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Medical Benefits Summary Charts

American University provides you with a choice of two medical options, CareFirst BlueChoice Advantage and Kaiser Permanente HMO. Both medical options offer many online tools, resources, and access to wellness discounts. 

These summaries are a reference for plan coverage details. American University makes every effort to ensure the accuracy of the information that appears on the benefits site. However, if there are discrepancies between the information presented and the legal documents governing a plan or program (the "plan documents"), the plan documents will always govern. American University reserves the right to amend or terminate any benefit plan at its sole discretion at any time, for any reason.

2019 Cost for medical coverage

Employee Monthly Cost CareFirst & Express Scripts Kaiser

Individual under $35K

$36.54

$25.94

Individual over $35K

$146.17

$103.75

Individual + 1

$511.12

$364.09

Family $740.96 $528.36

2020 Cost for medical coverage

Employee Monthly Cost CareFirst & Express Scripts Kaiser

*The salary cap for 2020 was raised to $40,000.

Individual under $40K*

$37.05

$24.97

Individual over $40K*

$148.21

$99.88

Individual + 1

$518.27

$350.51

Family $751.34 $508.65
Medical Benefits Summary Chart
  CareFirst BlueChoice Advantage Kaiser Permanente
  In-network Out-of-network HMO

*The amount that BCBS will pay for a given covered service is determined by the Plan Allowance for that service. The Plan Allowance for covered services is determined by the contracted rate or fee schedule that participating providers have agreed to accept for that service or the rate or fee that is established by law.

Choice of physician

May use any provider in BlueChoice, BluePreferred PPO, or BlueCard PPO.

No referrals required.

Choose any physician. No network limitations.

No referrals required.

Must select a primary care physician from the list of physicians at one of Kaiser Permanente's medical centers.

Annual deductible

$400 individual

$800 individual +1

$800 family

The in-network annual deductible applies to non-preventive care services. Preventive care such as annual physicals and mammograms are not subject to the deductible, however, copayments still apply.

$1,000 individual

$2,000 individual + 1

$2,000 family

None

Copayments

$20 primary care

$40 specialty care

No copayment for preventive care office visits.

No copayment for women's preventive health services.

None

$20 primary care

$40 specialty care

Does not apply to outpatient mental health and prescription benefits.

No copayment for preventive care office visits for adult and children over age 5.

No copayment for primary care physician office visits for children under age 5 (specialist copayments apply for children under age 5).

No copayment for women's preventive health services.

Coinsurance

90% paid by health plan*

10% paid by participant

65% paid by health plan*

35% paid by participant

None

Maximum out-of-pocket expense

$2,750 individual

$5,500 individual +1

$5,500 family

The BlueChoice plan does not cover any portion of your medical bills until you first meet your annual deductible; copayments still apply and do not count toward the deductible.

After the deductible is met for the year, you pay the copayment for certain covered services. Most covered services are reimbursed by BCBS at 90% of plan allowance and you pay 10%. If you reach the maximum out-of-pocket expense for the year, BCBS pays 100% of the plan allowance(s) for covered expenses for the remainder of the year.

$4,000 individual

$8,000 individual +1

$8,000 family

The out-of-network plan does not cover any portion of your medical bills until you first meet your annual deductible.

After the deductible is met for the year, most covered services are reimbursed by BCBS at 65% of plan allowance and you pay 35%. Once you reach the maximum out-of-pocket expense for the year, BCBS pays 100% of the plan allowance(s) for covered expenses for the remainder of the year.

$3,500 individual

$9,400 family

Lifetime maximum

Unlimited

Unlimited

Unlimited

Claim forms

No claim forms to file.

You may need to file your own claims.

If your provider participates with BCBS through another plan, they are required to submit your claims on your behalf and BCBS will reimburse them directly.

No claim forms to file.

Pre-certification

Hospital certifications arranged by physicians.

You are responsible for arranging your own hospital certifications. There is a financial penalty if pre-certification is not arranged.

Hospital certification arranged by the member through the plan.

Alcohol and drug abuse treatment comparison chart
  CareFirst BlueChoice Advantage Kaiser Permanente
  In-network Out-of-network HMO

Outpatient/alcohol substance abuse

100% coverage for physician expenses after $20 per visit copayment, subject to annual deductible.

65% of plan allowance for physician expenses, subject to annual deductible. Limited to 30 visits per calendar year.

65% of plan allowance for covered services at an outpatient facility, subject to annual deductible.

100% coverage for first 20 visits.

$20 per visit copayment for individual or $10 per visit copayment for group for each additional visit.

Inpatient alcohol/substance abuse treatment

Detoxification: 90% coverage after $250 copayment, subject to annual deductible.

Rehabilitation: 90% coverage after $250 copayment, subject to annual deductible.

Coverage for up to 30 days. All detoxification and rehabilitation benefits count against the mental health day/visit maximums.

Detoxification: 65% of plan allowance, subject to annual deductible.

Rehabilitation: 65% of plan allowance, subject to annual deductible.

$250 copayment. Unlimited inpatient days.
Diagnostic and screening services comparison chart
  CareFirst BlueChoice Advantage Kaiser Permanente
  In-network Out-of-network HMO

Diagnostic services

90% coverage only at approved locations, subject to annual deductible.

65% of plan allowance, subject to annual deductible.

100% coverage.

Non-emergency CT scans and MRIs

$40 copayment, subject to annual deductible.

65% of plan allowance, subject to annual deductible. 

$50 copayment.

Family planning/fertility
 

100% coverage for primary care provider, after $20 per visit copayment, subject to annual deductible then 100% of allowed benefit to $100,000 lifetime maximum.

100% coverage for specialist, after $40 per visit copayment, subject to annual deductible then 100% of allowed benefit to $100,000 lifetime maximum.

Prior authorization is required. Documented 1 year period of trying to become pregnant.

Diagnosis and treatment of infertility, including medically necessary, non-experimental artificial insemination and in vitro fertilization (IVF).

Testing provided to determine that a diagnosis for infertility exists. The testing is covered at 65% of plan allowance, subject to the annual deductible.

No further benefits available if diagnosis is confirmed.

50% coverage, after $40 per visit copayment for family planning and counseling services and physician services for the diagnosis and treatment of involuntary infertility such as artificial insemination, lab and x-rays.

In vitro fertilization (IVF): 50% coverage to $100,000 benefit maximum up to 3 procedures per live birth.

Documented 1 year of trying to become pregnant.

Preventive care mammography
 

100% coverage.

65% of plan allowance, subject to annual deductible. Limited to:

Ages 35-39: one preventive mammogram of both breasts in the 5 years.

Ages 40-49: one preventive mammogram of both breasts every 2 years.

Ages 50 and above: one preventive mammogram of both breasts every year.

100% coverage.

Durable medical equipment plan comparison chart
  CareFirst BlueChoice Advantage Kaiser Permanente
  In-network Out-of-network HMO

Durable medical equipment

90% of plan allowance, subject to annual deductible.

65% of plan allowance, subject to annual deductible.

100% coverage with certification by primary care physician.

Hearing aids

90% of plan allowance per 36-month period, subject to annual deductible.

Amount above the allowed amount is billed to the member.

65% of plan allowance per 36-month period, subject to annual deductible.

Amount above the allowed amount is billed to the member.

$0 copayment, 1 hearing aid per ear every 36 months up to a $1,000 maximum.
Emergency and urgent care comparison chart
  CareFirst BlueChoice Advantage Kaiser Permanente
  In-network Out-of-network HMO

Emergency room
(in and out of area)

$100 copayment waived when admitted.

$100 copayment waived when admitted.

100% coverage after $75 copayment when life-threatening situation or when authorized by plan. 

$75 copayment waived when admitted but $250 inpatient copayment applies.

Emergency transportation
 

100% coverage, subject to annual deductible.

100% coverage, subject to annual deductible. 100% coverage after $50 copayment when life-threatening situation or when authorized by plan.

Urgent care

$40 copayment.

$40 copayment.

Urgent care centers are available at Kaiser facilities for urgent and non-life threatening emergencies.

Hospital admissions comparison chart
  CareFirst BlueChoice Advantage Kaiser Permanente
  In-network Out-of-network HMO

Medical, surgical, and obstetrical

90% coverage after $250 copayment when admitted by a BCBS physician to an approved hospital only at approved locations. Subject to annual deductible.

65% of plan allowance, subject to annual deductible. Pre-certification is required.

100% coverage after $250 copayment.

Rehabilitative admission
(not related to alcohol and drug abuse treatment and rehabilitation)

XX% after $250 copayment covered up to 30 days per confinement in an acute care hospital when hospitalization is medically necessary and authorized by BCBS. Subject to annual deductible.

Not covered.

100% coverage after $250 copayment.

Preadmission testing

90% coverage, subject to annual deductible. If testing requires hospital stay, $250 copayment applies.

65% of plan allowance, subject to annual deductible for diagnostic testing, x-rays and lab work when rendered in the outpatient department of a hospital.

100% coverage. If testing requires hospital stay, $250 copayment applies.

Inpatient physician visits comparison chart
  CareFirst BlueChoice Advantage Kaiser Permanente
  In-network Out-of-network HMO

Medical/surgical physician services

90% coverage for an approved admission, subject to annual deductible.

65% of plan allowance, subject to annual deductible.

100% coverage.

Specialist care

90% coverage for an approved admission, subject to annual deductible.

65% of plan allowance, subject to annual deductible. 

100% coverage.

Inpatient consultation

90% coverage for an approved admission, subject to annual deductible. 65% of plan allowance, subject to annual deductible.  100% coverage.
Maternity care comparison chart
  CareFirst BlueChoice Advantage Kaiser Permanente
  In-network Out-of-network HMO

Inpatient hospital

90% coverage after $250 copayment at approved locations. Subject to annual deductible.

65% of plan allowance, subject to annual deductible.

100% coverage after $250 copayment.

Outpatient hospital

90% coverage at approved locations, subject to annual deductible.

65% of plan allowance, subject to annual deductible. 

Not covered.

Physician office visit (prenatal)

100% coverage.

65% of plan allowance, subject to annual deductible.

100% coverage through first postnatal visit.

Nurse midwife

100% coverage after $40 per visit copayment up to $400 copayment per pregnancy.

Nurse midwife must be associated with an approved center. 

Subject to annual deductible.

65% of plan allowance, subject to annual deductible.

Benefits may not be available for nurse midwife services if already billed by physician.

100% coverage through first postnatal visit.

Birthing center

100% coverage after $40 per visit copayment, subject to annual deductible.

Up to $400 copayment per pregnancy at approved locations.

65% of plan allowance, subject to annual deductible.

Not covered.

Mental health care comparison chart
  CareFirst BlueChoice Advantage Kaiser Permanente
  In-network Out-of-network HMO

Outpatient mental health care

100% coverage after $20 per visit copayment, subject to annual deductible.

Includes psychotherapy for gender identity disorders.

65% of plan allowance, subject to annual deductible for therapy rendered by psychiatrist, licensed psychologist, or licensed clinical social worker.

Includes psychotherapy for gender identity disorders.

100% coverage after $20 per visit copayment for individuals or $10 per visit copayment for group.

Psychological testing

100% coverage after $20 per visit copayment, subject to annual deductible.

Coverage for psychological and neuropsychological testing is provided for outpatient services to treat mental illnesses, emotional disorders, drug abuse, or alcohol abuse including psychological and neuropsychological diagnostic purposes. Services include evaluation, diagnosis and treatment of acute and non-acute conditions. The benefits for neuropsychological testing are not counted toward any outpatient mental health and substance abuse visit benefit.

65% of plan allowance, subject to annual deductible. 

Coverage for psychological and neuropsychological testing is provided for outpatient services to treat mental illnesses, emotional disorders, drug abuse, or alcohol abuse including psychological and neuropsychological diagnostic purposes. Services include evaluation, diagnosis and treatment of acute and non-acute conditions. The benefits for neuropsychological testing are not counted toward any outpatient mental health and substance abuse visit benefit.

Covered.

Inpatient mental health care

90% coverage after $250 copayment for short term, acute mental health conditions. Subject to annual deductible. 65% of plan allowance, subject to annual deductible.  100% coverage after $250 copayment.
Non-hospital care comparison chart
  CareFirst BlueChoice Advantage Kaiser Permanente
  In-network Out-of-network HMO

Hospice care

90% coverage, subject to annual deductible. 

No limit. Available during last 6 months of life.

65% of plan allowance, subject to annual deductible.

Limit of 180 days per lifetime, 60 of which may be used for inpatient hospice care. 45 lifetime reserve days are also available for inpatient or home care. Available during last 6 months of life.

100% coverage. Subject to evaluation and authorization by plan.

Available during last 6 months of life.

Home health care

90% coverage, subject to annual deductible.

65% of plan allowance, subject to annual deductible. 

100% coverage, when medically necessary. Subject to evaluation and authorization by plan.

Extended care facility (ECF)

90% coverage when authorized by plan. Subject to annual deductible.

65% of plan allowance, subject to annual deductible. 

100% coverage for up to 100 days. Includes bed, board and general nursing care, when authorized by HMO physician.

Nursing care comparison chart
  CareFirst BlueChoice Advantage Kaiser Permanente
  In-network Out-of-network HMO

Inpatient private duty nurse

90% coverage when authorized by plan for an approved admission due to medical necessity. Subject to annual deductible.

Not covered.

100% coverage when authorized by plan.

Outpatient private duty nurse

Not covered.

65% of plan allowance, subject to annual deductible. Limited to a maximum of two hours a day (1 visit) up to 50 visits per calendar year.

100% coverage when authorized by plan.
Outpatient physician visits comparison chart
  CareFirst BlueChoice Advantage Kaiser Permanente
  In-network Out-of-network HMO

Medical services and physician office visits

100% coverage for primary care provider after $20 per visit copayment.

100% coverage for specialist after $40 per visit copayment.

Subject to annual deductible for non-preventive care services.

65% of plan allowance, subject to annual deductible.

100% coverage for primary care provider after $20 per visit copayment.

100% coverage for specialist after $40 per visit copayment.

No copayment for primary care physician for children under age 5; specialist copayments apply for children under age 5. 

Well baby care

100% coverage for primary care provider.

65% of plan allowance, not subject to annual deductible. Unlimited visits to age 18.

100% coverage for preventive services for children.

Routine physicals

100% coverage for primary care provider.

Not covered.

100% coverage for preventive services.

Home physician visits

100% coverage for primary care provider after $20 per visit copayment.

100% coverage for specialist after $40 per visit copayment.

Subject to annual deductible for non-preventive care services.

65% of plan allowance, subject to annual deductible.

100% coverage when medically necessary. Subject to evaluation and authorization by plan.

Prescription drug coverage comparison chart
  Express Scripts Kaiser Permanente
  In-network Kaiser Center Pharmacy Outside Pharmacy

*After the first three retail prescription fills for maintenance drugs, CareFirst participants pay an additional $10 for each retail fill. Use CVS Smart90 program or switch to home delivery to avoid the surcharge.

**Excluded drugs do not apply towards out-of-pocket maximums.

Generic drugs, retail
(30-day supply)

$10

$10

$20
Brand name formulary drugs, retail*
(30-day supply)

30% coinsurance to $30 maximum

$20

$40
Brand name non-formulary drugs, retail*
(30-day supply)

50% coinsurance to $50 maximum

$35

$55

Excluded drugs**, retail

100% participant responsibility

Not applicable

Not applicable

Generic drugs, home delivery
(90-day supply)

$25

$20

$20

Brand name formulary drugs, home delivery
(90-day supply)

30% coinsurance to $75 maximum

$40

$40

Brand name non-formulary drugs, home delivery
(90-day supply)

50% coinsurance to $125 maximum

$70

$70

Excluded drugs**

100% participant responsibility

Not applicable

Not applicable

Out-of-pocket maximum**, individual

$3,850

Included with medical

Included with medical

Out-of-pocket maximum**, individual + 1 or family

$7,700

Included with medical

Included with medical

Special care services comparison chart
  CareFirst BlueChoice Advantage Kaiser Permanente
  In-network Out-of-network HMO

Acupuncture

$40 copayment, subject to annual deductible, up to 20 visits.

Covers acupuncture for pain management and anesthesia. Coverage will be provided when such treatment is rendered by a trained practitioner who is licensed or certified as such by the duly constituted authority in the area in which service is rendered and when acting within the scope of such license or certification; and if the practitioner rendering the acupuncture treatment is not an M.D., such treatment must be under the direct supervision of an M.D.

65% of plan allowance, subject to annual deductible. No visit limit.

Covers acupuncture for pain management and anesthesia. Coverage will be provided when such treatment is rendered by a trained practitioner who is licensed or certified as such by the duly constituted authority in the area in which service is rendered and when acting within the scope of such license or certification; and if the practitioner rendering the acupuncture treatment is not an M.D., such treatment must be under the direct supervision of an M.D.

$40 copayment, up to 20 visits.

Chiropractic

$40 copayment, subject to annual deductible, up to 20 visits.

65% of plan allowance, subject to annual deductible. No visit limit.

$40 copayment, up to 20 visits.

Dental service

Discounted dental benefits provided for limited number of services.

Not covered.

Discounted dental benefits provided for limited number of services after $30 copayment.

Eye exams (routine)

100% coverage for participating vision centers after $10 per visit copayment.

100% coverage for ophthalmologist after $25 per visit copayment.

Limited to one per calendar year.

Not covered.

100% coverage for routine eye exam after $20 per visit copayment.

100% coverage for ophthalmologist after $40 per visit copayment.

Limited to one per calendar year.

Eyeglasses and contact lenses

Discounts available at participating vision centers.

Additional cost for contact lens fittings.

Not covered.

Discounts available at Kaiser centers and participating optical centers.

Hearing screening exams

100% coverage after $20 per visit copayment, subject to annual deductible.

65% of plan allowance if exam is required as a result of accidental injury. Subject to annual deductible.

100% coverage, copayments may apply.

Inoculations including travel inoculations

100% coverage after $20 per visit copayment for primary care provider, subject to annual deductible.

100% coverage after $40 per visit copayment for specialist, subject to annual deductible.

65% of plan allowance, subject to annual deductible.

Not covered.

Surgery care comparison chart
  CareFirst BlueChoice Advantage Kaiser Permanente
  In-network Out-of-network HMO

Outpatient surgery

100% coverage for primary care provider after $20 per visit copayment.

100% coverage for specialist after $40 per visit copayment.

90% coverage for facility, subject to annual deductible.

Subject to annual deductible for non-preventive care services.

65% of plan allowance, subject to annual deductible.

Pre-certification is required.

100% coverage after $50 copayment.

Inpatient surgery

90% coverage for an approved admission after $250 copayment. Subject to annual deductible.

65% of plan allowance, subject to annual deductible. 100% coverage after $250 copayment.

Second or multiple surgical opinion consultation

100% coverage for specialist after $40 per visit copayment, subject to annual deductible.

Paid in full if requested by CareFirst.

65% of plan allowance, subject to annual deductible.

100% coverage after $40 per visit copayment.

Anesthesia services

90% coverage, subject to annual deductible.

65% of plan allowance, subject to annual deductible.

100% coverage.

Organ transplant

90% coverage for limited services, subject to annual deductible. 65% of plan allowance for limited services, subject to annual deductible.

100% coverage for limited services when authorized by plan.

Therapeutic services comparison chart
  CareFirst BlueChoice Advantage Kaiser Permanente
  In-network Out-of-network HMO

Radiation/chemotherapy dialysis (physician)

100% coverage after $40 per visit copayment or $20 copayment for primary care provider. Subject to deductible.

65% of plan allowance, subject to deductible.

100% coverage, after $40 per visit copayment.

Physical therapy physician-billed or physical therapist billed

100% coverage after $40 per visit copayment for short term care up to 40 visits, subject to deductible.

Short term care means significant improvement is expected within 90 days.

65% of plan allowance, subject to deductible. 40 visit limit (combined with in-network).

100% coverage after $40 copayment per visit for up to 40 visits or 90 days, whichever is greater.

Speech therapy
(outpatient physician)

100% coverage after $40 per visit copayment, subject to deductible.

65% of plan allowance, subject to deductible.

100% coverage after $40 per visit copayment for up to 40 visits or 90 days, whichever is greater.

Occupational therapy
(outpatient physician)

100% coverage after $40 per visit copayment, subject to deductible.

65% of plan allowance, subject to deductible.

100% coverage after $40 per visit copayment for up to 2 months per contract year.

Transgender care comparison chart
  CareFirst BlueChoice Advantage Kaiser Permanente
  In-network Out-of-network HMO

 

Covers pre- and post-surgical hormone therapy, surgery, if performed by a qualified provider and in conformance with HBIGDA standards. Requires pre-authorization.

Surgical, hospital, and laboratory benefits, subject to $400,000 lifetime maximum.

Covers pre- and post-surgical hormone therapy, surgery, if performed by a qualified provider and in conformance with HBIGDA standards. Requires pre-authorization.

Surgical, hospital, and laboratory benefits, subject to $400,000 lifetime maximum.

Covers pre- and post-surgical hormone therapy, surgery, if performed by a qualified provider and in conformance with HBIGDA standards. Requires pre-authorization.

Surgical, hospital, and laboratory benefits, subject to $400,000 lifetime maximum.