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Who do these changes affect?
The change affects non-represented employees at The Johns Hopkins Hospital and Johns Hopkins Health System Corporation, plus all employees at Johns Hopkins Bayview Medical Center, Johns Hopkins HealthCare, Johns Hopkins Community Physicians, Johns Hopkins Home Care Group, Johns Hopkins International, and Johns Hopkins Intrastaff.
What is included in "Complex Case Management (CCM)?"
CCM is for members with complex medical conditions, or have multiple conditions. They work closely with a care manager who will help to assess their health status, work with them to develop a self-management plan and help them in getting the right care.
Who is eligible for case management and how do I enroll?
If you are identified with certain needs you are automatically enrolled and a case manager will contact you. You are under no obligation to participate. You also may self-refer by calling 1-800-557-6916 or email@example.com
If I change jobs or health plans, what happens to my lifetime maximum?
If you were to change plans, you would be subject to any lifetime maximum set by your new plan. Any claims paid under the Hopkins plan will have no bearing on your new plan.
How do I know if this is the right plan for me?
Your decision about which plan is right for you depends on your personal circumstances and preferences. Your human resources benefits professional and EHP's customer service team are available to help you understand your options.
Can I switch to my spouse’s health plan?
Johns Hopkins places no restrictions on where you choose to obtain coverage. Obviously, different plan options come with different terms and conditions, but there is no requirement to stay within the Hopkins plan.
How do these changes affect my other benefits?
Changes to the medical benefit do not affect any other benefit selections you may make (such as life insurance, etc.).
Is there a chance that I could be turned down for coverage?
No. The plan is available to all Hopkins employees.
Is dental or vision coverage affected?
There are no changes to the dental or vision plans.
Are my pharmacy benefits changing?
There are changes to pharmacy co-payments and the specialty drug coverage.
Is urgent care "inpatient" or "outpatient?"
Urgent care is considered outpatient care.
What if I'm traveling and go to a hospital far away?
EHP is a member of the national Multi-plan Network, which allows you to obtain care under the 90/10 coverage level from institutions and providers across the country that also are members of the Multi-plan Network. You will be responsibile for costs at the 70/30 level for care received at non-Multi-plan Network providers and facilities (Out of EHP Network).
If you arrange an ambulance transfer from a non-Hopkins facility how is that covered?
Ambulance fees are covered 100 percent.
Is this just the first of additional increases?
All the changes that are planned have been shared with you. There will be modest increases in premiums, very similar to years past, that will be shared with you during Open Enrollment as we have done in the past, but the basic design of the benefit will remain as it has been described to you. The two-year phase-in of the 90/10 co-insurance feature was approved so that there wouldn't be surprises down the road.
What is an "allowed amount"?
Allowed amount refers to the maximum amount that the health plan will pay for covered health care services. In EHP Network providers have agreed to accept the allowed amount for services on an individual claim. Out of EHP network providers may charge higher amounts for services. In these cases, the patient is responsible to pay the difference between the allowed amount and the total charge.
I still don’t understand deductibles. How much are these?
Deductibles are the (fixed) amount you owe each year for health care services before your health insurance plan begins to pay. For individuals in the EHP plan, the total annual deductible is $100, and $200 for those on the family plan. Those amounts are $750 and $1,500 respectively for out-of-network providers. Your deductible is included in your annual out-of-pocket maximum.
Can my deductible change?
All the rates in the plan are fixed for the duration of the calendar year.
What’s the least I could potentially pay?
The very least you could pay is the total amount of your premiums, but we caution strongly against planning on only this expense. There are no co-payments for preventive care services, but obviously, there are many factors that will affect your health and therefore what you might pay in a given year.
What’s the most I could pay?
There is an annual maximum out-of-pocket cost limit that varies depending on whether your plan is "individual" or "family," and whether you receive care at a hospital that is In EHP Network or Out of EHP Network. See the Schedule of Benefits for details.
Does the out-of-pocket maximum include deductibles and co-pay?
The out-of-pocket maximum includes the annual deductible, but does not include co-payments.
How will my premuims be deducted?
Your monthly health plan premiums are deducted from your regular paycheck. All other health-related expenses for which you are responsible are paid by you directly.
What's the date you'll use in setting my salary tier?
Salary tiers will be set based on the level of pay on January 1.
How do you determine "salary?"
Salary in this instance refers to base salary, excluding overtime.
How do you set salary tiers for part-time workers?
Part-time employees' hourly rate (excluding overtime) is annualized to establish the tier.
Why are JHH/JHHS "basic" and "premium" plans and the Bayview CareFirst plan being eliminated?
Our intent is to simplify our medical benefit offerings and ensure that they are as fair as possible.
What is being done to protect the privacy (access by co-workers to my electronic health record) of employees who use Hopkins providers?
Our rules and procedures regarding the privacy of patient records remain paramount and unchanged. We take very seriously any breach in these rules that protect all our patients, including our employees who happen to be our patients. Any violation of patient privacy will result in disciplinary action that may include termination.
What do you mean by "preferred access?"
By "preferred access" we mean that every reasonable effort will be made to ensure that Hopkins employees have timely access to care they seek from within the system. This will mean having preference over others who might also be seeking care.
What action is required on my part?
At Open Enrollment, you will make the benefit elections most appropriate for you. Human Resources, EHP website and cutomer service can help you make these decisions.
What is "co-insurance?"
Co-insurance is the term used by health insurance companies to refer to the amount that a patient is required to pay for a medical claim, apart from any co-payments or deductible. For example, this is the patient's 10 percent share of the cost under the "90/10" plan, in which the plan pays 90 percent.
What is an "annual out-of-pocket maximum?"
Annual out-of-pocket maximum is a fixed upper limit to how much a patient could pay in co-insurance in each calendar year. Your deductible is included in the annual out-of-pocket maximum, but co-payments are not.
What is "R&C?"
R&C stands for Reasonable and Customary and refers to the way that the plan determines the amount it will reimburse providers. It is based on average or typical amounts charged in the part of the country where services are performed. If the charge is within the “reasonable and customary” parameters, the expense is paid, less any deductible or co-insurance. If the charge is more than what is reasonable and customary, the patient must pay the difference to the provider.
What is "Durable medical equipment?"
Durable medical equipment are equipment and supplies ordered by a health care provider for everyday or extended use by the patient, such as oxygen tanks.
What are "Habilitation Services?"
Habilitation Services are health care services that help a person keep, learn, or improve skills and functioning for daily living.
What are "Hospice Services?"
Hospice Services are services that provide comfort and support for persons in the last stages of a terminal illness and their families.
What is "Hospital Outpatient Care?"
Hospital Outpatient Care is care that takes place in a hospital that usually doesn’t require an overnight stay.
What defines a "out of network provider"?
A "out of network provider" is a provider who doesn’t have a contract with your health insurer or plan (EHP), to provide services to you.
What is "pre-authorization"?
Pre-authorization is a decision ("authorization" made in advance of receiving services) by your health insurer or plan (EHP) that a health care service, treatment plan, prescription drug or durable medical equipment is medically necessary.
What is a "premium"?
A "premium" is the amount that must be paid each month in order for you to participate in the health insurance program or plan.
What is a "pre-certification?"
Pre-certification is confirmation by EHP of a patient's eligibility for coverage for specific services. It is done to ensure payment for services and procedures that are medically necessary, appropriate and cost-effective without compromising the quality of care.
What's a lifetime maximum?
A "lifetime maximum" is a limit set by some insurance plans on the total, cumulative amount they will pay over the entire period of time that a person is a member of that plan. There is no lifetime maximum in the Hopkins plan.
What is "Balance Billing"?
When a provider bills you for the difference (the "balance") between their charges and the allowed amount, this is referred to as "Balance Billing."
What is a "co-pay?"
A co-pay (or co-payment) is a fixed amount (for example, $15) you pay for a covered health care service, usually at the time you receive the service.