New Medical Plan Options

Beginning in January 2024, we’ll offer two new medical plans—the CareFirst Core PPO Plan and the LiUNA BU CareFirst Network Only Plan—through CareFirst BlueCross BlueShield (BCBS). The Kaiser Permanente HMO Plan will continue to be available.

Here are the medical options for 2024:

All three plans cover eligible preventive care at 100%, including annual checkups, immunizations, and screenings to help you stay healthy and detect or prevent serious illness. They also cover emergency care and prescriptions and limit the amount you will pay out of pocket each year. The plans differ in which providers (doctors, hospitals, etc.) you can see and how the plans pay for medical expenses.

If you select one of the CareFirst medical plans, you will:
- Have access to Quantum Health, JHU’s new health care advocacy service
- Have your prescription drugs managed by Capital Rx
- Receive one medical ID card with information about both your medical and pharmacy benefits, including contact info for Quantum Health and Capital Rx
- Have a combined out-of-pocket maximum (the most you’ll pay in a year for medical, mental health, and prescription drugs); see the medical comparison chart below for more details
- Need prior authorization for certain services, including surgeries, diagnostic tests and scans, oncology care and services, dialysis, transplants, hospice care, hospitalization, inpatient care, and medical equipment rentals or purchases
There are no changes to the Kaiser Permanente HMO Plan.

To find in-network CareFirst providers, you will need to enter the prefix: JHU.

Provider Search (Prefix: JHU)

Before you choose a medical plan for 2024, it’s important to understand how each plan works. All the plans provide coverage for the same broad range of services, including eligible preventive care (covered at 100%) and prescription drug coverage. The medical plans differ in the way you access and pay for care. Here’s a summary of some key plan features:

Big Picture

The Details

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	$20 copay SBC:$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	You pay 10% of cost after deductible is met SBC: $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	MD Live - $20	MD Live - $15	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)	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
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.
* 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 new 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.

What else you need to know about these plans

CareFirst Core PPO Plan	LiUNA BU CareFirst Network Only Plan	Kaiser Permanente HMO Plan
Providers located across the country Covers in- and out-of-network care (pay less in-network) Does not require you to choose a primary care physician Includes access to Quantum Health, JHU’s new advocacy service New—Some surgeries and services will now require prior authorization, which Quantum Health will coordinate	Providers located throughout Maryland, Washington, D.C., and Northern Virginia Does not cover out-of-network care (except in true emergencies) Does not require you to choose a primary care physician Includes access to Quantum Health, JHU’s new advocacy service New—Referrals won’t be required to see specialists New—Some surgeries and services will now require prior authorization, which Quantum Health will coordinate	Most providers are in a central location with some community-based services Does not cover out-of-network care (except in true emergencies) Must choose a primary care physician who coordinates and approves care

Due to the end of the public health emergency, COVID-19 testing, including over-the-counter tests, will no longer be covered at 100% by JHU’s medical plans.