Understanding your medical benefits options

Image caption: Employees opting out of a JHU plan must remember to submit a medical waiver form for 2018.

If the thought of picking a health plan makes you feel a little woozy, you're not alone. As nice as it is to have an array of options, it can also be overwhelming when it comes to actually selecting the plan that's best for you and your family.

Know your benefits
10 ways JHU employees can customize their coverage

Fortunately, JHU has compiled a host of informative resources to help you make a choice during Annual Enrollment, Oct. 20 to No. 7. From the simple summary offered on the JHU Benefits website, to the handy myChoices comparison tool, to a thorough explanation in JHU's Health and Welfare Handbook, there's no shortage of information at your fingertips. You also can attend a Benefits Fair or town hall to hear more about medical coverage from JHU's benefits experts.

Before you dig deeper, here's a quick summary of what's on offer:

Your choices

If you're a full- or part-time faculty or staff member, a bargaining unit member, or visiting faculty or staff, you can choose from several plans, all of which offer prescription drug coverage. Limited-time employees also have a plan they can select.

EHP Classic: This point-of-service plan, open to full- and part-time faculty and staff, allows you to see doctors in or out of network (you'll pay less if you see in-network providers and won't need a referral). Once you meet your deductible, you'll pay a percentage of the cost of each service you receive. There is a separate deductible you'll need to meet with out-of-network providers. EHP's network extends to all 50 states, which is great if you travel frequently or have children in college outside Maryland. There are annual deductibles and co-pays, with prescription coverage offered through Express Scripts.

CareFirst BlueCross BlueShield: This indemnity plan, open to full- and part-time faculty and staff and to bargaining unit members, allows you to see any provider, with no pre-authorization from your primary care physician (though you'll pay less if you use in-network providers). Once you meet your deductible, you'll pay a percentage of the cost of each service you receive. CareFirst has an extensive provider network, which may be important if you travel frequently or have dependents who live farther afield. Prescription coverage is offered through Express Scripts.

Kaiser Permanente HMO: This health maintenance organization plan, open to full- and part-time faculty and staff, and to bargaining unit members, limits you to using physicians and facilities that are in-network and requires approval from your primary care physician for all services (except emergencies). There's no annual deductible, but you'll pay a low flat co-payment for most services you receive. Prescriptions are covered through Kaiser's pharmacies or affiliated community pharmacies.

BlueChoice HMO: This HMO is open only to bargaining unit members and current participants and requires plan members to use a network of physicians and other medical providers. All care must be coordinated and approved by a primary care physician. Like the Kaiser HMO, it has no deductible and a flat co-pay for most services. Prescription coverage is offered through Express Scripts.

CareFirst Plan III: Open to limited-time faculty only, this traditional indemnity plan is administered by CareFirst BlueCross BlueShield and offers plan members access to the same network of providers (you can use out-of-network providers, but your out-of-pocket costs will be higher). Prescription coverage is offered through Express Scripts.

Your costs

As you select your plan, you'll want to have an idea of all your potential costs, from premiums to deductibles to co-pays.

One bit of good news for 2018: JHU's health plan premiums will see only a 1 percent increase for employees this year. Just how much you'll pay in premiums varies by employment status and which plan you select. For full-time staff enrolling in EHP or BCBS, premiums are tiered based on salary; HMOs come with a flat premium rate. Deductibles and co-pays, meanwhile, vary only by plan.

One tip from JHU benefits administrator Megan Kiriazoglou: Compare coverage costs with an eye on the care you or your family might need in the upcoming year. Is your favorite doctor in-network on one plan but not another? Are there services you may need—in vitro fertilization or pre- and post-natal care, for example—that will be covered differently by each plan? Would you like to avoid paying a deductible even if it means being limited to a certain network? The comparison tool will help, as will detailed descriptions of coverage included in JHU's Health and Welfare Handbook.

What you need to do

If you're an existing employee who plans to continue the coverage you had last year, you don't need to do anything; you'll be automatically re-enrolled (though Kiriazoglou says it's a good time to browse the options anyhow and think about whether your needs will change in the coming year). If you're a full-time faculty or staff member who has coverage elsewhere and you don't plan to enroll in a JHU plan, you'll need to provide a medical waiver form for 2018, even if you've done so for past years. The good news: You'll be eligible for the annual waiver credit of $800 (if your salary is $40,000 or less) or $500 (if your salary is more than $40,000). Everyone else needs to select a plan during Annual Enrollment.

Who's eligible: Varies by plan; coverage can include eligible dependents, such as a spouse, domestic partner, and dependents up to the end of the year the dependent turns 26 (or any age for a child with a disability).

When do I sign up? At hire; during Annual Enrollment, Oct. 20 to Nov. 7, 2017; or following a qualified life event.

How do I pay for it? Payroll deduction.

More information: The JHU Health and Wellness Handbook, pages 38 to 101.

Terms to know

Indemnity plan: Also known as "fee for service" plans, indemnity plans allow you to see any provider (though you'll likely pay more to see out-of-network providers), with your insurer paying a portion of the cost once you've met your deductible.

Point-of-service (POS) plan: A type of health care plan that allows you to see doctors in or out of network (though you'll pay more to see out-of-network providers). Plan members must choose a primary care physician, who is their main point of contact and makes referrals, must meet a deductible, and will pay co-pays or a percentage of the cost of service once the deductible is met.

Health Maintenance Organization (HMO): A health insurance organization that offers service from select health care providers for a predetermined fee. Members pay no deductible but pay co-pays for some services.

Co-pay: A fixed amount you pay as your share of a health care service covered by your insurer.

Deductible: A set amount that you must pay, out-of-pocket, for your health care before your insurer begins making payments.

Premium: A set amount you pay, deducted from your paycheck, to cover the cost of your insurance. This is in addition to deductibles and co-pays.

Express Scripts: JHU's prescription plan administrator.

You might also like