How the Medical Plan Works

Hi, I'm Jane!

Status: full-time employee
Plan: employee-only coverage
Annual Salary: $65,000

Jane tends to be healthy but takes one preventive medication for asthma that she fills four times a year through 90-day maintenance mail order.

Jane has a bad cold and decides to go to an in-network doctor. Jane has already had her yearly physical office visit and her well women’s visit, during which she received eligible preventive screenings at no cost to her. This is the first time this year that she has gone to the doctor, and Jane hasn’t met her health plan deductible. Later in the year, Jane visits a dermatologist.

What will the GW HSP cost for Jane in 2025?

Cost of Care	Total Cost of Service	GW HSP
Well adult office visit routine physical and eligible preventive screenings	$200	$0 Covered at 100%
Well women's visit routine physical and eligible preventive screenings	$200	$0 Covered at 100%
90 day prescriptions for generic preventive asthma medication filled four times	$640 ($160 per Rx)	$0 Covered at 100%
One primary care visit	$150	$150
One generic antibiotic	$15	$15
One specialist visit	$322	$322
Total Cost of Care	$1,527	$487
Cost of Coverage
Total annual premium cost deducted from paycheck		$1,086
Amount contributed by Jane to her HSA from paycheck		$600
Amount contributed by GW to Jane's HSA		($600)
Jane's Total Costs (Payroll Contributions and Cost of Care)		$2,173

* Jane decides to save $50/month in her Health Savings Account (HSA) to pay for medical and prescription drug costs and maximize the GW match. GW matches her contribution up to $600. After using her HSA to pay $487 for her cost of care, Jane carries $713 in her HSA over to the next year for future health-related expenses.

Hi, I'm Robert!

Status: full-time employee
Plan: family coverage (spouse plus two kids)
Annual Salary: $100,000

Robert and each of his family members receive their yearly physicals and annual preventive screenings, including their flu shots, at no cost.

Unfortunately, Robert's child is injured playing soccer and goes to the emergency room. He receives a prescription for generic pain medication (filled at a retail pharmacy) and sees a specialist for a consultation a week later.

Robert's spouse has high blood pressure, for which she receives a generic prescription that is filled four times a year through 90-day maintenance mail order. Robert himself is prescribed an anti-inflammatory medication to treat chronic shoulder pain; he fills his brand formulary prescription twice.

Robert's second child has allergies, for which she sees a specialist twice a year.

What will the GW HSP cost for Robert and his family in 2025?

Cost of Care	Total Cost of Service	GW HSP
Four office visits routine physical and eligible preventive screenings	$1,200	$0 Covered at 100%
One visit to the emergency room	$1,186	$1,186
One generic pain medication	$25	$25
90-day prescriptions for generic preventive high blood pressure filled four times	$640 ($160 per Rx)	$0 Covered at 100%
Three specialist visits	$966	$966
30-day prescription for brand formulary anti-inflammatory medication filled two times	$300 ($150 per 30 day Rx)	$300
Total Cost of Care	$4,317	$2,477
Cost of Coverage
Total annual premium cost deducted from paycheck		$4,172
Amount contributed by Robert to his HSA from paycheck		$1,200
Amount contributed by GW to Robert's HSA		($1,200)
Robert's Total Costs (Payroll Contributions and Cost of Care)		$7,849

* Robert contributes $100 each month (pre-tax) to his Health Savings Account (HSA) to pay for medical and prescription drug costs in order to receive GW’s match of $1,200.