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Medical Plan Options for LiUNA Bargaining Unit Members
NEED HELP NAVIGATING YOUR 2024 HEALTHCARE BENEFITS?
Contact Quantum Health care coordinators at 844-460-2801, Monday-Friday 8:30 a.m. to 10 p.m.
Click here to access your Quantum Health member portal.
| Medical Plan Options |
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Selecting a Medical Plan
Before you choose a medical plan, it’s important to understand how each plan works.
Overview of Services
All three 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.
The plans vary in terms of cost, coverage, and providers that you’re able to see, and eligibility varies based on your employment status.
If you select one of the CareFirst medical plans, you’ll have access to some additional services:
- Health care advocacy and navigation support through Quantum Health, your go-to guide and front door for all medical questions, big and small
- Prescription drug benefits management through Capital Rx
- Telehealth visits available through MDLive, with a $20 copay per visit (including behavioral health). Register here to access care 24/7.
As the administrator for the medical plans, CareFirst will process your medical claims. Capital Rx will process your prescription drug claims. You’ll receive one medical ID card with information about both your medical and pharmacy benefits, which will include contact info for Quantum Health and Capital Rx. Quantum Health can answer questions about both your medical and pharmacy benefits.
Medical Plan Options
Your options include:
- A preferred provider organization (PPO) plan, which offers a larger network, so you have more doctors and hospitals to choose from. Your out-of-pocket costs are usually higher with a PPO than with an HMO or EPO plan.
- An exclusive provider organization (EPO) plan, which offers a narrower network of doctors and hospitals for you to choose from. Your out-of-pocket costs are less with an EPO than a PPO or HMO; however, out-of-network care is not covered (except in an emergency).
- A health maintenance organization (HMO), 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).
| JHU Medical Plans | CareFirst BCBS Core PPO Plan | LiUNA BU CareFirst BCBS Network Only Plan | Kaiser Permanente HMO Plan |
|---|---|---|---|
| Plan type | Preferred provider organization (PPO) | Exclusive provider organization (EPO) | Health maintenance organization (HMO) |
| Network of providers | Providers located across the country
Covers in- and out-of-network care (pay less in-network)
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Providers located throughout Maryland, Washington, D.C., and Northern Virginia
Does not cover out-of-network care (except in true emergencies) |
Most providers are in a central location with some community-based services
Does not cover out-of-network care (except in true emergencies) |
| Out-of-pocket expenses | Has a combined out-of-pocket maximum (the most you’ll pay in a year for medical, mental health, and prescription drugs)
After the annual deductible has been met, you pay a percentage of the cost of the service received (called “coinsurance”)
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Has a combined out-of-pocket maximum (the most you’ll pay in a year for medical, mental health, and prescription drugs) for in-network expenses
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Has a combined out-of-pocket maximum (the most you’ll pay in a year for medical, mental health, and prescription drugs) for in-network expenses |
| Referrals needed | Does not require you to choose a primary care physician or seek referrals to see specialists | Must choose a primary care physician who coordinates and approves care | |
| Prior authorization required | Some surgeries and services require prior authorization, which Quantum Health will coordinate
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Surgeries and services require prior authorization by Kaiser Permanente | |
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 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. |
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| 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 |
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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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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.