The Student Health Plan (SHP) is an insurance program you can enroll in as a student at the School of Public Health. You are not obliged to sign up for SHP but, if you do not, you must be enrolled in a comparable health insurance program. Contact the Business Office to find out what plans are comparable to SHP. SHP covers 80% of most services and prescriptions and allows you to see the physician of your choice. SHP coverage requires that you pay a $100/person ($300/family) annual deductible. The University Health Services (UHS) is a supplemental benefit available to students and their dependents who are enrolled in SHP. UHS runs a free clinic at 401 N. Caroline St. (accessible by the #2 shuttle), which offers general medical appointments. In addition, when you are referred to another doctor or specialist for treatment by a UHS physician, your deductible and 20% copay will be paid by UHS. Thus, there should be no out-of-pocket cost for medical care received at UHS, or by a physician referred to you by UHS. SHP and UHS are two separate entities that are not related to each other. Make sure you know what each offers so that you can get the full benefit of your health coverage. See the Useful Documents page on our site for downloadable versions of the most current program descriptions. back to top No. Only students and their dependents enrolled in SHP may go to the UHS clinic or receive benefits through the UHS Benefits Office. back to top Yes, if you are being charged a deductible for a visit which was referred through UHS and you bring the bill to the UHS Benefits Office (see below for more information about billing). back to top The Student Health Plan does not generally cover preventive services; however, many preventive services, including yearly gynecology exams and recommended adult immunizations are offered through the UHS clinic at no cost to students. At last check, the list of covered vaccines included: tetanus/diptheria, MMR, flu, pneumococcal, and varicella. Contact UHS for details. back to top Participants in the SHP do have prescription drug coverage. Prescriptions are covered on a three-tier formulary. For a 30-day supply, generic drugs (Tier I) have a $10 copay, preferred brand-name drugs (Tier II) have a $20 copay, and non-preferred brand-name drugs (Tier III) have a $35 copay. A mail order prescription program is also available at a discounted cost. For more information, visit the UHS Prescription Drug Plan webpage. back to top One eye exam per calendar year (NOT academic year) is paid for by UHS at the Wilmer Institute in the hospital. Make an appointment by calling 410-955-5080. Please note that you will receive a bill for this visit, and you must bring that bill to the UHS Benefits Office for payment. Walk-in visits at Wilmer and eyeglasses/contacts are not covered, however eyeglass frames and lenses are 30% off for all Hopkins students and their family members at the Wilmer Vision Center in the Outpatient Center (410-955-9373). back to top Dental insurance is now offered by the School of Public Health, through United Concordia. There are two options for dental care: the Access Plan (also called PPO) and the DHMO plan. Each plan carries a different yearly premium and provides for slightly different coverage levels. Current premium and copay costs, and provider listings can be found at the school's Dental Insurance page. back to top Mental health is covered differently than physical health. One of our current hot-topics is to increase the mental health coverage to match that of physical health, but this is currently not yet the case. Our insurance now covers an unlimited number of visits to Student Mental Health. We constructed a mental health fact sheet (on our Useful Documents page) to help answer these questions in more detail. In addition, UHS maintains a Student Mental Health website here. The University also provides the Student Assistance Program (SAP) to help students deal with the pressures of the professional and academic environment we live in. The website for this program is here. back to top When you are away from Baltimore, whether in or out of the US, you are covered by SHP as described in the Summary Plan Description. In general, if you are outside of the country you will have to pay the bills yourself and then file claims with SHP to be reimbursed once you return. Be aware that SHP will only pay usual and customary charges, which may be different from what physicians, especially in foreign countries, bill. When you travel however, you are not able to take advantage of the supplemental benefits available through UHS since these require that you receive services and referrals at the UHS clinic. back to top If you have a non-emergency, you have two options. You can make an appointment with a physician at UHS and the entire visit will be paid for by SHP and UHS. In order to make a UHS appointment simply stop into the UHS clinic, located at 401 N. Caroline St., or call the clinic at 410-955-3250 (Monday – Friday, 8am - 4pm and Tuesday 5-8 pm). Alternatively, you can make an appointment with the physician of your choice and SHP will pay a percentage of the cost (usually 80%, but check the Summary Plan Description for details). To receive mental health care at no cost to you, you can make an appointment with the Student Assistance Program (410-955-1220) or with Student Mental Health Services (410-955-1892, first 8 visits are free). Both programs offer free services as well as referrals to other services. Obstetrical (OB) care can be scheduled by contacting the UHS clinic. Once pregnancy is confirmed, you are referred to the Faculty OB practice. Should you seek care by an obstetrician of your choice without referral through UHS, you will liable for any costs after consideration by our insurance. back to top Care at UHS is provided by the Division of Internal Medicine. The clinic has recently added more faculty physicians and a nurse practitioner and is phasing out employing preventative medicine fellows at the clinic. Please be aware that these are fully accredited physicians, not medical residents. Fellows may be students or faculty members in the School of Public Health, therefore be aware that some of the doctors at the UHS clinic might be your classmates or your professors. back to top You have the right to request any doctor at the UHS clinic that you would like to see, even if your reason for not wanting to see a specific doctor is that they are your classmate, friend, or teacher. The receptionists, nurses, and doctors are aware that you may be uncomfortable being treated by someone you know personally, and it is completely acceptable to request the doctor of your choice. Please keep in mind that this may cause a longer wait for an appointment. UHS is now providing longitudinal care for patients. The doctor you see on your first visit will be your physician during your time at Hopkins, unless you request to change. If you choose to go outside UHS, you may also see any physician of your choice. However be aware that SHP will only reimburse a percentage of usual and customary fees and that some providers who are not participating provides may charge more. You can find out what the usual and customary charges are for a given service by calling SHP (410.424.4485). To find a list of participating providers, call SHP or visit their website (www.ehp.org). back to top This coverage has recently changed. You no longer require a referral from UHS in order to see a specialist, but some specialists will still require one before granting you an appointment. As before, if the specialist is in-network, your care will be covered 100%. You may be responsible for additional charges (beyond the R&C charges) if you see an out-of-network provider. A Participating Provider Search is available through the insurance plan website. back to top You should go to or call the UHS clinic during normal business hours, or call the after-hours on-call physician (410-955-4331 for medical/surgical emergencies; 410-955-5964 for psychiatric emergencies) in order for UHS to cover the 20% that the Student Health Plan does not cover. Starting this academic year, you should be able to reach your UHS physician through the after-hours call service during the week. For weekend emergencies, you will be connected to the on-call physician for Hopkins general medicine. If you go directly to Hopkins’ Emergency Room (ER), or any other ER, the SHP will cover 80% but you will have to pay the remaining 20%. In addition, it is necessary to contact SHP within 48 hours of any emergency care in order to receive this coverage. back to top Children of SHP members are covered for care with a pediatrician of your choice. SHP must know that your child(ren) are part of your plan, so notify them within the month of the child’s birth, or as soon as you become a member of the program. The UHS Benefits Office has a list of local pediatricians to assist you. If your child requires specialist care, he or she must be referred by his or her listed pediatrician. The UHS Benefits Office will pay for the referral only if it is made by the child’s pediatrician. The UHS Benefits Office must be notified, in writing, of any referrals to specialists (you can request a copy of the note to bring over to the Benefits office yourself; this will avoid delays in payment). Additional information regarding pediatric emergencies, diagnostic procedures, and mental health services can be found in the current plan descriptions. If your child needs emergency pediatric care, contact the child’s pediatrician first for instructions on how the matter should be handled. This is especially important if you want the Benefits Office to pay what SHP does not cover. If you do not contact your pediatrician first, you will be responsible for any balance after payment consideration by SHP. back to top You should always receive an Explanation of Benefits (EOBs) from SHP which lets you know how much the services cost and what portion was paid by SHP. These EOBs will say on them “This is not a bill” but you need to hold onto them because the UHS Benefits office may need them to pay for the supplemental benefits they provide. As of December 1, 2006, you should only receive bills for charges tjhat you actually owe (and annual eye exams, which are covered by UHS). This is a real bill and you need to make sure the balance gets paid. This is a big change from the old system, in which you recieved bills for charges paid by UHS. If you have questions about a bill, bring it along with the corresponding EOB to the UHS Benefi ts Office (Blalock 144). back to top Hold on to all EOBs and bills. Except for your yearly eye exam, you are responsible for the charges reflected on any bill you receive. If the bill is for the yearly eye exam or if you have a question about a charge, you should bring the bill along with the corresponding EOB to the UHS Benefits Office (Blalock 144). back to top Reasonable and Customary Charges (R&C) are those charges that an insurance company deems to be reasonable for a given procedure. This varies by the service performed, the geographic location, and other factors, and has been predetermined for SHP. What does this mean to you? Our health insurance pays 80% of R&C for most services. If you recieve treatment or a referral for treatment through the UHS clinic, UHS will pay the remaining 20% of R&C on your behalf (you pay nothing). If you choose to go to an EHP-participating doctor, but without a referral from UHS, you will be responsible for paying the 20% portion of the R&C charges that remains after SHP pays their 80%. If you choose a doctor that does not participate with EHP, they may charge more than R&C. In this case, SHP still pays 80% of R&C, and you are responsible for paying the remaining charges in full (20% of R&C, PLUS the difference between R&C and your doctor's charges). As an example, pretend you need a medical service performed that has an assigned R&C of $100... - If you go to UHS to get the service performed or to get a referral: SHP pays $80, UHS pays $20, you pay nothing.
- If you go to an EHP provider without a UHS referral: SHP pays $80, UHS pays nothing, you pay $20.
- If you go to a non-EHP provider who charges $150 for this service: SHP pays $80, UHS pays nothing, you pay $70 ($20+$50).
As you can see, you reduce your out-of-pocket costs tremendously by first seeking care through UHS. In addition, UHS will pay your insurance deductible ($100/person or $300/family) if you go there first... if not, you will have to pay your deductible each year before SHP will start paying their share. This concept is further explained in the booklets posted in our documents section: "Summary of Health Benefits for Postdoctoral Fellows and Students" (pages 3-5, and 14-16), and "Summary Plan Description" (pages 8, and 12-15). This can have major impact on how much you are required to pay out-of-pocket fo your health insurance, so be sure that you understand it. We'll be happy to answer any questions, or to clarify the concept... just e-mail us! back to top
If you have any additional questions or issues that you would like to share with us, please send us an e-mail at shprep@jhsph.edu. | 
