The CareFirst BlueCross BlueShield Plan is a Preferred Provider Organization (PPO) 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.
There are two networks available, the JHU Preferred Physician Network and CareFirst’s PPO/BlueChoice Advantage Network; however you can always visit providers outside of the plan network.
Preferred Physician Network: The university has created a special Preferred Physician Network, which consists of many School of Medicine physicians. When you see a Johns Hopkins Preferred Physician who is in this network, there are no out-of-pocket costs for eligible professional services once your deductible has been met. For diagnostic testing, facility, and hospital charges, you will incur additional expenses. You pay less for care when you use JHU’s special Preferred Physician Network.
CareFirst’s PPO/BlueChoice Advantage Network: When you see a physician who is a member of CareFirst’s national PPO network you pay less based on your physician’s negotiated fee. The CareFirst BlueChoice Advantage (PPO) network offers even deeper discounts through network providers in MD/DC/VA, which means lower-out-of-pocket costs. Check carefirst.com to see providers in the CareFirst BlueChoice Advantage network: Select “Find a Doctor”, log into your member account or continue as a guest, enter your zip code and select the “BlueChoice Advantage” network.
Here are highlights of how your benefits compare in-network vs. out-of-network. For more information, refer to the 2023 Faculty & Staff Medical Plan Coverage Comparison Chart or 2023 LIUNA BU Medical Plan Coverage Comparison Chart and the Summary Plan Description(SPD). You can also Ask ALEX, our interactive decision support tool. ALEX acts as a virtual benefits counselor to help you learn more about your benefit options, so you can choose what’s best for you.
Plan Benefits |
In-Network | Out-of-Network |
|---|---|---|
| You Pay… | ||
| Annual Deductible | $500 per person $1,500 per 3 or more persons* |
$500 per person $1,500 per 3 or more persons* |
| Physician Services (office visits, medical and surgical | 0 for JHU Preferred Physician Network provider after deductible**
20% for all other providers after deductible |
30% after deductible |
| Preventive care (physical exams and well-baby) | $0, 100% JHU covered | 30% no deductible |
| Emergency care | Facility: $100 copay (waived if admitted) Physician: 20% after deductible |
Facility: $100 copay (waived if admitted) Physician: 20% after deductible |
| Urgent care | $50 | 30% after deductible |
| Hospital copay per inpatient admission | $250 | $250 |
| Hospital service benefits | 20% after deductible and $250 inpatient copay |
30% after deductible and $250 inpatient copay |
| Outpatient surgery | Facility: $0 Physician: 20% after deductible |
Facility: 30% after deductible Physician: 30% after deductible |
| Biennial Adult Eye Exam (Wilmer Eye Institute School of Medicine Network Provider only). Call 410-955-5080 to schedule | $0 for one exam every two years
Eyeglasses, new contact lenses, and dispensing of contact lenses not included. |
Not covered |
| Plan Year Maximums | ||
| In-Network | Out-of-Network | |
| Annual Maximum Benefit | None | |
| Annual Out-of-Pocket Maximum (includes deductibles, copays and coinsurance) |
$2,000 per person
$6,000 per 3 or more persons |
$2,000 per person
$6,000 per 3 or more persons |
* When the type of coverage is family (3 or more persons), the family deductible amount is calculated by combining the amounts contributed by all the family members covered under the plan. Benefits are paid for a family member who reaches the individual deductible amount before the family deductible amount is reached. A family member may not contribute more than the individual deductible amount to the family deductible amount.
** JHU Preferred Physician services only covered 100% after deductible. You will incur additional expenses for diagnostic testing, facility, and hospital charges.