings Account (HSA) eligible | Yes | No | No |
| JHU Health Savings Account (HSA) contribution (contribution amount depends on salary band) |
Salary band $40,000 or less: $500 individual $1,000 family Salary band $40,001–$60,000: $250 individual $500 family |
Not applicable | Not applicable |
| Flexible Spending Account (FSA) eligible | No; eligible for Limited Purpose FSA (for eligible dental and vision care expenses only) | Yes | Yes |
| Prescription drugs managed by | Capital Rx | Capital Rx | Capital Rx |
| Prescription drugs | After meeting the plan's medical deductible, you pay a copay or coinsurance amount per prescription | No deductible; you pay copay or coinsurance depending on the type of drug | No deductible; you pay copay or coinsurance depending on the type of drug |
| 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 | You pay 20% of the cost after deductible is met | You pay 10% of the cost after deductible is met |
| Diagnostic, X-ray, MRI, CAT scan | You pay 20% of the cost after deductible is met | You pay 20% of the cost after deductible is met | You pay 10% of the cost after deductible is met |
| Urgent care | You pay 20% of the cost after deductible is met | $50 copay | $40 copay |
| Emergency room | You pay 20% of the cost after deductible is met | $150 copay (waived if admitted) | $100 copay (waived if admitted) |
| Outpatient surgery (medical and mental health services) |
You pay 20% of the cost after deductible is met | You pay 20% of cost after deductible is met | You pay 10% of cost after deductible is met |
| Hospitalization (medical and mental health services) |
You pay 20% of the cost after deductible is met | $250 copay + you pay 20% of the cost after deductible is met | $250 copay + you pay 10% of the cost after deductible is met |
| Mental Health & Substance Abuse - outpatient | You pay 20% of the cost after deductible is met | You pay 20% of cost after deductible is met | You pay 10% of cost after deductible is met |
| Mental Health & Substance Abuse - inpatient | You pay 20% of the cost after deductible is met | $250 copay + you pay 20% of the cost after deductible is met | $250 copay + you pay 10% of the cost after deductible is met |
| 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 | You pay 20% of cost after deductible is met | You pay 10% of cost after deductible is met |
| Pre- and Post-Natal Care- routine | 100% covered, no deductible | 100% covered, no deductible | 100% covered, no deductible |
|
Artificial Insemination (AI) and Intra-Uterine Insemination (IUI)
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 20% of the cost after deductible is met | You pay 20% of cost after deductible is met | You pay 10% of cost after deductible is met |
|
In-Vitro Fertilization (IVF)
limited to three (3) attempts per live birth; and a lifetime maximum of $100,000 combined with AI/IUI and Prescription Drugs. |
You pay 20% of the cost after deductible is met | You pay 20% of cost after deductible is met | You pay 10% of cost after deductible is met |
| Gender Affirming Care | Benefits are available to the same extent as benefits provided for other inpatient and outpatient services. Click here for an overview. | ||
| 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 |
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| Telemedicine – MD Live |
$20 copay
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| Prescription drugs: retail (up to 30-day supply) |
Generic: $10 copay after deductible Formulary brand name: You pay 20% of the cost after deductible is met Non-formulary brand: You pay 25% of the cost after deductible is met |
Generic: $10 copay Formulary brand name: You pay 20% of the cost (max $60) Non-formulary brand: You pay 25% of the cost (max $125) |
Generic: $10 copay Formulary brand name: You pay 10% of the cost (max $30) Non-formulary brand: You pay 10% of the cost (max $75) |
| Prescription drugs: mail order (up to 90-day supply) (applies to Johns Hopkins Outpatient Pharmacies**) |
Generic: $25 after deductible Formulary brand name: You pay 20% of the cost after deductible is met Non-formulary brand: You pay 25% of the cost after deductible is met |
Generic: $20 copay Formulary brand name: You pay 20% of the cost (max $120) Non-formulary brand: You pay 25% of the cost (max $250) |
Generic: $20 copay Formulary brand name: You pay 10% of the cost (max $60) Non-formulary brand: You pay 10% of the cost (max $150) |
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Family includes two or more individuals.
*You 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. **The full family deductible must be met before you begin paying coinsurance. The deductible may be met by one individual or the combined amount contributed by all members covered by your insurance. |
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*You 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.
**You also can fill prescriptions through one of the Johns Hopkins Outpatient Pharmacies or use their mail-order services. 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:
To find out if your provider participates in the EyeMed network, go to eyemed.com.
| 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 |
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.