Calendar Year 2018 Benefits Program

Johns Hopkins Health System

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• Benefits positioned to be competitive• Benefit menu designed to provide choice,

affordability and accessPhilosophy

• Academic Medical Centers

Comparative Markets

• Non-Academic Medical Centers• Non-Healthcare• Maryland• Mid-Atlantic Region• National

Benefits Strategy

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Long term strategy for sustained

viability

Affordable care for employees

Competitive and delivers value

Focused on equity and cost

management

Benefits Structure

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Who is Affected?

All employees in these participating organizations:• Johns Hopkins Health System Corporation • Johns Hopkins Bayview Medical Center• Johns Hopkins HealthCare• Johns Hopkins Community Physicians• Johns Hopkins Home Care Group • Johns Hopkins Medicine International• Johns Hopkins Intrastaff• The Johns Hopkins Hospital

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2018 Benefits Program Summary

• Simplify plan design to one plan 90/80/70• Employee contributions increasing minimally to align with market median Medical

• New vendor - Delta Dental PPO • Additional services providedDental

• Tighten formulary by transitioning to the CVS/Caremark Advanced Control FormularyPharmacy

• No change in design or employee contributionsVision, Life, Disability, Retirement

• No changesTime Off (PTO)

• Dependent tuition – 4 year eligibility• Wellness/wellbeing continuing with future enhancementsOther

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New Enrollment Platform

• SmartSource is new platform

• Active Enrollment for 2018

If you do not enroll during Open Enrollment Oct 16-Oct 31, you will not have medical, dental, or vision benefits for 2018

Any existing documentation on currently enrolled dependents will transfer over – for example, marriage and birth certificates 6

Overview of Medical Benefits Changes

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Employee premiums based on comparison to market and tiered for salary

One single plan with co-insurance

Medical

JHHS Health Plan

• JHHS Health Plan– Hopkins Preferred – 90% of allowed

amount after deductible and any applicable co-pay

– EHP Network – 80% of allowed amount, after deductible and any applicable co-pay

– Out of Network – 70% of R&C, after deductible and any applicable co-pay

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ONESINGLE

PLAN FOR 2018

Medical

Preventative Care

• Preventive services, immunizations, and lab test provided by Hopkins Preferred or EHP Provider will continue to be paid at 100%.

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Medical

Deductible –Hopkins Preferred / EHP Network

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Medical• Annual Salary Under $50,000

– Individual – decreasing from $200 to $150– Family – decreasing from $400 to $300

• Annual Salary $50,000 and over– No change

Out-of-Pocket (OOP) Maximum –Hopkins Preferred / EHP Network

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Medical• Annual Salary Under $50,000

– Individual – decreasing from $2,000 to $1,500– Family – decreasing from $4,000 to $3,000

• Annual Salary $50,000 and over– No change

Office Visits – Co-pay to Co-insurance

• In 2018, co-pays for the following will be replaced with co-insurance (90/80/70). – Radiology Procedures – Acupuncture– Chemo & Radiation Therapy– Specialty Care Office Visit only– Chiropractic Care– Nutritional Counseling– Biofeedback– Therapy

• Co-pays for PCPs and Urgent Care have not changed

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Medical

Please Note:

These scenarios are examples only –• Actual billed amounts are dependent upon what the

provider submits to EHP.• Facility fees, if applicable, depend upon whether a service

is provided in a regulated or non-regulated space. • Deductibles and out of pocket maximums are dependent

on salary.• Actual cost to employee will depend upon meeting

deductible.13

Medical

Scenario 1 – Rose is sick and visits her Hopkins Preferred Network Provider PCP

- Rose’s PCP charges $250 for this visit

- JH pays $240 - Rose pays $10 co-pay

14NOTE: This is an example. Employees should contact EHP with questions about any bill.

Medical

JH Pays $240Employee Pays $10

Scenario 2 – Marcos sees a Hopkins Preferred Network Provider Specialist

- Marcos’s provider charges $300 for his services and his facility charges $220 for using their facility

- Marcos has already met his $150 annual deductible- JH pays $468

- $270 for the professional fee- $198 facility fee

- Marcos pays $52- $30,10% co-insurance for the professional fee - $22, 10% co-insurance for the facility fee

15NOTE: This is an example. Employees should contact EHP with questions about any bill.

Medical

JH Pays $468Employee Pays $52

Scenario 3 – Mary has Inpatient Surgery and an Inpatient Hospitalization at a Hopkins Preferred Network Provider

- Mary’s provider charges $1000 for her service and her facility charges $6000 for using their facility

- Mary has already met her $200 annual deductible- JH pays $6165- Mary pays $150 co-pay for the facility- Mary also pays

- $100, 10% co-insurance for the $1000 professional fee- $585, 10% co-insurance for the remaining $5850 facility fee

($6000 less the $150 co-pay)

16NOTE: This is an example. Employees should contact EHP with questions about any bill.

Medical

JH Pays $6165Employee Pays $835

Dental Coverage Change

• Delta Dental PPO (currently United Concordia)– May use Premier dentist at extra charge– Minimal or no increase in premium

• Improvements– Dental implants– Resin/composite– Additional cleaning for pregnant women

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Dental

Prescription Drug Formulary Change

• CVS/Caremark Advanced Control Formulary (currently Standard Formulary)– Considered the mid-level formulary with regard to excluded

drugs– EHP will reach out to those affected

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Pharmacy

Other Benefits Changes

• FSA Limit increasing to $2,600 (please note that FSA applies only to non-represented employees)

• Group voluntary benefits through the Enrollment Exchange– Accident (Unum)– Critical Illness (Aflac)– Hospital Indemnity (Aflac)– Whole Life with LTC Option (Unum)

• Dependent Tuition (effective 1/1/18)– Increase from 2 year to 4 years of continuous employment– Grandfather those active as of 12/31/2017

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Other

What can we do? More than you think.

• The healthier we are, the lower our health care costs. We have world-class resources to help employees take control of individual health and health care.

• Annual physicals, immunizations, and other preventive services and exams, which will continue to be paid at 100%, are among the most important steps employees can take to stay healthy and lower costs.

• Healthy@Hopkins programs/resources will continue to be offered and Human Resources will continue to strengthen and support those offerings. 20

Help Managing Your Care

• EHP provides care management support for patients with diabetes and asthma, COPD, and Cardiovascular Disease, as well as cancer, HIV/AIDS, and several other conditions.

• Ongoing monitoring and support is available to members with less complicated conditions.

• Other population health-based services are available, from educational materials to Treatment Coaches and a TeleWatchPatient Monitoring System.

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Resources and Information

• Your supervisor, Human Resources team and EHP customer service representatives are available to help.

• More communications between now and Open Enrollment that begins October 16:- Schedule of Benefits and Coverage- Frequently Asked Questions online- Open Enrollment Newsletter- InsideHopkins announcements- Departmental and general meetings

• HR website http://www.hopkinsmedicine.org/human_resources/benefits/open_enrollment.html

• EHP Customer Service410-424-44501-800-261-2393 22

Questions?

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Appendix

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Health Plan Definitions

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Billed The amount the provider or facility billed for the services the patient received.

Allowed The maximum amount the network will allow for the service the patient received. Any co-pay/coinsurance that the patient is responsible for paying are deducted from the allowedcharge.

Reasonable and Customary (R&C)

The usual fee charged by similar providers for the same services or supplies in the same geographic area Johns Hopkins EHP determines what is a Reasonable and Customary Charge. Non-network providers can charge more.

Deductible The amount that the patient must pay within the plan year before the plan begins to paybenefits.

Co-pay A flat fee the patient must pay at the time of service.

Co-insurance Percentage of medical costs that the patient shares with the plan.

Member Total The amount the member is responsible for paying (up to the out-of-pocket maximum).

Out of Pocket(OOP)Maximum

The maximum amount the member pays for medical expenses during a plan year. After the member has paid the annual out-of-pocket limit, the Plan pays any additional covered expenses at 100% for the remainder of that plan year.

Health Plan Definitions

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Plan Pays The amount the plan pays for the member’s services.

Member Pays The amount the member is responsible for paying.

EOB An “Explanation of Benefits” document outlines …

Professional Fee

The fee submitted to your insurance by the provider of services.

Facility Fee The fee submitted to your insurance by the facility where the services were provided.

Regulated Space

This generally refers to services that are provided in a hospital.

Non-regulated Space

This generally refers to services that are provided outside of the hospital environment, for example in free-standing clinics.