JHU Benefits Site - Information by Benefit Plan

Information by Benefit Plan

Eligibility and Effective Dates

Coverage for benefits you elect during Annual Enrollment begins on January 1, 2015.

You are eligible to enroll in benefits under the myChoices program as long as you are a full-time member of the faculty or staff at the university. You may also cover your eligible dependents, as follows:

  • Your legally married spouse or same-sex domestic partner*; and
  • Your child(ren) until the end of the year in which your child turns 26. Coverage may be continued for children up to any age, if they cannot support themselves because of a mental or physical disability (certification of disability is required; contact the provider for more information).

You will be required to provide the appropriate documentation for your spouse, same-sex domestic partner or dependents that are added to the plan. Please see our dependent certification summary for details.

For this purpose, "children" are: biological children, adopted children, children placed with the eligible employee for adoption, stepchildren, children of the employee's same-sex domestic partner, or children for whom the eligible employee has been appointed legal guardian.

*Must qualify for coverage under the Johns Hopkins University Same-sex Domestic Partner Benefits Policy.


Coverage Levels

When you enroll, you'll choose your coverage level for medical and dental coverage. Dependents may only be covered under the plan you elect for yourself. The types of coverage available are:

  • Individual - faculty/staff member
  • Adult and Child(ren) - faculty/staff member and one or more children
  • 2 Adults - faculty/staff member and spouse or same-sex domestic partner* (You must fill out an Affidavit of Marriage/SSDP form if you are newly electing this level of coverage.)
  • 2 Adults and Child(ren) - faculty/staff member, spouse or same-sex domestic partner*, and one or more children.

*Must qualify for coverage under the Johns Hopkins University Same-sex Domestic Partner Benefits Policy.


Medical Plan

You have three medical plan options from which to choose. Click on the plan below to view features for that plan.

  • CareFirst BlueCross BlueShield Plan: You may see any provider. You pay less for care when you use the JHU network providers. When you need care that is not covered as preventive care, you pay the determined cost of service until you meet the annual deductible. Once you meet the deductible, the plan kicks in to pay a high percentage of the cost of the service, called the coinsurance, and you pay the rest until you reach the out-of- pocket maximum.
  • EHP Classic Plan: You have the flexibility to see any provider - in or out-of-network. Your out-of-pocket costs are lower if you use providers who participate in the EHP network. This plan has a deductible for non-preventive care, even if you see an in-network provider.
  • Kaiser Permanente HMO Plan:This plan only pays benefits when you see a provider who is a member of Kaiser's network. You choose a Primary Care Physician (PCP), who coordinates all of your in-network care. For most services, you pay a flat copayment.
  • BlueChoice HMO Plan: This is a managed health care plan consisting of a network of physicians and other medical providers. All of your health care must be coordinated and approved by your PCP and received in network. Note: The BlueChoice HMO Plan is available only to bargaining unit members and current participants. New participants will not be accepted into the plan.

You may also waive medical coverage by submitting a Medical Waiver Form; however, you must prove that you have coverage from another source. You may not opt out of all medical coverage unless you have coverage from another source.

All options provide specified benefit coverage for preventive, routine, and emergency medical treatments and services. Your three plan options differ in important ways:

Things to Consider When Making Your Choice

Choosing the right plan may seem challenging. Here are some important questions to ask yourself when making your enrollment elections:


Things to Consider.. CareFirst BlueCross BlueShield might be better if... EHP Classic
might be better if...
Kaiser Permanente or an HMO might be better if...
Medical Premiums You prefer to pay lower medical premiums and higher out-of-pocket costs You prefer to pay lower medical premiums and higher out-of-pocket costs You prefer to pay higher medical premiums and lower out-of-pocket costs
Deductible required* You must first meet the deductible:
$500 per individual
$1,500 for three or more family members
You must first meet the deductible:
In-network:
$250 per individual
$750 for three or more family members
Out-of-network:
$500 per individual
$1,500 for three or more family members
You do not need to meet a deductible
Payment for Services You prefer to pay the same percentage (20% co-insurance) for coverage, no matter which non-JHU provider you use, up to certain annual maximums. You prefer to pay less for in-network providers (20% co-insurance), but accept that you may pay a greater cost for using out-of-network providers (30% co-insurance), up to certain annual maximums. You prefer to pay a flat copayment for services.
Out-of-Pocket Maximum** You have an out-of-pocket maximum to protect you:

$2,000 per individual
$6,000 for three or more family members
You have an out-of-pocket maximum to protect you:

In-network:
$2,000 per individual
$6,000 for three or more family members
Out-of-network:
$4,000 per individual
$12,000 for three or more family members
You have an out-of-pocket maximum to protect you:

$3,500 per individual
$9,400 for three or more family members
Freedom and Flexibility You prefer to see any provider You prefer to use in-network providers, but would like the flexibility to go outside the network You prefer using in-network doctors only and selecting a Primary Care Physician
Out-of-Network Coverage You have dependents who need access to coverage outside of your local area You are comfortable paying more for coverage for emergency care when outside your local area You are comfortable having coverage for emergency care only when outside your local area
International Coverage You expect to travel internationally and may need care. BlueCard Worldwide covers you internationally You do not expect to need care abroad. If you were to need international care, you would need to file an out-of-network claim for reimbursement You expect to travel internationally and may need care. Kaiser Permanente will cover sudden and serious medical conditions internationally
* A deductible is the amount of out-of-pocket expenses you must pay for health services before the plan pays.
** Copays and the deductible count toward the out of pocket maximum.
 

Your Medical Plan includes coverage for Prescription Drugs. For more details, see the Medical Plan Coverage Comparison Tool.


Prescription Drug Overview

When you enroll for medical coverage, you and your covered family members also receive prescription drug benefits. The cost of your prescription depends upon whether:

  • You purchase it from a retail pharmacy or through mail order
  • Your drug is on the approved drug list (i.e., formulary) or not on the formulary
  • Your prescription is filled with a generic drug or a brand-name drug
  • Prescription drug costs will count toward a separate pharmacy out-of-pocket maximum. Once you meet this maximum, eligible expenses are covered 100% through the end of the plan year.

If You Are Covered by CareFirst BlueCross BlueShield, BlueChoice HMO or EHP Classic

The university offers prescription drug coverage through Express Scripts. The chart below shows your share of the cost for both retail and mail order.


Prescription Drug Benefits - BCBS, BlueChoice, EHP
  Retail
(up to a 30-day supply)
Mail Order
(up to a 90-day supply)
Out-of-Pocket Maximum $2,000 per individual / $6,000 for three or more family members $2,000 per individual / $6,000 for three or more family members
Generic $10 $25
Formulary Brand 20% coinsurance
($30 min; $45 max)
$75
Non-Formulary Brand 25% coinsurance
($60 min; $100 max)
$150
 

If You Are Covered by Kaiser Permanente HMO

Prescription Drug Benefits - Kaiser Permanente
  Kaiser Pharmacy
(up to a 30-day supply)
Community Pharmacy
(up to a 30-day supply)
Mail Order
(up to a 90-day supply)
Out-of-Pocket Maximum Integrated with medical Integrated with medical Integrated with medical
Generic $15 $20 $30
Formulary Brand $25 $45 $50
Non-Formulary Brand $40 $60 $80
 

Dental Plan Overview

You have three dental options from which to choose:

You may also choose to not elect dental coverage.

How the Dental Plans Compare
Things to Consider... CareFirst BlueCross BlueShield Dental Plan (PPO) CIGNA Dental Plan (PPO) UnitedConcordiaPLUS Dental HMO Plan (DHMO)
JHU premium cost Medium Highest Lowest
Out-of-network benefits Yes - You must file claims directly with CareFirst for out-of-network care Yes - You must file claims directly with CIGNA for out-of-network care No
Deductible required* In-network: No
Out-of-network: Yes
No No
Annual Benefit Maximum
(excludes orthodontia)
$1,500 $1,500 No
* A deductible is the amount of out-of-pocket expenses you must pay for health services before the plan pays.
 

For a side-by-side comparison of the plans, see the dental plan comparison chart.


Vision Plan Overview

Vision benefits, provided by United HealthCare and administered by Mercer Voluntary Benefits, are available to full-time, benefits-eligible faculty and staff and their dependents. Coverage includes benefits for eye exams, frames and lenses and contact lenses.

Covered Benefits In-Network Out-of-Network
Plan pays...
Eye Exam (every 12 months) 100% after $15 copay Up to $40
Lenses (every 12 months)
    Single Vision
    Lined Bifocal
    Lined Trifocal
    Lenticular
100% after copay of:
   $15
   $15
   $15
   $15
 
Up to $40
Up to $60
Up to $80
Up to $80
Frames (every 24 months) After $15 copay, up to $130 Up to $45
Contact Lenses (every 12 months in lieu of glasses)

Covered-in-full Contacts
All Other Contacts
Necessary Contact Lenses
Boxes of Disposable Contacts
 


After $15 copay, 100% up to plan limits
   Up to $150
   100%
   4
 


   Up to $150
   Up to $150
   Up to $210
Laser Vision Correction 15% of usual and customary price for Laser Vision Network of America providers    n/a
 

Note that your medical plan may offer some limited eye care coverage. Details on each are available on the Medical Plan Coverage Comparison Tool.

With UnitedHealthcare's Vision Plan, you can also take advantage of a hearing aid discount program. This program allows you to purchase high-quality, digital hearing aids at meaningful savings over retail through hiHealthInnovations™. You can learn more about this program by visiting www.hiHealthInnovations.com or call 1-855-523-9355.

Cost of Coverage

You can choose among three coverage levels. Provided below are monthly premium rates for each of these coverage levels. The premiums you pay are deducted from your paycheck after taxes.

You Only You and 1 Dependent You and Family
$6.18/month $11.11/month $17.50/month
 

Visit Mercer Voluntary Benefits to enroll, review more information and check the network of vision care providers.


Flexible Spending Accounts

Flexible Spending Accounts (FSAs) help you save money by allowing you to deduct tax-free dollars from your pay to cover certain health and dependent care expenses you incur during the year.

We offer a Health Care Flexible Spending Account and a Dependent Care Flexible Spending Account - both are administered by WageWorks. You may participate in one or both plans; you decide how much you wish to contribute. You must enroll each year during annual enrollment to renew your participation in these accounts. You can only make changes at annual enrollment or when you experience a qualified life event.

Remember, this year you are able to carry over up to $500 from your 2014 Health Care FSA into the new plan year. This rollover allowance does not apply to the Dependent Care FSA.

You will not be able to contribute any more than $2,500 to a Health Care Flexible Spending Account in 2015. Please note rollover dollars do not count toward the annual maximum. The maximum for the Dependent Care Flexible Spending Account is still $5,000 annually.

You can use the Medical Plan Cost Estimator Tool to help you estimate how much to contribute to your Health Care Flexible Spending Account.

To learn more, review the sections below:


Life, Accident and Travel Insurance

Life and Accident Insurance benefits offer financial protection in case of death, paralysis, or a covered loss. These coverages include the following options:

Designating a Beneficiary
It's always a good idea to check your beneficiaries during annual enrollment. You may do so when you enroll online. At other times during the year, please complete the Group Life Insurance Beneficiary Designation Form.


Disability Protection

Short-Term Disability Coverage
You may choose to elect short-term disability (STD) coverage during annual enrollment. Short-term disability pays 60% of your pre-disability base salary (up to a maximum of $1,000 per week), if you are unable to work for more than 14 consecutive days and your claim is approved by The Hartford. This benefit may be paid for a maximum of 11 weeks.

If you purchase STD coverage, you do so with tax-free dollars, so the benefit you receive would be taxed as ordinary income. If you have not elected short-term disability in the past, but enroll during a future annual enrollment period, you will be subject to a pre-existing condition limitation. This means that benefits will not be paid for a disability caused by a pre-existing condition during the first 12 months of coverage. After that, if you become disabled due to what was considered a pre-existing condition, short-term disability benefits will be paid.

Long-Term Disability Coverage
The university provides long-term disability (LTD) coverage at no cost for full-time faculty and staff after one year of continuous full-time service. Long-term disability benefits replace 60% of your pre-disability base salary (not to exceed $10,000 monthly) if you are unable to work more than 90 consecutive days and your claim is approved by The Hartford.


Voluntary Benefits

Voluntary Hyatt Legal Plan
This voluntary plan option offers expert legal advice from over 11,000 attorneys nationwide. You can receive a consultation over the phone or in person, regarding services related to:

  • Estate planning: preparation of wills, codicils, testamentary trusts, living wills, living trusts, deeds, and powers of attorney
  • Financial: creditor issues, debt collection defense, identity theft defense, personal bankruptcy, tax audits, and the purchase, sale, and refinancing of a home

Most people pay upwards of hundreds of dollars an hour for legal services like these. But full-time employees can elect this benefit for $15.00 per month.

Critical Illness Insurance
Critical Illness Insurance from MetLife is designed to give you the peace of mind needed to concentrate on recovery instead of finances. Although not a replacement for traditional medical or disability insurance, MetLife Critical Illness Insurance provides a lump-sum payment of $10,000, $15,000, or $20,000 in the event that you or a covered dependent experience one of the following medical conditions and meet the policy and certificate requirements:

  • Cancer
  • Heart Attack
  • Stroke
  • Alzheimer's Disease
  • Kidney Failure
  • Coronary Artery Bypass Graft
  • As well as many other conditions

From co-pays and deductibles to mortgage payments and child care, you can use the lump-sum payment as you see fit to help protect your family's finances so you can focus on recovery.

If you are actively at work, you may enroll for coverage and your policy will be issued subject to the provisions of the plan. Be advised that this coverage contains Limitations/Exclusions related to a prior diagnosis or pre-existing conditions for certain conditions, including Full and Partial Benefit Cancer. Please review the Disclosure Statement or call MetLife at 888-865-7934 (option 1) for additional information.

Accident Insurance
Colonial Life's Accident Insurance plan covers:

  • Sports-related accidental injuries
  • Broken bones
  • Burns
  • Concussions
  • Lacerations
  • Back or knee injuries

Paid directly to you, Accident Insurance helps offset the unexpected medical expenses, such as emergency room fees, deductibles and co-payments that can result from a covered accident.

Long-Term Care Insurance - You can elect competitive coverage through CNA providing benefits for covered long-term care services, whether you receive them at home, in assisted living or adult day care facilities, or in a nursing home setting. Hospice and respite care are also covered.

Choice Auto and Homeowner's Insurance - Get a competitive quote from a selection of top-rated auto and homeowner's insurers. Compare the coverage side by side and determine if there is an option that meets your needs. You can insure more than your vehicle and home - you may also be eligible to cover a rental property, boat, or motor home. Additional discounts are available.

To enroll or review more information on any of these voluntary benefits plans, please visit our JHU Voluntary Benefits site or call 1-866-795-9362.


Legal Notices

Legal notices are provided to you to inform you of your rights under Federal law. For details, visit Legal Notices on the benefits website.


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