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, 2018.

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 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, 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 domestic partner, or children for whom the eligible employee has been appointed legal guardian.

*Must qualify for coverage under the Johns Hopkins University 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 domestic partner*
  • 2 Adults and Child(ren) - faculty/staff member, spouse or domestic partner*, and one or more children.

*Must qualify for coverage under the Johns Hopkins University 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 uploading a completed Medical Waiver Form proving you have other medical coverage. You may not opt out of all medical coverage unless you have coverage from another source. If you will not be electing JHU medical coverage for 2018, you will be required to submit a Medical Waiver Form even if you submitted one in the past.

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 formulary brand-name drug
  • You met your annual out-of-pocket maximum. Prescription drug costs count toward a separate pharmacy out-of-pocket maximum. Once you reach this limit, eligible expenses are covered 100% through the end of the plan year.

It's first important to understand drug categories (or tiers) and the associated costs. There are three "tiers" of medications that specify how a drug will be covered:

Generic drugs typically cost 30% to 75% less than brand name drugs Generic drugs:

Identical in dosage, safety, strength, quality, and all other performance measures of their brand name equivalents.

Typically sold at substantial discounts from the branded price, which means lower costs for you and for the university.
Sometimes brand name drugs are needed to help treat problems when there is not a generic option Formulary brand name drugs:

Formulary brand name drugs are drugs on Express Scripts' formulary list that are preferred under our health plans because they offer the greatest overall value.

If a generic version of the drug is not available, your provider will likely prescribe a formulary brand name drug.
Non-formulary brand drugs are drugs not on the preferred drug list because there is a less expensive generic or formulary brand name alternative Non-formulary brand drugs:

Usually more expensive for you than generic and formulary brand name equivalent medications that work just as well.

If your doctor believes that there are special reasons you should continue using your current brand medicine, he or she can request a coverage review. Or, you can call Express Scripts Member Services to request a review of your coverage.
 


The university wants to help you use your prescription drug benefits wisely, and will be introducing new programs in 2018 to help you get the best medication at the right price. Beginning in 2018, the following programs will be introduced and will mostly impact new prescriptions going forward:

  • Mandatory generics - member pays the difference (for existing and newly filled prescriptions). Generic drugs are lower-cost medications that are just as effective as brand-name drugs. You may pay more if you purchase a brand medicine when a generic-equivalent drug is available. You will pay the generic copay plus the difference in cost between the brand and generic drug.
  • Prior authorization (applies to new prescriptions in certain drug categories after 1/1/2018; current are grandfathered while in continuous use). Some medications will require prior authorization, or review and approval, before the plan will cover the cost. This is to ensure that the medication you receive is safe and effective for your situation. Prior authorization may be required for drugs that:
    • Have potentially dangerous side effects
    • Are harmful when combined with other drugs
    • Are often misused
    • Are prescribed when less expensive drugs are as effective
    • Are specialty medications that are meant to treat very specific diseases and require appropriate clinical markers (biological characteristics that help assess whether a drug will be effective in a specific patient)
  • Step Therapy (applies to certain new prescriptions after 1/1/2018; current are grandfathered while in continuous use). Step Therapy requires you to try lower-cost (often generic) medications first, before "stepping up" to medications that cost more. If your medication requires Step Therapy, you will be obligated to try a step-one medication before "stepping up" to a step-two (or step-three) medication. Step-one alternative medications are proven to be safe, effective, and affordable; and, can provide the same health benefits as more expensive medications at a lower cost to you.
  • Quantity limitations (for existing and newly filled prescriptions). To reduce waste and ensure that the most cost-effective product strength is prescribed, all medications will be subject to quantity limitations (as determined by the FDA). If your treatment exceeds the quantity limitation of your drug, your prescription will require further authorization. Express Scripts will send you a letter in late November if you are affected by this change for future refills of your medication.

If your medication needs approval, either you or your pharmacist will need to let your doctor know. Your doctor might switch your therapy to another drug that doesn't require prior authorization, Step Therapy, or quantity limitations by calling Express Scripts at 1-888-406-1213 to start the approval process.

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)
Annual Out-of-Pocket Maximum
Individual
Three or more family members

$2,000
$6,000

$2,000
$6,000
Generic $10 copay $25 copay
Formulary Brand If no generic is available, 20% coinsurance ($30 minimum; $45 maximum) If no generic is available, 20% coinsurance ($75 minimum; $112.50 maximum)
Non-Formulary Brand If no generic or formulary brand is available, 25% coinsurance ($60 minimum; $100 maximum) If no generic is available, 25% coinsurance ($150 minimum; $250 maximum)
 

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)
Annual Out-of-Pocket Maximum Integrated with medical
Generic $15 copay $20 copay $30 copay
Formulary Brand $25 copay $45 copay $50 copay
Non-Formulary Brand $40 copay $60 copay $80 copay
 

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 UnitedHealthCare 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, 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
$5.25/month $9.44/month $14.88/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) offer you a tax-free way to pay for every day services or products you need. This could mean a 15-30% savings, depending on your income and tax level.

The FSAs are administered by WageWorks. There are two types of FSAs from which you can benefit:

Health Care FSA: You can enroll in a Health Care FSA to use tax-free dollars to pay for eligible medical expenses. If enrolled in a Health Care FSA, you are eligible to contribute up to $2,600 in tax-free dollars for the year. Up to $500 in unused contributions made during 2017 can be rolled over into the 2018 plan year. Roll over dollars do not count towards the annual maximum.

Dependent Care FSA: You can also enroll in a Dependent Care FSA and save money on out-of-pocket dependent day care expenses in 2018. You can contribute up to $5,000 tax-free dollars annually to pay for eligible expenses. You must use all of the money in your FSA by the annual deadline or you forfeit any remaining funds.

The Dependent Care FSA is for day care expenses only. To save and be reimbursed for a dependent's health care expenses, you need to contribute to the Health Care FSA.

You may participate in one or both plans. You cannot use Health Care FSA funds for Dependent Care FSA expenses, and vice versa.

You must enroll each year during open enrollment to renew your participation in these accounts. You can only make changes at annual enrollment or when you experience a qualifying life event.

To learn more, review the sections below:


Life and Dependent Life Insurance

JHU provides you with financial protection for you and your family in the event of death by offering Life Insurance coverage for you and your eligible dependents. Beginning in 2018, Life Insurance will move to Securian Life.

Basic Life Insurance
All full-time benefits-eligible faculty and staff receive Basic Life coverage of $10,000 through Securian, paid entirely by the university.

Supplemental Life Insurance
You may purchase additional coverage - up to four times your annual base salary - to a maximum benefit of $2,000,000.

You pay the full cost of coverage over $10,000. The following Supplemental Life Insurance benefit coverage options are available to you:

  • $50,000
  • 150% of your base salary
  • 250% of your base salary
  • 400% of your base salary

You have the opportunity during Annual Enrollment to review your current Life Insurance coverage and make any changes, without having to provide evidence of insurability (proof of good health), up to the guaranteed amount of the lesser of four times your annual salary or $500,000. If you do not make a new election, your current Supplemental Life Insurance coverage will carry over at the same or lower rates.

Dependent Life Insurance
You may also purchase Dependent Life Insurance for your spouse or domestic partner, and dependent child(ren). The following Dependent Life Insurance coverage options are available to you:

  • Option 1:
    • Spouse/domestic partner coverage: $4,000
    • Dependent child coverage: $2,000 per dependent
  • Option 2:
    • Spouse/domestic partner coverage: $10,000
    • Dependent child coverage: $5,000 per dependent

If you are currently enrolled in Dependent Life Insurance, your coverage will carry over to the following year. However, you may use Annual Enrollment as an opportunity to change your coverage amounts.

Designating a Beneficiary
It's always a good idea to check your beneficiaries during annual enrollment. You may do so when you enroll online.


Accidental Death and Dismemberment (AD&D)
(formerly Personal Accident Insurance or PAI)

AD&D Insurance provides a benefit to you and your insured family members if you die or are injured as the result of an accident in the course of business or pleasure. As a full-time benefits-eligible faculty or staff member, you will receive $10,000 in university-paid AD&D coverage for yourself, which pays a financial benefit to your beneficiary upon accidental death or a qualified dismemberment. Like Life Insurance, additional AD&D Insurance can be purchased for yourself and your eligible dependents.

During Annual Enrollment, you may elect additional AD&D Insurance for yourself as well as coverage for your family. You pay the full cost of additional AD&D coverage. Please note that your current PAI coverage will not carry over, so you must enroll during Annual Enrollment to have more than the university-provided $10,000 of employee AD&D Insurance coverage effective January 1, 2018.

The following AD&D Insurance coverage options are available to you:

  • $50,000
  • 150% of your base salary
  • 250% of your base salary
  • 400% of your base salary

If you choose AD&D Insurance for yourself, you can also purchase AD&D Insurance coverage for your spouse or domestic partner and children. The benefit amount depends on which family members you cover and is structured as follows:

  • Spouse/domestic partner and children: Your spouse/domestic partner would have 50% of your benefit amount, up to $250,000, and your children would have 15% of your benefit amount, up to $50,000.
  • Spouse/domestic partner only: Your spouse/domestic partner would have 60% of your benefit amount, up to $250,000.
  • Children only: Your children would have 20% of your benefit amount, up to $50,000.


Business Travel Accident Insurance

Business Travel Accident Insurance is also available to you. For more information about this benefit, visit the benefits website.


Disability Protection

Short-Term Disability Coverage
You may choose to elect short-term disability (STD) coverage during annual enrollment. STD coverage provides valuable income protection when you are unable to work, such as in case of injury, illness, or pregnancy. Short-term disability pays 60% of your pre-disability base salary (up to a maximum of $2,500 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.

When you purchase STD coverage, you do so with tax-free dollars, so the benefit you receive will be taxed as ordinary income. There is no pre-existing condition limitation with this coverage.

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 copays 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
MetLife'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. You may choose between the low and the high coverage options.

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 the Legal Notices page.


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