Information About Choosing Medical Insurance

All full-time Johns Hopkins graduate and undergraduate students are required to be covered by medical insurance while enrolled at the University.

Students have the option of purchasing the University's health insurance plan, which is designed specifically for Hopkins students, or enrolling in a comparable plan purchased elsewhere.

Health insurance plans vary widely in coverage and cost. While cost is frequently students' primary consideration, lower-cost plans are often very limited in their coverage and have substantial out-of-pocket expenses (deductibles, co-insurance, co-pays). When deciding upon a plan, these are things you should consider:

1) What is covered by the plan?

Some plans are more comprehensive than others. Your personal health needs should be carefully considered when deciding upon a plan. Check to see how hospital in-patient and out-patient services, doctor's visits, physical therapy, mental health services, and prescription medications are covered, and whether or not referrals are required.

2) What is not covered by the plan?

Most plans exclude certain conditions or behaviors from coverage, such as cosmetic surgery, accidents due to motorcycle riding or sky diving, etc. Some plans even refuse coverage for cancer. Read the exclusion list carefully.

3) What is the maximum benefit (total amount of money) the plan will pay? Is it per illness or injury, or is it an annual or lifetime aggregate amount?

Plans have vastly different maximum benefits, ranging from $10,000 to $250,000 or more. While $10,000 may seem adequate for a healthy person, one serious accident or illness can wipe it out quickly, leaving the student personally responsible for the remainder of the bills.

4) How much is the deductible? Is it an annual deductible or a per illness/injury deductible?

Plans with higher deductibles generally have lower premiums. If you select a high-deductible plan, make sure you can afford to pay out-of-pocket if you get sick.

5) Is there a co-payment; if so, how much?

Some plans charge a co-payment, or amount which the student must pay for services rendered. The co-payment can be a set dollar amount or a percentage of the fee.

6) Is there an out-of-pocket maximum?

The OPM is the total amount of money you will have to pay out of pocket before your insurance picks up 100% of the cost for eligible expenses. Make sure the OPM is one you can afford. Find out if the deductible and co-pays count toward the OPM.

7) Is the plan a traditional plan (generally, insurance pays 80%, you pay 20%, up to a certain amount), an HMO, or a preferred provider network?

HMO's have their own network of providers and referrals are needed if you go outside of the network. PPO doctors agree to accept what the insurance company will pay them. Doctors who have not entered into such an arrangement will bill the patient for the difference between the allowed amount and the amount charged — an amount that can be considerable.

8)If the plan is an HMO or a PPO, what are the penalties for going to doctors who are not part of the network?

HMOs usually require that patients be seen by HMO-approved doctors, and will not pay for services provided by non-HMO doctors without prior approval. PPOs usually provide more choice by paying one percentage of the cost for PPO-approved doctors (often 80-90%), and a lesser percentage for non-PPO doctors (60-70%).

9) Is the plan age-rated or medically underwritten?

Age-rated plans vary in cost depending upon the age of the student enrolling. Medically underwritten plans can exclude students based upon the results of a physical exam or, they may institute a pre-existing condition clause for conditions you may have been seen or treated for prior to purchasing insurance.

10) Is there a per day cap on in-hospital care, doctors' fees, and ancillary costs?

Some plans have per diem caps on fees. Students are responsible for paying the difference between the per diem and the actual charge. The average daily hospital charge for JHU students who were hospitalized in 1993-94 was $1,277; the per diem cap for a plan in which many graduate students enroll was $900 for the same time period. The difference was borne by the students.

11) Does the plan require authorization for emergency care?

Most plans will not cover emergency room treatment for non-emergency conditions as defined by the insurance company. Generally, emergency treatment must be authorized by the insurance company.

Health Insurance Comparisons

Traditional Indemnity Health Insurance: Blue Cross/Blue Shield and other insurance companies usually have an annual deductible which must be met before insurance begins to cover eligible expenses and the co-insurance requirements. Most traditional plans exclude preventive care such as immunizations, pap smears, and contraceptives, unless State law mandates these services be covered.

Health Maintenance Organization (HMO): HMO's provide comprehensive health coverage for one annual fee. Preventive care and pharmaceuticals are included, but may require small co-payments. HMO insurance tends to be more expensive, but more services are offered and covered in full. The choice of providers, specialists, facilities, etc. are limited by the HMO. Travel outside of the local HMO network can be a problem if you become ill but do not require emergency services.

Preferred Provider Organization (PPO): PPO's offer some of the traditional health insurance freedom of choice while often paying for more outpatient and preventive services, if they are rendered within the network. Patients can receive care out-of-network at a higher cost to themselves than for care received in-network.

 
Frequently Asked Questions About the Johns Hopkins Student Health Plan

1) Am I required to have health insurance while attending Hopkins ?

Yes. Health insurance is required for all full-time students. It protects both the students and the University.

2) What type of plan is the student health plan?

The Hopkins student health plan is a traditional indemnity health plan with a Preferred Provider Network. Primary care is available at the Student Health and Wellness Center for Engineering, Arts & Sciences, and Nursing students and at Johns Hopkins Community Physicians @ Wyman Park for Peabody students. SAIS students receive treatment through the Georgetown University Student Primary Care Clinic. A list of the PPN providers is available at the Health Center , or in your school's student health insurance office, or on the Aetna website. After the deductible, the plan pays 80% for in-network services by PPO doctors and 65% (of eligible charges) for services rendered by non-PPO doctors. The non-PPO provider can charge the difference between the allowed amount and the fee charged. Once you reach the out-of-pocket maximum, the insurance covers 100% of allowable charges. The plan has a $1,000,000 lifetime per illness or injury maximum.

3) How does Hopkins decide upon a plan, on what the plan will cover (the plan benefits) and, on the deductible, the out-of-pocket maximum, and the plan maximum?

The Student Health Insurance Committee, comprised of staff and students from Arts & Sciences, Engineering, Nursing and Peabody, assesses student needs,reviews plan options, and selects the plan which it feels will provide students with the best coverage available at the most affordable price. Many of the plan benefits, such as mental health, maternity, and well-baby care, are mandated by the State of Maryland and cannot be excluded from the plan.

4) What is the relationship between the Student Health and Wellness Center and the insurance plan?

The Health Center provides primary care, women's and men's health services, and preventive care to full-time students enrolled in the Schools of Arts & Sciences, Engineering, and Nursing. Peabody students receive their care at Johns Hopkins Community Physicians @ Wyman Park, and SAIS students use the Georgetown University Student Primary Care Clinic. The insurance plan is designed to supplement these services and provide coverage for emergencies, serious accidents or illnesses and specialty health care providers such as gastroenterologists, dermatologists, etc.

5) What is the relationship between the Counseling & Student Development Center and the insurance plan?

The Counseling Center provides free short-term psychological counseling to full-time students from A&S, Engineering, the School of Nursing, and Peabody. SAIS students are eligible for subsidized care in Washington, D.C. and should check with the SAIS Health Insurance Office for details. Students at all campuses who require long-term counseling or hospitalization are referred to non-University providers. The insurance plan covers a substantial portion of the cost of treatment once the deductible is satisfied.

6) Are there deductibles and insurance plan limits of coverage?

The annual deductible is $250 ($500 per family), with an out-of-pocket maximum of $5,000 per year (in-network) of eligible expenses. Eligible students who receive their primary care at their appropriate Health Clinic and are subsequently referred out to the network pay a $75 per illness or incident deductible. The plan pays 80% for in-network services and 65% of eligible expenses for out-of-network services. Once the OPM is realized, the plan pays 100% of eligible expenses up to a lifetime maximum of $1,000,000 per illness or injury. Mental health coverage is paid at 80% for visits. Some services, such as well physician's visits (care you can obtain at your health center) are not subject to the deductible.

7) Does the plan have a pharmacy benefit?

Yes. The Homewood Student Health & Wellness Center has a formulary of the more commonly prescribed drugs and the co-pay is $8.00 if you are eligible for services at Homewood ; otherwise; most prescription drugs (minus preventive vaccines) are covered after a co-pay of $15 generic/$25 name brand pharmaceuticals.

8) Should I consider other less expensive insurance plans I have seen on the market?

Certainly, but review the plans carefully to be sure that the coverage is comparable to the Hopkins plan and meets your healthcare needs.

9) How can I provide feedback about the plan?

Contact the Student Health Insurance committee through P. Lynn Stein, Student Health & Wellness Center ,410-516-5216 or by e-mail at lstein1@jhu.edu.

10) Who do I call to resolve problems with my health insurance?

First contact the 800 number listed in the insurance certificate. If you cannot resolve the problem directly with the insurance company, you can contact the student health insurance office on your campus. The Student Health Insurance office is usually associated with the Office of the Registrar or your school's Business Office.

11) What is the length of coverage?

Coverage begins on August 15th runs through August 14thof the following year. You will be insured through the end of the plan year even if you graduate early.

The cost of health insurance is based upon several factors: the plan benefits, the size of the deductible, co-payment, out-of-pocket maximum, and maximum benefit; the plan experience, or number of claims paid; and the number of students enrolled in the plan. Increasing the risk across a larger group lowers the premium.

Please note: this brochure is intended to provideda general overview of the University's student insurance plan — the actual benefits are defined in the certificate.

The Student Health Insurance Committee is comprised of student affairs administrators, insurance experts, and graduate students who review health insurance options and attempt to design a plan that will best meet the needs of students. The committee encourages and welcomes all comments and suggestions.

[Updated February 2007]