The Johns Hopkins University Student Health Benefits Plan is available to undergraduate students, graduate students, medical students, PhD candidates, postdoctoral fellows, residents, interns, visiting students, and trainees.
All eligible students, learners and trainees have the following plans available to them:
But what IS health insurance, and how does it work?
Honestly, the answer is complicated. If you find the system confusing, that’s because it IS confusing.
The shortest, most straightforward answer we could find comes from HealthCare.gov: it’s a contract that requires your health insurer to pay some or all of your health care costs in exchange for a monthly fee. The fee is usually called a premium.
The details of how that contact is executed can vary widely, from person to person, plan to plan, and service to service. We’ll do our best to define important general terms, answer some frequently asked questions, and provide information on Hopkins-specific benefits.
If you have a specific question about your coverage that’s not answered here, reach out to the excellent team at JHUStudentBenefits@jhu.edu to get the details.
If you have a general question or a suggestion for something that should be included in this blog post, email wellbeing@jhu.edu.
Ancillary services: Medical services like lab tests and x-rays. Under the Wellfleet plan, these services incur a 10% co-insurance charge, unless you are seen as part of an urgent care center or emergency room visit.*
Claim: A request to be paid by a health insurance plan for health services given. In plain language, a claim is the bill that a health care provider sends to a health insurance company.
Co-insurance: A percentage of a fee for a medical service that is split between the health insurance company and the patient, after a deductible has been met. For example, on the Wellfleet plan, the co-insurance split is 90%/10% for a specialist office visit. So, if you’ve met your deductible and got a bill for $100, you would pay $10 and Wellfleet would pay $90.
Co-pay: The fixed amount an individual pays for health services at the time of the visit. In the Wellfleet system, the co-pay is usually $50 for an emergency room or urgent care center visit. You would have a 10% co-insurance charge for a specialist office visit. Important note: there are no co-pays for visiting health care providers at Primary Care or Mental Health Services. It’s possible you may be billed for ancillary services, like testing or imaging, or for prescribed medication and supplies, but you will not be billed for the visit itself.
Deductible: The amount an individual (or a family) must pay before insurance starts to pay for some or all of your health care needs. In the Wellfleet plan, it’s $150 for an individual and $450 for a family.
An example: If you have a $150 deductible, and you get a service that costs $100, you will personally pay $100 for that service, and you’ll have a deductible balance of $50 (150-100=50). If you get that $100 service a second time, you will pay $50 for it, and then you will have met your deductible, so your insurance company will pay the balance of the bill (or at least a part of it, depending on your co-insurance percentage). If you get that $100 service a third time, you will pay $0 dollars, and the insurance company will pay all $100 (or at least a part of it, depending on your co-insurance percentage).
Health care provider (HCP): An all-encompassing term for any clinician who provides diagnostic or therapeutic medical services. Most often, this term is used for doctors, nurse practitioners, or nurses, but it is also used for some other specialists, like physical therapists and chiropractors. If you see the term “health care provider” or the acronym HCP, you can probably substitute the term “doctor” in your head, even if their title is slightly different. In plain language, it’s the clinician who’s taking care of you.
Explanation of Benefits (EOB): A statement (NOT a bill) that a health insurance plan sends to a health plan member. It shows charges, payments by the health insurance company and by the individual, and any balances owed by either party. An EOB breaks down the details of what a health care provider did and what they charged for it, who paid for what, and if anyone still owes money. EOBs from Wellfleet will be mailed to the address on file. ***
Health insurance: A contract that requires your health insurance company to pay some or all of your health care costs in exchange for a premiums. Health insurance provides financial protection in cases of accidents and sickness, like payments for health care providers’ services, medications, hospital care, special equipment, and more. Insurance often provides no-cost preventative services, too, like immunizations, cancer screenings, and counseling. It is most often purchased via a monthly premium.*
Health insurance plan: A group health insurance plan is a plan established or maintained by an employer or other organization (such as a university or a union), or both, that provides medical care for health plan members and their dependents directly or through insurance, reimbursement, or otherwise. Different plans offer different services and levels of coverage.**
Health insurance company: A for-profit entity that offers health insurance plans in exchange for money in the form of premiums.
Health plan member: The individual person who has contracted with a health insurance company (such as Wellfleet) to participate in a health insurance plan.
In-network: A descriptor for health care providers and facilities (like clinics or hospitals) that have negotiated discounts with a health insurance company. If you have a health insurance plan, it is almost always cheaper to go to in-network providers. You can find Wellfleet’s in-network providers using this tool. The opposite of an out-of-network health care provider or facility.
Nurse practitioner (NP): A nurse with advanced clinical training who provides direct patient care, including ordering and interpreting tests and prescribing medication, without the supervision of a medical doctor.
Out-of-network: A descriptor for health care providers and facilities (like clinics or hospitals) who have not negotiated a discount with the health insurance company. If you have a health insurance plan, it is almost always more expensive to go to an out-of-network provider, particularly after you’ve met your deductible. The opposite of an in-network health care provider or facility.
Out-of-pocket: Your expenses for medical care that aren’t reimbursed by your particular health insurance plan. Common out-of-pocket costs are your deductible, co-insurance, co-pays, and ancillary services.
Out-of-pocket maximum: The maximum amount an individual (or a family) can pay in out-of-pocket costs in a year. On the Wellfleet plan, that amount is $3000 for an individual and $9000 for a family.
Premium: A monthly payment made to a health insurance company by a consumer (aka a health plan member). The consumer pays this amount every month, regardless of whether they access medical care.
Primary Care Provider (PCP): Also known as primary care physician. This is an in-network clinician who is a patient’s main contact for care. Often this person is a doctor who specializes in internal medicine or family medicine; a child’s PCP is usually their pediatrician. Some people use an obstetrician/gynecologist as a PCP. Nurse practitioners can also be PCPs. PCPs give referrals to specialists when needed. In some health insurance plans, a person must choose a PCP to coordinate care.***
Specialist: A health care provider who focuses on a specific area of medicine or a group of patients to diagnose, manage, prevent or treat certain types of symptoms and conditions. Generally, any health care provider who is not your primary care provider is a specialist.****
Urgent care centers: These centers can treat urgent, but non-life-threatening medical issues, like sprains, fractures, and minor burns. Urgent care centers are a convenient alternative to the emergency room. They’re staffed with nurses and doctors. You wait less than you would for an emergency room visit, and you don’t need an appointment (although you can schedule one if you want). Many are open seven days a week, and they often have longer hours than most doctors’ offices. You usually pay less for a visit to an urgent care center than you would for an emergency room visit, too. A list of urgent care centers near several Johns Hopkins campuses is available on the Primary Care website.***
Q: Do I have access to a health insurance plan through my academic affiliation with Johns Hopkins?
A: It depends on your enrollment and/or employment status. The Johns Hopkins University Student Health Benefits Plan is available to undergraduate students, graduate students, medical students, PhD candidates, postdoctoral fellows, residents, interns, visiting students, and trainees.
Q: If I’m eligible for insurance through Hopkins and I don’t want it, can I opt out?
A: International students with active F1 or J1 visa status cannot opt out of the university plan.
Everyone else can choose to opt out, if they can provide proof of comparable coverage. An important note: you must opt out of it every individual year you are enrolled at Hopkins, during the annual enrollment period.
Q: In what ways am I billed for medical services in the Wellfleet plan?
A: It depends on the type of learner/student you are. You may be billed on your SIS bill or have to pay AHP directly. You can reach out to jhustudentbenefits@jhu.edu for more information.
Then you have a $150 annual deductible. If you get any medical services, you will pay out of pocket for them until you have reached $150. After you have personally paid $150, you will only pay either a co-pay or co-insurance depending on the service that is needed or the rest of that academic year.
The maximum amount an individual (or a family) can pay in out-of-pocket costs in an academic year, is $3000 for an individual and $9000 for a family on the Wellfleet plan. Once those limits are hit, Wellfleet will pay the entire balance for any covered services.
Q: Why are there separate plans for dental care and vision? Aren’t my teeth and my eyes a part of my body like anything else?
A: Historically, dentistry and optometry existed as professions outside of medicine rather than disciplines within it. In the 20th and 21st centuries, US legislation and regulation (specifically the creation of Medicare and Medicaid) affirmed and strengthened these divisions, and today most health insurance plans do not include dental or vision coverage, even though oral and eye health are important parts of overall well-being. *****
*Adapted from https://www.cms.gov/files/document/nsa-health-insurance-basics.pdf
**Adapted from https://www.dol.gov/general/topic/health-plans
***Adapted from https://wellfleetstudent.com/wp-content/uploads/2019/07/Glossary.pdf
**** https://www.healthcare.gov/glossary
***** Adapted from https://journalofethics.ama-assn.org/article/why-dont-medicare-and-medicaid-cover-dental-health-services/2022-01