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JHU Retirees Plan — 2022-2023

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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
Available 24/7

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