Medical Benefits for 2014

What Are the Changes in JHH/JHHSC Benefits for 2014?

Hope Marsh, senior director of benefits and wellness for the Johns Hopkins Health System, provides an update on the 2014 benefits program for employees of The Johns Hopkins Hospital, The Johns Hopkins Health System Corporation, Johns Hopkins Bayview Medical Center, Johns Hopkins Community Physicians, Johns Hopkins HealthCare and Johns Hopkins Home Care Group. Mark your calendars for open enrollment, which will take place Oct. 21 through Nov. 4. We’ve also posted helpful information on the EHP website at ehp.org/benefitupdate and ehp.org/ehp-member-questions-answers.

After years of providing 100 percent paid health insurance, why did Johns Hopkins go to a 90/10 co-insurance plan?
Last year, Johns Hopkins announced that in an effort to control the rising medical care costs and improve the health and wellness of its employees, it was making important changes to the health benefits plan, known as the Employer Health Programs, or EHP. The most significant was that Johns Hopkins Medicine would shift from paying the total cost of health care coverage to a 90/10 cost-sharing split when the employee used a provider outside of the Johns Hopkins network for inpatient services. If you’re familiar with Johns Hopkins Medicine’s five-year strategic plan, you’ll see that these changes align with our people strategic initiative to improve the health and wellness of our workforce members, many of whom are at risk for at least one chronic illness, and improve employee access to the world-class care that Johns Hopkins provides; and the strategic initiative of performance, which focuses on cost savings, increased revenue and operational efficiencies that will strengthen each of our member institutions.

How does the 2014 medical benefit work?
We will continue to provide 100 percent coverage if you use Johns Hopkins-owned facilities, such as the six hospitals, and we will also continue to provide 100 percent coverage for preventive care services. Effective Jan. 1, 2014, if you use a provider or facility that is part of the EHP network, but not the Hopkins Preferred Network, you will pay 10 percent of the cost for inpatient and outpatient care, up to the yearly out-of-pocket maximum of $2,000 per individual and $4,000 for a family. Plan members who choose to obtain care from providers who are not members of the EHP network will pay higher copays and a higher percentage of co-insurance (70/30, rather than 90/10). You can view the Schedule of Benefits at ehp.org.

How will employees know who is a Hopkins Preferred medical provider?
You will be able to verify who is a Hopkins-Preferred Network medical provider through an online directory. To search for a provider in the Hopkins Preferred Network, use our Provider Directory.
A list of Hopkins Preferred Network providers can be found here.
Since PCP care is not changing, the listing of EHP in-network primary care providers can be found here and also in the provider directory.

Tell us about changes to the copay structure.
We listened to your concerns and comments about the benefits changes and responded where we could. We reduced copays for specialty care, urgent care and mental health care for 2014. You’ll pay $30 for specialty care, $25 for urgent care and $10 for mental health care. Most other copays have remained the same as 2013, except for primary care. If you provide EHP with the name of the EHP network primary care provider (PCP) for you and your dependents, and you see that PCP, your PCP copay will be $10. If you do not provide this information or do not see your designated PCP, your EHP network PCP copay will be $20. While we encourage employees to see Johns Hopkins providers when they can, there will be no Hopkins Preferred Network for primary care. The copays will be the same for EHP network providers and Hopkins Preferred providers for primary care. Gyn visits by EHP network providers will be $10 and you do not have to tell EHP who your gyn provider is to pay a $10 copay.

A number of employees complain that it takes weeks and even months to schedule appointments with certain physicians and providers. What’s being done to facilitate timely visits?
A toll-free member hotline will be provided to help employees navigate through the Johns Hopkins specialist providers. Whenever possible, the facilitator will assist with determining an appropriate timeline to receive care and help the member set up the appointment with the provider. We’ll provide more details about this system in a future JHM News e-newsletter and Inside Hopkins newsletter.

Now that it’s legal for same-sex couples to marry in Maryland, how will benefits change for domestic partners?
We’re aware of about 130 employees who are currently receiving benefits as domestic partners. Since June, we’ve been in contact with these employees to inform them that now that the Maryland General Assembly has passed same-sex marriage, couples who live in states where same-sex marriage is legal must be married in order to receive EHP benefits. All couples, including same-sex partners, must provide a marriage affidavit to retain their benefits. The tax liability for these couples will improve. Because the U.S. Supreme Court struck down certain provisions of the Defense of Marriage Act, taxes on these benefits will be adjusted.

How does health care reform affect benefits for EHP members?
The health care exchange takes effect Jan. 1, 2014. You will be receiving information about your eligibility for benefits under the exchange by Oct. 1, 2013. According to the law, if you are a benefits-eligible employee who works for Johns Hopkins, you may not be eligible to join an exchange because you are offered an employer-sponsored affordable health care benefit. Any employee who does not have health care coverage must pay a penalty, which will be levied through the Internal Revenue Service.

Where can employees get more information?
There are few things more important than providing health care coverage for you and your families. And the process can create a little anxiety for some of us. Open enrollment is Oct. 21 through Nov. 4, and HR is planning a Health and Benefits Fair on Thursday, Sept. 19, in Phipps Courtyard from 9 a.m. to 5 p.m. and from 9 p.m. to 2 a.m. Representatives from EHP, Wellnet and HR will be available to answer your questions. A fair will be held at Johns Hopkins Bayview Medical Center on Wednesday, Sept. 18, and at Johns Hopkins Home Care Group on Tuesday, Oct. 3. We will also be providing information to your managers and written material and informational sessions, so please watch for those live sessions.

What resources are available to improve my health?
There are many resources available on the Healthy@Hopkins page.

What about benefit changes regarding the Johns Hopkins University School of Medicine, Howard County General Hospital, Sibley Memorial Hospital and Suburban Hospital?
Information about the benefits programs for these employees will be available in the upcoming weeks.

Hopkins Happenings note: Important information has already been posted at ehp.org/benefitupdate. To ask a question or make a comment, please click on the button below. Please do not ask about personal situations or include personal health information or your medical history.

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42 Comments

{ 42 comments… read them below or add one }

Comments

karen September 13, 2013 at 3:33 pm

If you are admitted to a non-preferred hospital by a JHCP primary care physician will it be cover 100 percent or at the option 1 level.

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Molly October 14, 2013 at 2:42 pm

Hi Karen,

I'm not sure if you are a JHCP employee or not, but if so - we are hosting a webinar tomorrow, 10/15 at 5 p.m. to review a presentation and to ask any questions our employees have. If you need that information, send me an email at mjacks74@jhmi.edu and I'll make sure you have the log-in information.

Thanks!

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WM August 29, 2013 at 3:03 pm

I am a housestaff/resident member at JHH and have a question regarding maternal-fetal care and Labor and Delivery costs/charges. Our Ob-Gyn (Dr. Deborah Hebb) is at GBMC but accepts EHP and I believe is listed under HOPKINS PREFERRED PROVIDERS. My wife is pregnant with our second child and she wishes to again give birth at GBMC as with our previous child. Would pregnancy associated ultrasound studies and appointments be covered differently? Would Labor and Delivery and post-partum care also be covered at 90/10? We still had some costs that we were responsible with our last pregnancy and labor and delivery so we are wondering how was this covered previously and what would be the major change/difference starting in January, 2014. If my wife gave birth at a Hopkins owned hospital would everything be covered 100%? Thank you

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Hope August 30, 2013 at 8:52 am

Your physician is part of the Hopkins Preferred Network and any professional fees associated with her services will be covered as the Hopkins Preferred Network benefit. If your spouse delivers at GBMC then the facility fees will be covered at th 90/10 benefit up to the out-of-pocket maximum.
This explanation is for Johns Hopkins Health System and the Johns Hopkins Hospital employees, if you are a School of Medicine employee please contact the JHU Benefits Service Center at 410-516-2000.

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Linda Pierce August 29, 2013 at 11:40 am

Sorry, one more ?. What labs can we use for blood tests, Chest xrays, CT scans etc? Just those facilities within Hopkins hospitals? I haven't seen this addressed anywhere yet. Thx !

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Donnell Grate August 29, 2013 at 3:27 pm

This inquiry needs to be researched by EHP. I will contact you directly about this.

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Gene August 30, 2013 at 5:45 am

Good question. I believe the lab at JHCP WhiteMarsh was not operated by Hopkins when I last visited.

Linda Pierce August 29, 2013 at 8:40 am

A few ?'s. 1. How will this affect covered adult children living out of state or while traveling. Everything will be 90/10 ? 2. Will the new ins. cards reflect that we are to pay co-pay plus 10% or will there just be the co-pay and wait for bills ? 3. Is there going to be an annual deductible IF all providers are in plan ? 4. Re: labs, x-rays, mri's and the like; is Hopkins going to have more providers that are open beyond regular business hours? Last year I needed an MRI of my foot. COULD NOT get it done at JHH without taking time off work (nearly impossible unless pre-planned) but I was able to get one done on a Sunday afternoon at a competitor. Thx.

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Donnell Grate August 29, 2013 at 11:23 am

Children living out of state or traveling will have access to the multiplan network (www.multiplan.com) it will be the PHCS option, which allows them to seek care at the EHP in network level. Any emergency situation will require the $150 co-pay, then it is paid at 100%. If admitted, the $150 co-pay is waived and there will be the 90/10 cost share for inpatient services at an EHP in network facility. Deductibles will apply if you using the EHP in network option. No deductible will apply if using the Hopkins Preferred Provider network option. The insurance cards will reflect the co-pay only, not the 10%. We are working with our providers to improve overall access for all services.

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Terry Hollifield August 29, 2013 at 12:07 am

I just changed my PCP to a physician from JHCP in White Marsh but when I looked her up in the directory there is no Hopkins Preferred Physician under the tiers. Is she still a Hopkins Peferred Physician?

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Donnell Grate August 29, 2013 at 10:25 am

Thank you for your question. This inquiry needs to be researched by EHP. I will contact you directly about this.

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Patty Mullis August 28, 2013 at 9:39 pm

Since I do not currently have a PCP I have tried to make appoitments with some JHCP doctors and am always told they are not accepting new patients. What is Hopkins going to do to make more physcians available for this inflex?

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Hope August 29, 2013 at 8:25 am

Johns Hopkins Community Physicians is working hard to increase their physician roster.
While we encourage employees to see Johns Hopkins providers when they can, there will be no Hopkins Preferred Network for primary care. The copays will be the same for EHP network providers and Hopkins Preferred providers for primary care.

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Karen August 28, 2013 at 12:53 pm

If you are in an emergency situation, and taken by ambulance to a non JH hospital, and are admitted, does the 90/10 then apply for inpatient?

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Hope August 28, 2013 at 1:44 pm

Yes, if admitted, the ED co-pay is waived and you would pay the in-patient co-pay and 10% up to the out-of-pocket maximum of $2,000.
If you go the Emergency Room and are seen but not admitted, it wiould be $150 co-pay whether you are seen at an EHP hosptial or a Hopkins hospital. No deductible and no additional cost.
While it wouldn't be possible in all cases, if you were seen in a non-JH hospital emergency room and and your condition allowed you to be moved, you could request to be sent to the nearest JH hospital.

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Karen August 28, 2013 at 2:01 pm

And then is ambulance transport covered ?
I can see that an emergency situation that necessitates admission could end up to be very expensive!

Lefty3 August 28, 2013 at 11:43 am

The JHCP Odenton practice to which I've been going has a habit of referring me to PAtient First because they either are too busy to accommodate me or don't have the needed x-ray facilities with a decent turn-around-time. That forces me to pay an urgent care fee, which I presume will go up even higher under the new rules. Is there any framework/process being built for 2014 that would allow a discounted co-pay for the urgent care center when I'm going because my PCP can't look after me?

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Donnell Grate August 28, 2013 at 12:24 pm

The Urgent Care co-pay has actually reduced to $25.00, with the deductible waived for 2014.

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Gene August 30, 2013 at 5:36 am

I do not have a regular primary care physician. Patient First says they provide primary care services for patients who do not have a regular physician. If I see a Patient First primary care physician for an annual preventive exam, are you saying that it should be billed as an urgent care visit with a co-pay of $25? Why is that? Are the providers at Patient First in the EHP network - or outside the network?

Heidi Conway August 28, 2013 at 11:23 am

Good luck with your changes. This update is very helpful. Nice job.

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Cindy Harper August 28, 2013 at 9:58 am

I don't see my oncologist on the list, but I do see his nurse practitioner. I don't see many oncologists at all on the list. Is the list complete?

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Donnell Grate August 28, 2013 at 11:33 am

Good question. This needs to be researched by EHP. I will contact you directly about this.

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Herbert Mann August 28, 2013 at 9:38 am

I think some of the frustration level is not so much of the lengthy time to secure an appointment but the difficulty of even being seen by a provider and providers not wanting to see a certain patient population. Of course the JHH and JHU costs are increasing but it becomes difficult for persons covered under EHP when they are given a choice of higher out of pocket expenses or dealing with sometimes out right ignorance of providers and their staff. My 3 personal examples: No 1 When one infusion center tells you that EHP does not pay them enough to treat you and it is a burden on staff so be happy with when they can treat you – I was lucky enough to secure services at another infusion center. No 2 When Immunology at one hospital first informs you that you do not fit into any of their studies but they may keep you, the second appointment you are told you are wasting their time and increasing the cost of health care and when they review charts and lab results they frantically call you. You file a complaint with the hospital and then they refuse to see you or consult with any of the other services. This one has forced me to seek immunology services outside the network ; lucky enough my current team and the out of network doctor communicate and work well together so I can be treated in network to mitigate the cost. No 3 When you come to emergency department from out of state because your platelet count is so low they have to manually count it in the lab and the covering service HEME ONC does not feel comfortable seeing you and you have to wait until Heme comes back on service in 8-12 hours. During that time you start to actively bleed from the mucous membranes you have to call your attorney and physician and go to an out of network hospital for treatment. Number 3 is the best example when you may be faced with of higher out of pocket cost and a life threatening & altering condition and you have to decide what the best thing to do is? Please feel free to share any of this information.

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Hope August 29, 2013 at 8:22 am

These are serious clinical service issues that will be referred back to the areas involved as well as Patient Relations. We continue to work on improving the access to care within all Johns Hopkins hosptials and providers.

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Paula Mattingly August 29, 2013 at 9:13 am

Working on it doesn't help Herbert right now - right? So, what about Michelle with the Watersedge issue - that should not BE an issue. Once you get into this plan - you fall prey to these issues and have no place to turn other than voice it here?? How do you get "instant" resolution of these very dramatic events that should be given immediate attention? That's a concern to me since I have BC/BS which is why I do - though they have issues too. Paula

SM August 28, 2013 at 9:31 am

When will I no longer be taxed on my same-sex partners benefits? We are legally married in Maryland.

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Donnell Grate August 28, 2013 at 11:05 am

Please submit your proof of marriage documentation the benefits office via hrbenefit@jhmi.edu or fax to 443-997-4934 and the taxes will be removed.

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Patricia August 28, 2013 at 9:12 am

So I have been seeing my GYN for over 30 years, he accepts EPH, but is not a JH Provider - so I will have to pay 10% of his fees beginning 1/1/14? A lot of women don't feel comfortable as it is seeing a GYN and then when you dictate that we have to see certain ones that makes it even worse. I do not plan on changing my GYN after all of these years, but I feel that I am being penalized because he isn't a "JH Provider". So if he orders mammo's and other tests that I have performed at Bayview will those fees be paid at 100% or at 90%?

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Hope August 28, 2013 at 10:56 am

An annual GYN exam is considered preventive care and is covered at 100% for both EHP and Hopkins providers. Other GYN office visits would be a $10 co-pay whether the member is seen by an EHP provider or a Hopkins provider. The 90/10 cost share would be on treatment and diagnostic services performed in the office other than the visit itself. If you have your tests done at Bayview (a Hopkins hospital) they would be covered at 100%. The co-pay would be $30 if the visit was considered a specialty visit instead of a primary care visit.

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Ann Sundstrom August 28, 2013 at 8:18 am

I have a rpoblem with being charged $30 when I go to the primary care physician here at Bayview because she is categorized as an internal medicine specialist. How can I resolve this?

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Hope August 28, 2013 at 9:11 am

This question needs to be researched by EHP. We'll need the physician's name.

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Michele August 28, 2013 at 8:09 am

How can employees notify EHP of vacancies in the network in order for EHP to efficiently track the issues and locations? For example, on 3 different occasions I have attempted to schedule an appointment with my PCP in JHCP WatersEdge and he is not available for weeks. What is the plan to increase JHCP PCP availability at WatersEdge?

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Hope August 29, 2013 at 8:26 am

We are currently checking with JHCP regarding the physician group at WatersEdge.

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Gene August 28, 2013 at 1:08 am

I understand that we will no longer receive our Retirement Statement by mail as we have each June until now, but that it will be made available online at some point. I am disappointed to hear this. Can you tell me when it will be made available? And could you PLEASE ensure that we will not be required to give any portion of our social security number to access it?

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Hope August 28, 2013 at 10:09 am

Retirement statements will be integrated into the Total Compensation Statements available on the benefits enrollment website. Plans to include this information are underway now. Employees access the benefits enrollment site with their JHED ID and password, no social security numbers are used.

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Kelly Hagin August 28, 2013 at 12:16 am

Are there going to be town hall meetings to go over this as well as having opportunities for employees to here this as well.

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Hope August 28, 2013 at 10:21 am

The meeting schedule will be posted in the coming weeks. Yes, there will be meetings in Hurd Hall and department meetings, if requested. Meetings are being scheduled for the other facilities as well.

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MJJ August 28, 2013 at 10:39 am

Johns Hopkins Hospital is known as a high-cost hospital due to it being a teaching institution. Funds are built into our hospital rates to help cover such costs. With this being the case, why would it not be correct to state that requiring employees to utilize a JH-owned hospital in order to avoid the deductible is a so-called "vicious cycle" because it generates higher utilization costs which in turn must be passed along back to the employee by EHP via higher premiums, co-pays and/or even greater deductibles ?
Thank you........

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Hope August 28, 2013 at 1:03 pm

The Johns Hopkins Hospital is one of the finest academic hospitals in the world, and the cost of running the hospital is higher than community hospitals without the resources Hopkins has. Any shift to Hopkins may result in higher utilization costs; however, it goes towards keeping the organization financially sound. We are keeping the dollars within the organization instead of paying our competitors. The plan changes were designed with this in mind. The difference in cost of the service at Hopkins will be considered when the plan renews each year.

Janet August 27, 2013 at 3:55 pm

When will we know how much our premiums will be?

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Hope August 28, 2013 at 8:54 am

You will receive the information regarding 2014 premiums in your Open Enrollment Newsletter in mid-October. Open Enrollment begins October 21 and goes through November 4.

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Hope August 28, 2013 at 2:15 pm

Yes, the ambulance transport to a JH hospital would be covered.

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