PREVENTIVE CARE: Continuing to pay 100%
Preventive services, immunizations, and lab fees will continue to be paid at 100 percent for care within the EHP Network and Johns Hopkins-owned hospitals.
INPATIENT CARE: 90/10 at non-Hopkins EHP network hospitals; 100% at Johns Hopkins-owned hospitals
Beginning Jan. 1, 2013, inpatient services—the services provided when a patient is admitted to a non-Hopkins hospital—will be covered at 90/10 after co-pay and a deductible. However, when you are able to obtain care at a Johns Hopkins-owned facility, services will be paid with co-pay and then 100 percent by the health plan.
OUTPATIENT CARE: Beginning in 2014, 90/10 at non-Hopkins EHP network providers; 100% for care from Hopkins
Beginning Jan. 1, 2014, Johns Hopkins employees will pay 10 percent of inpatient and outpatient services (except preventive care paid at 100 percent) up to the out-of-pocket maximum. Again, Johns Hopkins providers and facilities will continue to be paid at 100 percent after co-pays and deductible.
It is expected that by Open Enrollment next year, further announcements will be made regarding which providers are part of the Johns Hopkins Health System and therefore covered at 100 percent.
ANNUAL OUT-OF-POCKET MAXIMUM: Known limit to your financial exposure
Except for co-payments, there is a known upper limit to how much employees and their covered dependents could pay during the course of a year. This “annual maximum” out-of-pocket amount is $2,000 for individuals and $4,000 for families who receive care from providers within the EHP network but which are not part of Johns Hopkins. This amount includes the deductible but does not include co-payments. It consists of all payments made as part of the employee’s 10 percent share of care.
For those who choose to obtain care from Out of EHP Network providers, the annual out-of-pocket maximum is $3,500 for individuals and $7,000 for families.
NEW ANNUAL DEDUCTIBLE: Employees pay first
When the 90/10 co-insurance payment sharing applies (for care received outside the Johns Hopkins system), employees and their covered dependents pay an annual deductible. The deductible is the (fixed) amount paid by the employee for health care services before the health plan begins to pay.
This inpatient deductible amount is $100 for individuals, and $200 for families who select the In EHP Network benefit coverage option. For Out of EHP Network providers, the annual deductible is $750 for individuals and $1,500 for families. After the deductible is paid, the plan begins to pay 90 percent and the employee begins to pay 10 percent of the cost of non-Hopkins care.
CO-PAYMENTS CHANGING: Some higher, some lower
Co-payments remain a basic part of the Johns Hopkins health plan. These are payments patients make at the time and place they receive care. Beginning in 2014 many co-payments will increase, while others will actually decrease.
PREMIUMS REMAINING THE SAME FOR MOST EMPLOYEES: Lower-compensated employees protected in 2014
Premiums, the monthly amount employees pay to participate in the health plan, will remain affordable in 2014.
The goal is to ensure that the plan remains affordable to all employees by limiting the increase for those who earn the least. There will be three salary tiers: under $50,000; $50,000 to under $100,000; and over $100,000. The date used to determine annual salary is January 1. The salaries of part-time employees will be “annualized” in order to determine their tier. Again, rates will be announced prior to Open Enrollment.
OUT OF NETWORK COSTS ARE HIGHER
Plan members who choose to obtain care from providers who are not members of the EHP network will pay higher co-pays, a higher percentage of co-insurance (70/30, rather than 90/10), and higher deductibles. Details are available on the 2014 Schedule of Benefits.