We offer a variety of medical plan options, including a high-deductible health plan (HDHP), two preferred provider organizations (PPOs), and a health maintenance organization (HMO), which is only available to current members. Your plan options depend on your employment status. JHU makes contributions toward the cost of coverage for all faculty and staff members except for part-time employees.
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Medical Plan Options for Faculty and Staff
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.
| Employee | Medical Plan Options |
|---|---|
| Full-time faculty and staff Part-time faculty and staff |
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| Limited-time faculty and staff and part-time instructors |
If you don’t have medical coverage elsewhere, you must select one of JHU’s medical plans. If you don’t select a medical plan, you’ll be enrolled automatically with individual coverage in the CareFirst BCBS Core PPO Plan.
If you’re covered under another plan, you may waive medical coverage by submitting a medical waiver, available on the myChoices Health & Life portal. Anyone waiving medical coverage is eligible to receive a credit for either $800 (if your annual salary is $40,000 or less) or $500 (if your annual salary is more than $40,000).
Selecting a Medical Plan
Before you choose a medical plan, it’s important to understand how each plan works.
Overview of Services
Our CareFirst medical plans offer:
- The same national network of providers
- Coverage for the same broad range of services, including eligible preventive care (covered at 100%)
- 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 may include:
- A choice of preferred provider organization (PPO) plans with different premium and out-of-pocket cost structures or
- A high-deductible health plan (HDHP)
The CareFirst BlueCross BlueShield PPO Plan is a Preferred Provider Organization plan. This means that you may see any provider, in-network or out-of-network, but you will generally pay more for out-of-network care. With this plan, you pay your deductible first, and then you pay a portion of the cost (your coinsurance amount) each time you use medical services.
The CareFirst HDHP offers the lowest monthly premiums and the CareFirst BCBS Enhanced PPO Plan has the highest. However, you’ll pay more for out-of-pocket expenses with the CareFirst HDHP compared to the CareFirst BCBS Core and Enhanced PPO Plans. That’s why the CareFirst HDHP comes with a tax-advantaged Health Savings Account that’s designed to help you set aside funds on a pretax basis to help pay your out-of-pocket health care expenses.
Medical Plan Comparison Chart
Here’s a summary of some key plan features for the three CareFirst medical plans. For more information about these plans, as well as the Kaiser Permanente HMO Plan and CareFirst BCBS Limited PPO Plan, refer to the plan’s Summary of Benefits and Coverage or Summary Plan Description.
| 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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Need help deciding which medical plan is right for you? Just ask ALEX! Our decision-support tool will help you compare options. You can also add your spouse or partner’s medical plan options for a fuller picture when choosing your coverage.
Find Providers
Click on the link below to search for in-network CareFirst providers. You’ll need to enter the prefix: JHU.
Provider Search (Prefix: JHU)
Cost of Coverage
Your semimonthly per-paycheck deductions for medical coverage depend on your employment status with the University and your salary tier.
Decision Support
Looking for expert advice about choosing your benefits? Ask ALEX is available 24/7 to help you pick the best benefits plan options for you. Once you answer a few questions about your preferences and health care needs, ALEX can narrow down the plan options to determine which one will give you the best coverage for the lowest cost.