We offer three medical plan options for you and your family. These include a preferred provider organization (PPO), an exclusive provider organization (EPO), and a health maintenance organization (HMO). JHU makes contributions toward the cost of coverage for all LiUNA BU members.
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Medical Plan Options for LiUNA Bargaining Unit Members
NEED HELP NAVIGATING YOUR HEALTHCARE BENEFITS?
CareFirst members can contact Quantum Health care coordinators at 844-460-2801, Monday-Friday 8:30 a.m. to 10 p.m. Access the Quantum Health member portal
Selecting Your JHU Medical Plan
Medical Plan Options
JHU supports your health journey with a selection of medical plans available through CareFirst Administrators, which offers access to BlueCross BlueShield’s BlueChoice Advantage doctor and specialist networks, and through the Kaiser Permanente HMO plan.
Eligibility
| Full-time and part-time LiUNA Bargaining Unit members |
You and your eligible dependents are eligible to enroll in these JHU medical plans:
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Important note: If you’re covered under another medical plan, such as through your spouse’s employer, you must formally waive the medical coverage available to you through JHU. To do so, you will need to submit a medical waiver form that requires you to provide proof of coverage elsewhere. This form is available on the myChoices Health & Life portal.
How the Plans Work
Our medical plans feature comprehensive, high-quality coverage at an affordable cost—plus access to provider networks and other resources that make accessing care and staying healthy easier.
CareFirst Core PPO Plan
This is a preferred provider organization (PPO) plan, which offers access to a large, nationwide provider network of doctors and hospitals. It allows you to see any provider, in-network or out-of-network, but you will generally pay more for out-of-network care.
This plan requires that you pay a deductible first. Then you’ll pay a portion of the cost for care—called coinsurance—each time you use medical services. Your out-of-pocket costs are usually higher with this PPO plan than with the LiUNA BU CareFirst Network Only plan.
LiUNA BU CareFirst Network Only Plan
This is an exclusive provider organization (EPO) plan, which offers access to a narrower network of doctors and hospitals located throughout Maryland, Washington, D.C., and northern Virginia. You pay no annual deductible, and your out-of-pocket costs are less with this plan; however, out-of-network care is not covered (except in an emergency).
Kaiser Permanente HMO Plan
This is a health maintenance organization (HMO) plan, which offers a local network of doctors and hospitals for you to choose from. Your primary care provider (PCP) coordinates your health care, and out-of-network care is not covered (except in an emergency).
Tax-advantaged flexible spending account
If you enroll in any of the medical plans, you can participate in the Health Care Flexible Spending Account (HCFSA) to pay for such qualified expenses as copays and coinsurance, contact lenses, prescriptions, and over-the-counter medications.
JHU’s Health Care FSA offers several options for managing your FSA expenses and reimbursement. When you first enroll, you’ll receive a benefits debit card you can use to pay your doctor or other provider expenses directly, and to pay for eligible health care expenses at qualified merchants. You’ll only receive a new debit card if your current card is about to expire.
How the CareFirst Plans Are the Same
Both of our CareFirst medical plans offer:
- Access to BlueCross BlueShield’s BlueChoice provider networks through CareFirst
- Coverage for the same broad range of services, including eligible preventive care (covered at 100%) and prescription drug coverage
- Prescription drug benefits managed through Capital Rx
- Health care advocacy and navigation support through Quantum Health, your go-to guide and front door for all medical questions, big and small
- Telehealth visits available through MDLIVE for medicaland behavioral health needs, with a low copay per visit. Register to access care 24/7. Find out how to create your MDLIVE account.
- A plan ID card that provides contact information for your JHU medical and pharmacy benefits—including Quantum Health, which can answer questions about both. You’ll receive your ID card when you first enroll in a JHU CareFirst medical plan; JHU does not issue new ID cards every year.
Adult vision exams
You and your eligible dependents age 18 and older 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 visit will consist of a routine eye exam and complete visual system exam. Call 410-955-5080 to schedule an appointment with Wilmer.
Please note: Eyeglasses and fitting or dispensing new contact lenses are not included in the routine eye exam and are not covered by JHU’s medical plans. However, you may enroll in the EyeMed Vision Plan available to you through JHU.
Medical Plan Comparison Chart
Here’s a summary of some key plan features. For more information about what’s covered and the cost, refer to the plan’s Summary of Benefits and Coverage or Summary Plan Description.
| 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, mental health & substance abuse) |
You pay 20% of the cost after deductible is met | $15 copay | $15 copay |
| Office visit (specialist) |
You pay 20% of the cost after deductible is met | $30 copay | $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 - telemedicine | 100% covered, no deductible | $15 copay | 100% covered |
| 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. |
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| Telemedicine (excluding mental health & substance abuse) |
$20 copay | $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 |
| Methadone Maintenance | You pay 20% of the cost after deductible is met | $15 copay | Refer to Prescription drug details above |
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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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Prescription Drug Benefits
| CareFirst Core PPO Plan | LiUNA BU CareFirst Network Only Plan | Kaiser Permanente HMO Plan | |
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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% ($30 min/$45 max) Non-formulary brand: You pay 25% ($60 min/$100 max) |
Generic: $10 copay Formulary brand name: You pay 20% ($30 min/$45 max) Non-formulary brand: You pay 25% ($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 |
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.
Find Providers
Click on the links below to search for in-network providers.
CareFirst Provider Search (Prefix: JHU)
Cost of Coverage
Your semimonthly per-paycheck deductions for medical coverage depend on whether you work full- or part-time.
Decision Support
Questions about the CareFirst medical plans? Quantum Health has answers. Quantum Health is your full-time health care benefits resource and advocate. Experienced care coordinators can answer questions about all your JHU health benefits, including how to select and make the most of your medical and prescription benefits all year long. Contact Quantum Health at 844-460-2801 or access the member portal.