Beginning January 2024, we’ll offer a single network of physicians and providers through CareFirst BlueCross BlueShield (BCBS). We’ll no longer offer the EHP Classic POS Plan. The Kaiser Permanente HMO Plan will continue to be available but only to those who are currently enrolled in it.
Here are the medical options for 2024:
Both the CareFirst Core PPO Plan and the CareFirst Enhanced PPO Plan are similar to the CareFirst BCBS PPO Plan currently offered. The CareFirst Core Plan offers 80% coinsurance (what the plan pays versus what you pay) and the CareFirst Enhanced PPO Plan offers 90% coinsurance.
To find in-network CareFirst providers, you will need to enter the prefix: JHU.
The cost of coverage for the CareFirst plans depends on your employment status with the university and your salary tier.
Before you choose a medical plan for 2024, it’s important to understand how each plan works. 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%) 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 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 |
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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) |
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.
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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If you choose the HDHP, you’re eligible to participate in a special tax-advantaged HSA that allows you to set aside funds on a pretax basis to help pay your out-of-pocket health care expenses.
If you earn $60,000 or less a year, JHU will contribute to your HSA. The amount of the annual contribution will depend on your salary band:
To be eligible for an HSA, you must be enrolled in the HDHP, and you cannot be: