2024 Open Enrollment Period: October 9 - 27, 2023
Medical Plan Highlights
| Note: The GW medical plan offerings use the UHC Choice Plus network | GW Health Savings Plan (HSP) | ||
|---|---|---|---|
| MFA Provider† | In-Network | Out-of-Network | |
| Deductible | |||
|
Individual |
-- | $2,000 | $3,000 |
| Family | -- | $4,000†† | $6,000† |
| Out-of-Pocket Maximum (OOPM)†† | |||
| Individual | -- | $4,000 | $6,000 |
| Family | -- | $8,000 | $12,000 |
| Coinsurance | |||
| After deductible |
GW - 90% |
GW - 80% Employee - 20% |
GW - 60% Employee - 40% |
| Lifetime Maximum | |||
| Unlimited | |||
| Office Visit | |||
| Primary Care Physician (PCP) |
After deductible: |
After deductible: GW - 80% Employee - 20% |
After deductible: GW - 60% Employee - 40% |
|
Specialist |
After deductible: GW - 90% Employee - 10% |
After deductible: GW - 80% Employee - 20% |
After deductible: GW - 60% Employee - 40% |
| Virtual Visits and Telemental Health Visits* | |||
| 100% covered In-Network Only by the GW PPO and GW HSP through 12/31/24 | |||
|
Imaging and Labs†††† LabCorp and Quest Diagnostics are GW's preferred vendors for lab work. |
|||
| Preferred | Non-Preferred | ||
| Diagnostic Test (x-ray, blood work) |
-- | After deduction: GW - 80% Employee - 20% |
After deduction: GW - 60% Employee - 40% |
| Imaging (CT/PET scans, MRIs) |
-- | After deduction: GW - 80% Employee - 20% |
After deduction: GW - 60% Employee - 40% |
*Virtual visits are those provided by a UHC Designated Virtual Visit Providers (i.e. Optum Virtual Care, Teladoc, Doctor on Demand, Amwell, Walmart Virtual Care.) Telemental Health Visits are provided by UHC In-Network Behavioral Health Providers. Note: Telehealth Visits are provided via phone or video by an In-Network Medical Provider (Primary Care Providers and Medical Specialists) in UHC’s Choice Plus Network. Copay or deductible/coinsurance apply.
† The MFA tier applies to professional charges by MFA providers; MFA behavioral health providers continue to be out-of-network.
† † For family coverage, no one in the family is eligible for the coinsurance benefit until the family coverage deductible is met.
† †† Under Healthcare Reform, all plans must have an out-of-pocket maximum. In addition deductibles, copays and coinsurance must apply to the OOPM. (Only allowed charges will count towards the OOPM for out-of-network benefits.)
†† †† Preferred Network = in-network freestanding facilities and GW hospital; Non-Preferred Network = in-network hospitals (other than GW Hospital) or out-of-network freestanding facilities or hospitals (in- or out-of-network deductible applies as appropriate).
|
GW HEALTH SAVINGS PLAN (HSP) |
||
| In-Network | Out-Of-Network | |
| Hospital Care | ||
| Inpatient |
After deductible: |
After deductible: GW - 60% Employee - 40% |
| Outpatient | After deductible: GW - 80% Employee - 20% |
After deductible: GW - 60% Employee - 40% |
| Urgent Care | After deductible: GW - 80% Employee - 20% |
After deductible: GW - 60% Employee - 40% |
| Emergency Room | After deductible: GW - 80% Employee - 20% |
After deductible: GW - 80% Employee - 20% |
| Preventive | ||
| Mammography* | 100% for one preventive mammogram per year, age 40 and over | |
| Pap Test* | GW covers 100% if part of wellness exam | After deductible: GW - 60% Employee - 40% |
| Prostate Ex | GW covers 100% if part of wellness exam | After deductible: GW - 60% Employee - 40% |
| Well Child and Well Adult Exams* | GW covers 100% | After deductible: GW - 60% Employee - 40% |
| Applied Behavior Analysis (ABA) | ||
| Covered | Covered | |
| Chiropractic Care | ||
| After deductible: GW - 80% Employee - 20% up to 60 visits per year (combined in-and out-of-network) |
After deductible: GW - 60% Employee - 40% up to 60 visits per year (combined in-and out-of-network) |
|
| Acupuncture | ||
| After deductible: GW - 80% Employee - 20% up to 20 visits per year (combined in-and out-of-network) |
After deductible: GW - 60% Employee - 40% up to 20 visits per year (combined in-and out-of-network) |
|
Preventive care guidelines are based on recommendations of the U.S. Preventive Services Task Force and other health organizations.
Visit uhc.com/health-and-wellness/preventive-care for additional details on ALL preventive care guidelines based on your age and sex.
|
GW HEALTH SAVINGS PLAN (HSP) |
|||
|---|---|---|---|
| In-Network | Out-Of-Network | ||
| Vision | |||
|
After deductible: |
After deductible: GW - 60% Employee - 40% |
||
| Durable Medical Equipment (DME) | |||
| After deductible: GW - 80% Employee - 20% |
After deductible: GW - 60% Employee - 40% |
||
| Prescription Drug Deductible | |||
|
Included in overall plan deductible ($2,000 individual / $4,000 family) |
|||
| Prescription Out-of-Pocket Maximum | |||
| Individual | Combined with medical | ||
| Family | Combined with medical | ||
| Preventive Drugs | |||
| Covered at 100% | |||
| Retail Prescription Drugs | |||
| Generic |
After deductible: |
After deductible: |
|
| Brand Formulary | After deductible: GW – 80% Employee – 20% |
After deductible: GW – 60% Employee – 40% |
|
| Brand Non-Formulary | After deductible: GW – 80% Employee – 20% |
After deductible: GW – 60% Employee – 40% |
|
| Mail-Order Prescription Drugs | |||
| Generic
Vacation Exception |
After deductible: GW – 80% Employee – 20% |
After deductible: GW – 60% Employee – 40% |
|
| Brand Formulary Vacation Exception Additional 30-day supply one time per year |
After deductible: GW – 80% Employee – 20% |
After deductible: GW – 60% Employee – 40% |
|
| Brand Non-Formulary | After deductible: GW – 80% Employee – 20% |
After deductible: GW – 60% Employee – 40% |
|
Summaries of Benefits and Coverage (SBC) will soon be available at hr.gwu.edu/affordable-care-act. Please review for additional plan coverage information. To review 2024 contribution rates for Medical Coverage, please refer here.