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.
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:
| 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 |
| 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 |
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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 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. |
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| CareFirst Core PPO Plan | LiUNA BU CareFirst Network Only Plan | Kaiser Permanente HMO Plan |
|---|---|---|
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