JHU Retirees Plan — 2022-2023
Medical Services and Supplies
Coverage for JHU Reitree Group
JHU Retiree Group members will remain with EHP through March 31, 2024.
For health care services provided through that date, JHU Retiree Group members can call EHP customer service with questions until March 31, 2025.
For questions about benefits after March 31, 2024, JHU retirees should contact Quantum Health* at 844-460-2801.
Coverage for Johns Hopkins University
Effective Jan. 1, 2024, Employer Health Programs (EHP) will no longer be the health plan for Johns Hopkins University (JHU) employees and dependents. Current EHP members from JHU will continue to use EHP as their health plan through Dec. 31, 2023 and will then switch to their new health plan.
For health care services provided through Dec. 31, 2023: JHU employees can call EHP customer service with questions until Dec. 31, 2024.
For questions about benefits after Dec. 31, 2023: JHU employees should contact Quantum Health* at 844-460-2801.
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| EHP Network Provider | Out of Network Provider | |
|---|---|---|
| Acupuncture | ||
| Medically necessary services for anesthesia, pain control, and therapeutic purposes | 80% of allowed amount (15 visits annual maximum for all networks combined); deductible applies (Pre-authorization required) | 70% of allowed benefit; deductible applies (15 visits annual maximum for all networks combined )deductible applies (Pre-authorization required) |
| Allergy Tests & Procedures | ||
| Allergy tests | 80% of allowed amount; deductible applies | 70% of allowed benefit; deductible applies |
| Desensitization materials and serum | 80% of allowed amount; deductible applies | 70% of allowed benefit; deductible applies |
| Ambulance Transportation | ||
| Medically necessary ground transport | 80% of allowed amount; deductible applies | 70% of allowed benefit; deductible applies |
| Medically necessary air transport | 80% of allowed amount; deductible applies | 80% of allowed benefit; in-network deductible applies |
| Biofeedback | ||
| Biofeedback | 80% of allowed amount; deductible applies (pre-authorization required) | 70% of allowed benefit; deductible applies (pre-authorization required) |
| Chemo & Radiation Therapy | ||
| Physician visit | 80% of allowed amount; deductible applies | 70% of allowed benefit; deductible applies |
| Materials and treatment | 80% of allowed amount; deductible applies | 70% of allowed benefit; deductible applies |
| Chiropractic Care | ||
| Chiropractor restricted to initial exam, x-rays, and spinal manipulations | 80% of allowed amount; deductible applies | 70% of allowed benefit; deductible applies |
| Chiropractor with PT privileges (physical therapy services) | Refer to Therapy Section | Refer to Therapy Section |
| Dialysis | ||
| Medically necessary services | 80% of allowed amount; deductible applies | 70% of allowed benefit; deductible applies |
| Durable Medical Equipment | ||
| Breast pumps (standard) and related supplies | 100% of allowed amount; deductible waived | 70% of allowed benefit; deductible applies |
| Contraceptive devices | 100% of allowed amount; deductible waived | 70% of allowed benefit; deductible applies |
| Custom DME, including custom wheelchairs | 80% of allowed amount; deductible applies (pre-authorization required) | 70% of allowed benefit; deductible applies (pre-authorization required) |
| Custom-molded orthotics | 80% of allowed amount; deductible applies (pre-authorization required) | 70% of allowed benefit; deductible applies (pre-authorization required) |
| Insulin pumps, Continuous Glucose Monitor and related supplies | 80% of allowed amount; deductible applies | 70% of allowed benefit; deductible applies |
| Hearing aids | For dependent children up to age 19: 80% of allowed amount; deductible applies, replacement aids once every 36 months (all networks combined) For members age 19 and over: 80% of allowed amount; deductible applies, $1,000 maximum benefit per ear every 36 months (all networks combined) | For dependent children up to age 19: 70% of allowed benefit; deductible applies, replacement aids once every 36 months (all networks combined) For members age 19 and over: 70% of allowed benefit; deductible applies, $1,000 maximum benefit per ear every 36 months (all networks combined) |
| Non-custom medical equipment and supplies | 80% of allowed amount; deductible applies | 70% of allowed benefit; deductible applies |
| Prosthetic devices | 80% of allowed amount; deductible applies (pre-authorization required) | 70% of allowed benefit; deductible applies (pre-authorization required) |
| Blood Pressure Cuff | 80% of allowed amount; deductible applies | 70% of allowed benefit; deductible applies |
| Emergency Services | ||
| Emergency care (facility fees) | $100 co-pay, then 100% of allowed amount; deductible waived (ER co-pay waived if admitted); See Inpatient Facility Care for coverage) | $100 co-pay, then 100% of allowed benefit; deductible waived (ER co-pay waived if admitted; See Inpatient Facility Care for coverage) |
| Emergency care (professional fees) | 80% of allowed amount; deductible applies | 80% of allowed benefit; in-network deductible applies |
| Home Health Services | ||
| Medically necessary services | 100% of allowed amount; deductible waived (90 visits per year maximum for all networks combined; pre-authorization required) | 70% of allowed benefit; deductible applies (90 visits per year maximum for all networks combined; pre-authorization required) |
| Home infusion therapy | 80% of allowed amount; deductible applies (pre-authorization required) | 70% of allowed benefit; deductible applies (pre-authorization required) |
| Hospice Care | ||
| Inpatient and home hospice | 80% of allowed amount; deductible applies (pre-authorization required) | 70% of allowed benefit; deductible applies (pre-authorization required) |
| Hospital Care | ||
| Inpatient care including newborn nursery care; NICU (facility fees) | $250 co-pay per admission, then 80% of allowed amount; deductible applies (semi-private, unless private room is medically necessary; pre-authorization required) | $250 co-pay per admission, then 70% of allowed benefit; deductible applies (semi-private, unless private room is medically necessary; pre-authorization required) |
| Inpatient care (professional fees) | 80% of allowed amount, after deductible | 70% of allowed benefit; after deductible |
| Skilled nursing/rehabilitation facility | 80% of allowed amount; deductible applies (120 days per year maximum all networks combined for medically necessary services; pre-authorization required) | 70% of allowed benefit; deductible applies (120 days per year maximum all networks combined for medically necessary services; pre-authorization required) |
| Short-term acute rehabilitation | 80% of allowed amount; deductible applies (120 days per year maximum all networks combined for medically necessary services; pre-authorization required) | 70% of allowed benefit; deductible applies (120 days per year maximum all networks combined for medically necessary services; pre-authorization required) |
| Observation care (facility fees) | $100 co-pay, then 100% of allowed amount; deductible waived (ER co-pay waived if admitted); see Inpatient Facility Care for coverage | $100 co-pay, then 100% of allowed amount; deductible waived (ER co-pay waived if admitted); see Inpatient Facility Care for coverage |
| Observation care (professional fees) | 80% of allowed amount; deductible applies | 80% of allowed benefit; deductible applies |
| Outpatient surgery & ambulatory surgical center (facility fees) | 100% of allowed amount; deductible waived (includes freestanding surgical centers) | 70% of allowed benefit; deductible applies (includes freestanding surgical centers) |
| Outpatient surgery & ambulatory surgical center (professional fees) | 80% of allowed amount; deductible applies (includes outpatient testing prior to outpatient surgery) | 70% of allowed benefit; deductible applies (includes outpatient testing prior to outpatient surgery) |
| Hyperbaric Oxygen Therapy | ||
| Medically necessary services | 80% of allowed amount; deductible applies (pre-authorization required) | 70% of allowed benefit; deductible applies (pre-authorization required) |
| Immunizations | ||
| Preventive immunizations for communicable diseases | 100% of allowed amount; deductible waived | 70% of allowed benefit deductible waived |
| Travel immunizations | 100% of allowed amount; deductible waived | 70% of allowed benefit deductible waived |
| Infusion Therapy | ||
| Home infusion therapy | 80% of allowed amount; deductible applies (pre-authorization required) | 70% of allowed benefit; deductible applies (pre-authorization required) |
| Outpatient infusion therapy | 80% of allowed amount; deductible applies | 70% of allowed benefit; deductible applies |
| Injections | ||
| Injections | 80% of allowed amount; deductible applies | 70% of allowed benefit; deductible applies |
| Materials and serum | 80% of allowed amount; deductible applies | 70% of allowed benefit; deductible applies |
| Laboratory | ||
| Laboratory tests including pathology | 80% of allowed amount; deductible applies | 70% of allowed benefit; deductible applies |
| Mental Health & Substance Use Disorder Services | ||
| Outpatient mental health care (facility fees) | 80% of allowed amount; deductible applies | 70% of allowed benefit; deductible applies |
| Outpatient mental health care (professional fees) | 80% of allowed amount; deductible applies | 70% of allowed benefit; deductible applies |
| Inpatient mental health care (facility fees) | $250 co-pay per admission, then 80% of allowed amount; deductible applies (pre-authorization required) | $250 co-pay per admission, then 70% of allowed benefit; deductible applies (pre-authorization required) |
| Inpatient mental health care (professional fees) | 80% of allowed amount; deductible applies | 70% of allowed benefit; deductible applies |
| Outpatient substance use disorder care (facility fees) | 80% of allowed amount; deductible applies | 70% of allowed benefit; deductible applies |
| Outpatient substance use disorder care (professional fees) | 80% of allowed amount; deductible applies | 70% of allowed benefit; deductible applies |
| Inpatient substance use disorder care (facility fees) | $250 co-pay per admission, then 80% of allowed amount; deductible applies (pre-authorization required) | $250 co-pay per admission, then 70% of allowed benefit; deductible applies (pre-authorization required) |
| Inpatient substance use disorder care (professional fees) | 80% of allowed amount; deductible applies | 70% of allowed benefit; deductible applies |
| Intensive outpatient program | 80% of allowed amount; deductible applies | 70% of allowed benefit; deductible applies |
| Partial hospital facility services | 80% of allowed amount; deductible applies | 70% of allowed benefit; deductible applies |
| Medication management | 80% of allowed amount; deductible applies | 70% of allowed benefit; deductible applies |
| Mental health testing and procedures | 80% of allowed amount; deductible applies | 70% of allowed benefit; deductible applies |
| Methadone Treatment | ||
| Medically necessary outpatient care | 80% of allowed amount; deductible waived | 70% of allowed benefit; deductible applies |
| Nutritional Counseling | ||
| Medically necessary services | 80% of allowed amount; deductible applies (limited to 2 visits per plan year for all networks combined) | 70% of allowed benefit; deductible applies (limited to 2 visits per plan year for all networks combined) |
| Office Visits for Treatment of Illness or Injury | ||
| Primary care office visit only (Adult) | 80% of allowed amount; deductible applies | 70% of allowed benefit; deductible applies |
| Primary care office visit (Pediatric: age 19 and under) | 80% of allowed amount; deductible applies | 70% of allowed benefit; deductible applies |
| Primary care office visit only (GYN) | 80% of allowed amount; deductible applies | 70% of allowed benefit; deductible applies |
| Specialty care office visit only (Adult & Pediatric) | 80% of allowed amount; deductible applies | 70% of allowed benefit; deductible applies |
| Treatment and diagnostic services in the office | 80% of allowed amount; deductible applies | 70% of allowed benefit; deductible applies |
| Preventive Services | ||
| Preventive exam (PCP, GYN and Well Child care) | 100% of allowed amount; deductible waived | 70% of allowed benefit; deductible waived |
| Diagnostic services for preventive exam | 100% of allowed amount; deductible waived | 70% of allowed benefit; deductible waived |
| Routine preventive screenings: mammogram, colonoscopy, PAP test, etc. | 100% of allowed amount; deductible waived | 70% of allowed benefit; deductible waived |
| Routine hearing exams | 80% of allowed amount; deductible applies | 70% of allowed benefit; deductible applies |
| Dermatological Screening | 100% of the allowed amount; deductible waived (One screening per year) | 70% of allowed benefit; deductible waived (One screening per year) |
| Private Duty Nursing | ||
| Private Duty Nursing | Not Available | Not Available |
| Radiology Procedures | ||
| Advance imaging including MRI, CT and PET scans | 80% of allowed amount; deductible applies | 70% of allowed benefit; deductible applies |
| All other imaging studies; including X-Ray and Ultrasound | 80% of allowed amount; deductible applies | 70% of allowed benefit; deductible applies |
| Reproductive Health | ||
| Physician office visits (prenatal care only) | Routine prenatal visits covered at 100%; all other pre-natal visits at 80% of allowed amount; deductible applies | 70% of allowed benefit; deductible applies |
| Infertility treatment | 80% of allowed amount; deductible applies (maximum lifetime benefit: $100,000, medical and pharmacy combined; maximum of 6 attempts per live birth for artificial insemination and intrauterine insemination; maximum of 3 attempts per live birth for in vitro fertilization; pre-authorization required for all services) | 70% of allowed benefit; deductible applies (maximum lifetime benefit: $100,000, medical and pharmacy combined; maximum of 6 attempts per live birth for artificial insemination and intrauterine insemination; maximum of 3 attempts per live birth for in vitro fertilization; pre-authorization required for all services) |
| Birthing centers (facility fees) | 80% of allowed amount; deductible applies | 70% of allowed benefit; deductible applies |
| Birthing centers (professional fees) | 80% of allowed amount; deductible applies | 70% of allowed benefit; deductible applies |
| Inpatient maternity care and delivery; newborn nursery care; NICU (facility fees) | $250 co-pay per admission, then 80% of allowed amount; deductible applies (pre-authorization required) | $250 co-pay per admission, then 70% of allowed benefit; deductible applies (pre-authorization required) |
| Inpatient maternity care and delivery; newborn nursery care; NICU (professional fees) | 80% of allowed amount; deductible applies | 70% of allowed benefit; deductible applies |
| Interruption of pregnancy | 80% of allowed amount; deductible applies | 70% of allowed benefit; deductible applies |
| Female sterilization (professional services for surgery, anesthesia and related pathology) | 100% of allowed amount; deductible waived | 100% of allowed benefit; deductible waived |
| Male sterilization (professional services for surgery, anesthesia and related pathology) | 80% of allowed amount; deductible applies | 70% of allowed benefit; deductible applies |
| Surgical Procedures | ||
| Surgical treatment for morbid obesity | 80% of allowed amount; deductible applies (pre-authorization required) | 70% of allowed benefit; deductible applies (pre-authorization required) |
| Primary care office surgical procedures | 80% of allowed amount; deductible applies | 70% of allowed benefit; deductible applies |
| Specialist care office surgical procedures | 80% of allowed amount; deductible applies | 70% of allowed benefit; deductible applies |
| Outpatient surgery (including freestanding surgical centers) (facility fees) | 100% of allowed amount; deductible waived | 70% of allowed benefit; deductible applies |
| Outpatient surgery (including freestanding surgical centers) (professional fees) | 80% of allowed amount; deductible applies | 70% of allowed benefit; deductible applies |
| Inpatient surgery (facility fees) | $250 co-pay per admission, then 100% of allowed amount; deductible waived (pre-authorization required) | $250 co-pay per admission, then 70% of allowed benefit; deductible waived (pre-authorization required) |
| Inpatient surgery (professional fees) | 80% of allowed amount; deductible applies (pre-authorization required) | 70% of allowed benefit; deductible applies (pre-authorization required) |
| Telemedicine | ||
| Telemedicine | 80% of allowed amount; deductible applies | 70% of allowed benefit; deductible applies |
| Therapy | ||
| Habilitative services for children under the age of 19 | 80% of allowed amount; deductible applies (pre-authorization required) | 70% of allowed benefit; deductible applies (pre-authorization required) |
| Physical therapy/occupational therapy medically necessary services | 80% of allowed amount; deductible applies (45 visits per year combined maximum for all networks) | 70% of allowed benefit; deductible applies (45 visits per year combined maximum for all networks) |
| Speech therapy (non-developmental medically necessary services) | 80% of allowed amount; deductible applies (30 visits per year maximum for all networks combined; pre-authorization required) | 70% of allowed benefit; deductible applies (30 visits per year maximum for all networks combined; pre-authorization required) |
| Pulmonary rehabilitation | 80% of allowed amount; deductible applies (pre-authorization required) | 70% of allowed benefit; deductible applies (pre-authorization required) |
| Cardiac rehabilitation | 80% of allowed amount; deductible applies (pre-authorization required) | 70% of allowed benefit; deductible applies (pre-authorization required) |
| Vision therapy | Not Available | Not Available |
| Urgent Care Center | ||
| Physician visit | $50 co-pay, then 100% of allowed amount, deductible waived | $50 co-pay, then 100% of allowed benefit, deductible waived |
| Diagnostic services and treatment | 100% of allowed amount; deductible waived | 100% of allowed benefit; deductible waived |
Revised
December 29, 2023
Group Number
E0005100 (*003C/*004C)
Plan Codes
225C0000
