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CareFirst High Deductible Health Plan + Health Savings Account

The High Deductible Health Plan (HDHP) has a higher deductible and out-of-pocket maximum than the CareFirst PPO or Kaiser HMO. While the HDHP may have a lower monthly premium, you’ll pay more out-of-pocket before insurance coverage begins.

The HDHP includes a Health Savings Account (HSA) for qualified medical expenses. AU contributes $500 for individuals or $1,000 for individual + child(ren), individual + spouse, or family coverage. You can also make pre-tax contributions up to the IRS annual limit. Your HSA earns interest, doesn't have a “use-it-or-lose-it” rule, and is yours to keep, even if you change jobs or retire.

HDHPs can be a good fit for people who are generally healthy, see a doctor infrequently, or expect limited medical visits.

Cost for coverage

Select your annual salary range to view your cost for coverage chart

Your portion of the cost of the medical coverage is deducted from your pay on a pre-tax basis.

Terms to know

In-network means you have lower out-of-pocket costs when you choose a BlueChoice, BluePreferred PPO, or BlueCard PPO network provider. If you are out of the DC, Maryland, and Northern Virginia, you may choose any provider nationwide that participates with a BlueCard PPO plan and receive in-network benefits.

Out-of-network provides a lower level of coverage in exchange for the freedom to seek care from any provider you choose. If you receive services from a provider outside of the BlueChoice, BluePreferred PPO, or BlueCard PPO networks, you will have to: 1) pay the provider's actual charge at the time you receive care, 2) file a claim for reimbursement, and 3) satisfy a deductible and coinsurance.

This chart provides an overview of the CareFirst High Deductible Health Plan (HDHP). Please refer to CareFirst HDHP Summary of Benefits for a comprehensive listing of medical benefits. Please note that “Individual +” applies to Individual + child(ren), + spouse/domestic partner, or family coverage.
  CareFirst HDHP
  In-network Out-of-network

*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.
AU's Contribution to the Health Saving Account

$500 individual / $1,000 individual +

Annual deductible

$3,000 individual

$6,000 individual +

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, but a coinsurance may apply.

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

$6,000 individual

$12,000 individual + 

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

Coinsurance

80% paid by health plan*

20% paid by participant

60% paid by health plan*

40% paid by participant

Copayments

Coinsurance after deductible is met.

 Coinsurance after deductible is met.

Annual out-of-pocket maximum

$7,000 individual

$14,000 individual +

The HDHP 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, you pay the coinsurance. If you reach the maximum out-of-pocket expense for the year, CareFirst pays 100% of the plan allowance(s) for covered expenses for the remainder of the year.

$12,000 individual

$24,000 individual +

The HDHP 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, you pay the coinsurance. If you reach the maximum out-of-pocket expense for the year, CareFirst pays 100% of the plan allowance(s) for covered expenses for the remainder of the year.

Lifetime maximum

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.

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.

Please call the provider's office directly to confirm that they still participate in the CareFirst network, even if they are listed as a provider on the CareFirst site.

To find an in-network provider, visit www.carefirst.com and select BlueChoice Advantage as your plan.

If your provider is not listed in the online directory, they are considered out-of-network. You will still have coverage, but your out-of-pocket costs will be greater.

Please call the provider's office directly to confirm that they still participate in the CareFirst network, even if they are listed as a provider on the BCBS site.

To find an in-network provider outside of the DC, Maryland, and Northern Virginia counties of Fairfax, Alexandria, and Arlington, visit www.bcbs.com and enter the first three letters of your member ID number on your insurance card in the "Already a Member" field.

If your provider is not listed in the online directory, they are considered out-of-network. You will still have coverage, but your out-of-pocket costs will be greater.

For behavioral health inpatient pre-certification and emergencies 24 hours/day, 7 days/week, contact CareFirst directly at:

(800) 245-7013
Monday through Friday
8 a.m. - 6 p.m.
After hours available for inpatient pre-certification and emergencies 24 hours/day, 7 days/week

When your primary care physician isn’t available and you need urgent care services, CareFirst Video Visit securely connects you with a doctor, day or night, through your smartphone, tablet or computer.

In addition, you can schedule visits for other needs such as behavioral health support from a therapist or psychiatrist, guidance from a certified nutritionist or breastfeeding support from a lactation consultant. It’s a convenient and easy way to get the care you need, wherever you are. Visit www.carefirstvideovisit.com to get started.

Patient centered medical home (PCMH) doctors provide coordination of care for patients with serious and chronic health conditions. If your physician participates, they will get streamlined access to specialist reports, test results, and hospitalization information. A nurse in your physician's office is designated to be available to answer questions, support the treatment process, and be proactive in providing care.

The program is confidential, voluntary, and provided at no additional cost to you. If you are contacted by your doctor, we strongly encourage you to enroll in the program so that you can get personalized care and support for you and your family.

To find out if your physician participates in the program, go to www.carefirst.com and look for the PCMH symbol near the provider's name.

CareEssentials is a personalized, confidential, and voluntary health coaching program to help people with chronic conditions, like diabetes or asthma, to manage their overall health. Highly trained nurses provide one-on-one telephone support and health information, help you prepare questions for doctor visits, answer questions about new diagnoses and medications; and assist with other health issues.

The CareEssentials team is available to support your relationship with your physician, not replace it. They will provide coordination of care with your physician. The program is administered by Healthways, Inc., a leading provider of integrated health management.

Expectant mothers can take advantage of the CareFirst Great Beginnings pregnancy support program designed to supplement the prenatal care and education you receive from your doctor, at no additional cost to you.

When you enroll in Great Beginnings, a nurse case manager will review your medical history. If you experience complications during your pregnancy, they will work closely with your doctor to coordinate necessary services.

You are covered while traveling outside the U.S. Visit the BlueCross BlueShield Global Core Website for more information.

  • Enter "RMR" in the sections that says, "Enter the first three letters of the Member ID on your card."

Some restrictions apply. Not all countries are covered.

A self-insured plan means that the university pays the claims. CareFirst administers the claims from health providers for AU faculty and staff. The university does not receive any private medical information or any details about claims incurred.

Our premiums for CareFirst are based on our claims experience. If we have a lot of claims in a year, the university has to pay more. And that means the next year the premiums go up.

But you can help. When you choose generic medications, stick with a healthy regimen, and get preventive screenings, you generally incur less in claims. The lower our claims, the lower our premiums are in the next year.

 

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.

New hire enrollment & life event changes

2025 Enrollment Guide
2024 Benefits Rate Sheet

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