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2019Guide to BenefitsREPRESENTED EMPLOYEES OFTHE JOHNS HOPKINS HOSPITAL2019 Guide to Benefits1
Contact e.comBright HorizonsJohns Hopkins FamilyDay Care Back Up Child & Adult Care855-781-1303www.care.com/backupcareCareWorks rksabsence.comDelta DentalDental Customer Service800-932-0783www.deltadentalins.comEHPCare Management Program800-557-6916www.ehp.orgClaims or Coverage Questions410-424-4450Short Term Disability410-762-5312Employee rg/humanresources/benefits/healthy at hopkins/Empolyee Health &Wellness ources/benefits/healthy at hopkins/Employee Labor aculty & Staff AssistanceProgram (FASAP)443-997-7000www.fasap.orgHealthy at Hopkins410-955-9538www.healthyathopkins.orgHR Solution CenterHR Solution Center443-997-5400HRSC@jhmi.eduHyatt Legal PlansPrepaid Legal800-821-6400www.legalplans.comaccess code: 1380010410-534-4500www.jhfcu.orgJohns Hopkins FederalCredit UnionMetLife800-543-2870Auto & Homeowners InsurancePet InsuranceOccupational 5-6211www.hopkinsmedicine.org/hse/occupational 01UNUMLong Term Care800-227-4165Long Term Life Insurance800-421-0344www.unum.comGroup Accident800-635-5597Group Whole Life800-635-5597Flexible Spending Questions855-774-7441Cobra kers’ e/workers compensation/WORKLife Programs443-997-7000www.hopkinsworklife.org
ContentsIntroduction. 2Eligibility. 3Our Medical Plans. 4Medical Plan Comparison. 6Prescription Benefits. 8Dental Plans. 9Vision Benefits.10Flexible Spending Accounts. 11Healthy@Hopkins. 12Life and Disability. 13Tuition Assistance. 15Time Off. 16Retirement. 17Voluntary Benefits. 18Enrollment Instructions.20Plan Rates. inside back coverSummary Plan DescriptionThe Johns Hopkins Summary Plan Description of BenefitPlans (SPD) gives detailed information about the planprovided under Employment Retirement Income Security Actof 1974 (ERISA). It contains the identity of the plan administrator, the requirements for eligibility and participation inthe plan, circumstances that may result in disqualification ordenial of benefits, and the identity of any insurers.The specific SPDs are displayed with information in reference to:The SPD can be retrieved from the Benefits section of theHuman Resources website:If you would like a free hard copy of any of the resourceslisted above, or if you have any benefits related questions,contact 443-997-5400 or HRSC@jhmi.edu.www.hopkinsmedicine.org/human resources Retirement & 403(b) Plans Medical, Dental, Short Term Disability,& Flexible Spending Accounts Life Insurance Long Term Disability Insurance2019 Guide to Benefits1
IntroductionWe value the people who work here, and The Johns HopkinsHospital is proud of the selection of benefits we've madeavailable to you. These benefits are an important part of yourtotal compensation package as a Hopkins employee, and weencourage you to take time to read this guide and becomefamiliar with all that we offer for you and your family. This guideprovides a brief overview of our benefits; it is not intended to bea complete source of information on the plans.2Represented Employees of Johns Hopkins Hospital
EligibilityEmployeesAll employees regularly scheduled to work 20 hours or more per week are eligiblefor most benefits. For most benefits except Short Term Disability and TuitionAssistance, coverage for new hires or newly eligible employees is effectivethe first day of the month following their date of hire or eligibilitywith completion of the enrollment process. All newly hired employeeshave 30 days from their date of hire to complete their enrollment. Tuition Assistance is available after 60 days of employment.Dependent Tuition Assistance is available to full-time empoyees afterfour years of service (or two years for employees hired before January 1, 2018).WHO IS ELIGIBLE:Employees scheduled30 hours/week: All benefits in this guideEmployees scheduled20-29 hours/week: All benefits exceptDependent Tuition For Short Term Disability benefits, employees regularlyscheduled to work 20 or more hours per week are eligibleafter completion of a 90-day probationary period. Sick Time is available after your 90-day probationary period.Free Days are available in your first year based on your monthof hire, to be used after your 90-day probationary period. Finally,Vacation Days become available after six months of service.DependentsWhen you enroll in a medical, dental, vision and/or dependent life insurance plan,you may also elect coverage for: Your children (with submission of birth certificate & Social Securitynumber) up to age 26 regardless of student or marital status Your legal spouse (with submission of certifiedmarriage certificate & Social Security number)If your spouse works for JHH/JHHSC, you cannot be covered as both an employeeand a dependent. In addition, your eligible dependents may only be covered underone plan.Family Status ChangesOutside of the annual enrollment period, the only time during the plan year thatyou can add or drop coverage or dependents is when you have a family statuschange. Qualifying events include: marriage or divorce, birth of a child, deathof a dependent, gain or loss of a spouse’s coverage and a change in your spouse’semployment status.To make a mid-year change in benefits, you must create a Qualifying Life Eventrequest in the enrollment system and upload supporting documentation of your lifeevent within 30 days of the event.2019 Guide to Benefits3
Medical PlansChoosing Your Health PlanOur health plans include prescription drug coverage,feature low deductibles and copays and offer reducedcosts when you use Hopkins Preferred providers andfacilities. You can choose between two plans.EHP EPO (EXCLUSIVE PROVIDER ORGANIZATION) PLANThe EHP EPO plan is designed to help lower your monthly health care costs whileproviding a wide choice of providers. If you only use in-network providers, the EHPEPO plan may be a cost-effective option for you. The plan offers in-network coverage only (and does not cover out-of-network care): you can visit any provider in theJohns Hopkins Preferred Network or EHP Network. Bi-weekly premiums are lowerin the EPO plan, but out-of-pocket costs may be higher when you seek care.EHP PPO (PREFERRED PROVIDER ORGANIZATION) PLANEHP EPO PLAN: In-network care only Lower bi-weeklypremiums Higher deductiblesand out-of-pocketmaximums Reduced costs at JohnsHopkins Preferredproviders and facilitiesEHP PPO PLAN: Higher bi-weeklypremiums Lower deductiblesand out-of-pocketmaximums 4In- and out-ofnetwork careReduced costs at JohnsHopkins Preferredproviders and facilitiesYou can visit both in-network and out-of-network providers. Bi-weekly premiums arehigher in the EHP PPO plan, while out-of-pocket costs when you seek care may be lower.For medical plan rates, please see the inside back cover of this guide.For EHP medical plan details, please visit benefits.ehp.org.Finding In-Network Care: Know your costsHopkins Preferred NetworkWhat you pay for care depends on the services you need and where you go. AtHopkins Preferred Network providers and facilities, both plans pay 90%, and youpay 10% of the costs for most covered services (after any deductible). This is often themost affordable option.EHP NetworkYou also have access to the EHP network, which pays 80% of the cost, while you pay20%. Different providers charge different fees, so sometimes a low-cost EHP networkprovider could be your most affordable choice.Preventive care services from Hopkins Preferred and EHP network providers arecovered 100%, including diagnostic services for preventive exams, preventive mammograms and preventive colonoscopy.Take time to compare plans and decide what works best for you. If you’re not surehow your provider is covered, go to ehp.org to learn more.MultiPlan NetworkMultiPlan is an extended network of over 600,000 providers nationwide, offeringout-of-area in-network providers beyond the EHP Network. MultiPlan’s PHCSHealthy Directions Network is available outside of Maryland and is considered thesame as EHP in-network benefits. To find a MultiPlan PHCS Healthy Directionsprovider outside of Maryland, visit www.multiplan.com.Represented Employees of Johns Hopkins Hospital
Out-of-Network CareUnder the PPO plan, out-of-network providers (not in theEHP Network) are covered at 70%, and you pay 30% of thecosts. However, under the EPO plan, out-of-network care isnot covered and you will pay 100% of the costs.Pharmacy BenefitsWhen you enroll in a Johns Hopkins EHP medical plan,prescription drug benefits are included. This four-tier benefitoffers savings for using EHP’s approved drug formulary. Thereis a mail order option for most maintenance medications.Vision BenefitsWhen you enroll in the Johns Hopkins EHP medical plan,your vision benefits are included. A full range of optometry andophthalmology vision care services are available, administered onan annual basis.Terms You Should KnowAllowed Benefit: This is the amount the plan has negoti-ated with network providers to accept as full payment. Forexample, if a service is covered at 90%, you only pay 10% ofthe allowed benefit up to your out-of-pocket maximum. Outof-network providers are not obligated to accept the allowedbenefit as payment in full and may charge you more. This iscalled balance billing.Balance Billing: When a provider bills you for the differencebetween the out-of-network provider’s charge and the allowedamount. For example, if the provider’s charge is 200 andthe allowed amount is only 155, the provider may bill youfor the remaining 45—above and beyond. An in-network,participating provider or facility may not balance bill you forcovered services.their services. These providers and facilities will submit theinsurance claim to EHP on your behalf. You are responsiblefor any applicable copays, deductibles and coinsurance.Hopkins Preferred Providers: Johns Hopkins Providersand Johns Hopkins facilities that have contracts with EHPand have agreed to accept discounted fees for their services.Hopkins Preferred Providers will submit the insurance claimto EHP on your behalf. You are responsible for any applicablecopays, deductibles and co-insurance.Out-of-Pocket Maximum: The most an employee andcovered dependent(s) will pay out of pocket each year indeductible, copay and coinsurance charges. Once the totalamount you or your covered dependents have paid in a yearreaches the out-of-pocket limits noted in the charts, the planwill pay 100% of your copays and coinsurance for the remainder of the plan year (through December 31).Out-of-Network Providers: Services received from providers/facilities that do not have a contract with EHP. Such services aresubject to any applicable copays, deductibles and coinsurance.Because the provider/facility is non-participating, they maybalance bill you for charges above the allowed benefit amount.Preauthorization: A decision by your health insurer or planthat a health care service, treatment plan, prescription drug ordurable medical equipment is medically necessary. Sometimescalled prior authorization, prior approval or precertification.EHP may require preauthorization for certain services beforeyou receive them, except in an emergency. Preauthorizationisn’t a promise that EHP will cover the cost.Coinsurance: A percentage of the cost you pay for certaincovered services. Coinsurance is different for services receivedfrom in-network providers and out-of-network providers.Copayment: A fixed dollar amount an employee or covereddependent pays at the time service is rendered. This moneygoes directly to the health care provider.Deductible: The amount an employee or covered dependentis required to pay each year before your medical plan beginspaying benefits for care.EHP Network Providers: Providers and facilities that havecontracts with EHP and have agreed to accept certain fees forSPECIALTY APPOINTMENT LINE1-866-206-7210The Johns Hopkins EHP Specialty appointment linehelps facilitate timely appointments for specialtycare with Hopkins Preferred Providers.It is designed to assist EHP members of Johns HopkinsCommunity Physicians, Johns Hopkins Healthcare,Johns Hopkins Home Care Group, The Johns HopkinsHospital, Johns Hopkins Health System Corporation,and Johns Hopkins Medicine International.2019 Guide to Benefits5
HOPKINS MEDICAL PLANS: SUMMARY OF COSTS AND SERVICESEHP EPO PlanCoverage DetailsHopkins**Annual DeductibleAnnual MedicalOut-of-Pocket MaximumCoinsurance(employee share for select services)EHP**EHP PPO PlanHopkins**Out-ofNetwork 500 per person 150 ( 50K), 200 ( 50K- 120K), 300 ( 120K) (determined by salary tier) 750(all salary tiers) 1,000 per family 300 ( 50K), 400 ( 50K- 120K), 600 ( 120K) (determined by salary tier) 1,500(all salary tiers) 3,000 per person 1,500 ( 50K), 2,000 ( 50K- 120K), 3,000 ( 120K) (determined by salary tier) 3,500(all salary tiers) 6,000 per family 3,000 ( 50K), 4,000 ( 50K- 120K), 6,000 ( 120K) (determined by salary tier) 7,000(all salary tiers)you pay 10%you pay 30%you pay 10%Lifetime Maximumyou pay 20%Unlimitedyou pay 20%UnlimitedEHP** 20 copay 20 copaySpecialist Office Visityou pay 10%*you pay 20%*you pay 10%*you pay 20%*you pay 30%*Preventive ellness Visit(PCP, GYN, Well Child Care) 0 0 0 0you pay 30%*Routine Screenings(Mammogram, Colonoscopy, PAPtest, etc.) 0 0 0 0you pay 30%*Routine Hearing Exams 0 0 0 0you pay tal Inpatient Admission(including maternity,pre-authorization required) 250 copay,then pay 10%* 250 copay,then pay 20%* 150 copay,then pay 10% 150 copay,then pay 20%* 500 copay,then pay 30%*Inpatient Physician Servicesyou pay 10%*you pay 20%*you pay 10%*you pay 20%*you pay 30%*Outpatient spital Outpatient Surgeryyou pay 10%*you pay 20%*you pay 10%*you pay 20%*you pay 30%*Surgery in an AmbulatorySurgical Centeryou pay 10%*you pay 20%*you pay 10%*you pay 20%*you pay 30%*Primary Care Office VisitFacility ServicesHopkins** 10 copay at designated PCP,otherwise 20 copay* For select services such as hospitalization, coverage begins once you have met the deductible for the year.** You can locate providers in the Johns Hopkins Preferred Network and EHP network at www.ehp.org.Represented Employees of Johns Hopkins HospitalEHP**Out-ofNetworkHopkins **Office Visits6EHP**you pay 30%*
HOPKINS MEDICAL PLANS: SUMMARY OF COSTS AND SERVICESEHP EPO PlanEHP PPO PlanLab and rkRoutine Lab Testsyou pay 10%you pay 20%you pay 10%*you pay 20%*you pay 30%*Radiology Procedures(X-Ray, Ultrasound)you pay 10%*you pay 20%*you pay 10%*you pay 20%*you pay 30%*Advanced Radiology(MRI, CT, PET Scan)you pay 10%*you pay 20%*you pay 10%*you pay 20%*you pay 30%*Emergency ServicesHopkins**EHP**Hopkins**EHP**Out-ofNetwork 40 copay 25 copay 25 copayyou pay 30%* 250 copay* 250 copay* 250 copay* 250 copay*you pay 10%*deductible,then no chargedeductible,then no chargedeductible,then nochargeUrgent CareEmergency Room(copay waived if admitted)Ambulance(Medically Necessary Transport)Mental Health,Substance AbuseInpatient Facility(pre-authorization required)Hopkins**EHP**Hopkins**EHP**Out-ofNetwork 250 copayper admission,then pay 10%* 250 copayper admission,then pay 20%* 150 copay peradmission,then pay 10%* 150 copay peradmission, thenpay 20%* 500 copayper admission,then pay 30%*Outpatient Facility 20 copay 10 copay 10 copayyou pay 30%*Outpatient Professional 20 copay 10 copay 10 copayyou pay 30%*Therapy hysical & OccupationalTherapy (60 visits per year, preauthorization required for visits 13-60)you pay 10%*you pay 20%*you pay 10%*you pay 20%*you pay 30%*Speech Therapy (30 visits peryear, pre-authorization required)you pay 10%*you pay 20%*you pay 10%*you pay 20%*you pay 30%*Chiropractic Care(20 visits per year)you pay 10%*you pay 20%*you pay 10%*you pay 20%*you pay 30%*Acupuncture(20 visits per year)you pay 10%*you pay 20%*you pay 10%*you pay 20%*you pay 30%*Other ome Health Care(40 visits per year, preauthorization required)you pay 10%*you pay 20%*you pay 10%*you pay 10%*you pay 30%*Hospice Care(pre-authorization required)you pay 10%*you pay 20%*you pay 10%*you pay 10%*you pay 30%** For select services such as hospitalization, coverage begins once you have met the deductible for the year.** You can locate providers in the Johns Hopkins Preferred Network and EHP network at www.ehp.org.2019 Guide to Benefits7
Prescription Drug BenefitsUsing Your PrescriptionDrug BenefitsDrugs by Tier: Generic vs. Brand NameWhen you get your medications at a pharmacy, you areresponsible for paying a copay or coinsurance.Prescription drugs are coveredunder the EHP medical plans. In most instances, your cost is the lowest whenyou select a generic drug — an affordable andeffective alternative to a brand name drug.Prescription drugs are available in four tiers, with savingswhen you use generic drugs or EHP’s preferred drugformulary. Preferred brand drugs have the next highest cost,but still cost less than other brand-name drugs. They arechosen for their clinical value and cost-effectiveness.Your cost to fill a prescription depends on the health planyou are enrolled in, the tier your drug is in, and whetheryou purchase at a retail pharmacy or through mail order (formaintenance medications). Choosing non-preferred brand namedrugs will result in the highest cost, eventhough they are covered under the plan. Finally, specialty drugs include expensiveinjectable and oral specialty medications for specificconditions. Your costs depend on the drug, andthey are only available at a retail pharmacy.Retail vs Mail Order PrescriptionsYou can fill a prescription at any in-network CVS Caremarkpharmacy. Depending on your prescription, you may be ableto order a 90-day supply of maintenance medications, eitherat a retail pharmacy or through mail order. Mail order is aconvenient way to make sure you're c
The Johns Hopkins Summary Plan Description of Benefit Plans (SPD) gives detailed information about the plan provided under Employment Retirement Income Security Act of 1974 (ERISA). It contains the identity of the plan admin-istrat
