Graduate Student and Postdoc Health Care & Insurance

 

Your Health Coverage

See GSA Website for updated versions, Q & A, and Suggestion Box: http://www.med.jhu.edu/gsa/health.html

JHU SOM graduate students have health coverage through THREE separate offices:

  1. Student Health Program (SHP)
    1. Administered by Employee Health Program (EHP)
    2. Contact: 888-400-0091 or 410-424-4485 (M-F 8 am to 5 pm)
    3. SHP provides the bulk of your insurance coverage
    4. Annual Deductible=$100; Annual Maximum Out of Pocket=$3000
    5. For specific coverage information refer to SHP Booklet or to http://www.ehp.org/
  2. University Health Services (UHS) Clinic
    1. Location: Carnegie Building Rm 136 (M-F 8:00 am - 4:30 pm)
    2. Appointments & Information: 410-955-3250
    3. UHS Clinic provides certain types of care with no charge to the JHU SOM student
    4. Refer to Ambulatory Health Care Program for Students & Fellows Brochure or to http://www.hopkinsmedicine.org/education/studentsfellows.html for more info
  3. University Health Services (UHS) Benefits Office
    1. Location: Blalock 144 M-F 8:30 am - 4:30 pm
    2. Contact: Darnell Williams 410-955-3872
    3. UHS provides supplementary insurance coverage, mainly for outpatient services

Health Services

  1. UHS Clinic: Appointments & Information 410-955-3250
    1. Location: Carnegie Building Rm 136 (M-F 8:00 am - 4:30 pm)
    2. Handles almost all medical needs including physicals, annual gynecological exams, & illness
    3. If you need to see a specialist, you must first get a Referral from the UHS Clinic (the UHS Benefits Office will only pay for doctor visits outside the UHS Clinic if you have a Referral)
    4. Oral Contraceptives, not covered by SHP, are available at cost through the UHS Clinic
    5. Some services (e.g. surgery, inpatient care, medical supplies) require pre-certification by SHP (888-400-0091 or 410-424-4485) even if prescribed by your physician
  2. Pharmacy Benefits (through SHP)
    1. Take your SHP ID card (with PCS logo) & Prescription to participating pharmacy
    2. You must pay 20% co-pay up front
    3. Maximum benefit for any one prescription is 34 days or 90 days through Mail Order
    4. Mail Order Forms may be obtained from UHS Benefits Office (144 Blalock)
  3. Wilmer Eye Institute: Appointments 410-955-5080
    1. Location: Outpatient Center (M-F 9:00 am - 3:00 pm)
    2. Students are entitled to one eye exam per academic year (July 1 - June 30) at no charge
    3. Contact lens exams, eyeglasses, and contacts are available at an employee discount (20%)
  4. Student Mental Health Office: Appointments 410-955-1892
    1. Location: 550 Building Rm 403
    2. Students are entitled to 8 visits per academic year (July 1 - June 30) at no charge
    3. Precertification is required for SHP coverage of inpatient or outpatient facility treatment programs for mental health services
  5. Occupational Health Services (OHS): 410-955-6211
    1. Location: 3 East Phipps (M-F 7:30 am - 3:30 pm)
    2. Offers Hepatitis B Vaccines, annual Flu Shots, and other vaccinations & testing for employees

Graduate Student Health Care & Insurance

Emergencies

  1. Physical Health Emergencies - You have 4 options:
    1. Call the UHS Physician On-Call
      1. M-F 8:00 am to 4:30 pm: 410-955-3250 (also the UHS Clinic Appointments #)
      2. Evenings, Weekends, Holidays: 410-955-4331
      3. If the physician instructs you to go to the Emergency Room, SHP is obligated to cover the ER visit costs
    2. If Life Threatening, go directly to the nearest ER
      1. ER services rendered 72 hours after an Accident are covered in full by SHP
      2. You must notify SHP Customer Service (888-400-0091 or 410-424-4485), within 48 hours of the ER visit to receive coverage
      3. If SHP determines the situation was not an emergency, they may deny coverage
    3. Urgent Care Centers- e.g. Patient First or Urgent Care Facility, JH Hospital (NOT the ER)
      1. For illnesses or injuries that require prompt medical assistance but do not qualify as an emergency (life or limb threatening)
      2. Only covered at 80% by SHP
    4. For non-life threatening illness or injury, schedule appointment at UHS Clinic or speak to a Nurse if you can't get an appointment @ 410-955-3250. DO NOT walk in hoping for an appointment.
  2. Mental Health Emergencies: Daytime 410-955-1892; Nightime/Weekends: 410-955-5964
  3. Needle Sticks
    1. 410-955-STIX (410-955-7849) Available 24 hours/day, 7 days/week
    2. For exposure to potentially infected blood or other body fluid, call Immediately!!!

The Billing Process

  1. The PROVIDER sends a Claim Form to SHP
  2. The PROVIDER sends a Statement of Services to YOU (this form usually says "This is not a bill." and explains which charges have been sent to SHP for processing)
  3. SHP sends an Explanation of Benefits to YOU (explains charges that SHP has paid on your behalf)
  4. The PROVIDER sends a Bill to YOU (this is the amount still due after SHP coverage)
  5. YOU must take the Bill and Explanation of Benefits to the UHS Benefits Office (Blalock 144) to request supplementary coverage from UHS
  6. YOU are responsible for determining if any charges are still due to the PROVIDER. Please call the contact people at SHP and the UHS Benefits Office if you have any questions!!!
  7. Claims filed more than 18 months after the expenses were incurred are not covered by SHP or the UHS Benefits Office- So, bring in the bill & explanation of benefits as soon as you receive the bill!!!

Dental Insurance

  1. CareFirst BlueCross BlueShield: Annual Deductible=$50; Annual Maximum Out of Pocket=$1500
  2. Provider: YOU have the exclusive right to choose your own Provider. HOWEVER, YOU pay for charges above the allowed amount with a Non-Participating Provider. Participating Providers can be found @ http://www.carefirst.com/ or by calling 800-248-8410
  3. Claims:
    1. Participating Providers: Provider sends claim directly to CareFirst
    2. Non-Participating Providers: YOU are responsible for submitting claim
    3. Claims must be submitted within 12 months of the date the service was provided
    4. Coverage: Oral Exam & Routine Cleaning twice per year @ 80% with no deductible
    5. Precertification: Call 800-443-5434; Required for some services to obtain full coverage
    6. For specific coverage information refer to CareFirst Employee Benefit Guide or http://www.carefirst.com/