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COVID-19 MEDICAL PLAN WAIVERS

The Kaiser Permanente National Benefit Policy to waive member out-of-pocket costs for visits associated with treatment for positive COVID-19 diagnosis will expire on 7/31/2021, unless otherwise mandated by law. Kaiser participants will pay for COVID-19 related treatments similar to paying for other treatments, as outlined in the Kaiser Permanente 2021 Summary of Plan Benefits.

CareFirst is ending member waivers for COVID-19 treatment effective September 1, 2021. Treatment on or after 9/1/21 will be subject to copay, coinsurance, and deductibles as outlined in the CareFirst 2021 Summary of Plan Benefits.

Medical Plan Options

AU offers full-time faculty and staff a choice between two medical options:

  • CareFirst BlueChoice Advantage
    • PPO providers locally and nationally
    • No requirement to designate a Primary Care Provider (PCP)
    • Uses Express Scripts prescription service (included in monthly premium)
  • Kaiser Permanente HMO 
    • Over 30 locations in DC, Maryland and Virginia

Cost for medical coverage

American University contributes 80% towards individual coverage and 65% for individual +1 and family coverage of the total cost of your medical premium. The university contributes 95% towards individuals under $40,000. Your portion of the cost of the medical coverage is deducted from your pay on a pre-tax basis.

You can elect coverage for yourself, one other qualified adult in your household (spouse or domestic partner), and your dependent children.

Prescription drug coverage is included with your cost for medical coverage.

2020 Medical Costs
   
   
   

2020 Cost for medical coverage
Employee Monthly Cost CareFirst & Express Scripts Kaiser

Individual under $40K

$39.87

$26.09

Individual over $40K

$159.47

$104.37

Individual + 1

$557.66

$366.28
Family $808.44 $531.54

This chart provides an overview of plan options. Please refer to medical plan options summary & comparison charts or the plan documents for a more comprehensive listing of medical benefits.
  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.

Use the online provider directories for each plan.

Under the CareFirst plan, it is your responsibility to ensure that your provider participates in-network. Contact your new and existing providers and ask if they still participate or if they are considered "in-network" with the plan.

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.