How to Utilize Your Care

How Prescription Coinsurance Works

Coinsurance is your share of the costs of a covered healthcare service, calculated as a percent (for example, 20 percent) of the total cost for the service or prescription drug. GW pays the remainder of the cost. 

There is financial protection built into the prescription drug benefit in that you will never pay more than the "maximum." Once you reach the out-of-pocket maximum (OOPM), GW will pay 100 percent of prescription drug costs thereafter.

 For those on the GW HSP:

• You must pay all prescription drug costs until you meet your annual deductible. After you meet your annual deductible, you will be responsible for 20 percent coinsurance until you reach the out-of-pocket maximum. Your pharmacy deductible is combined with your medical deductible.
• You can use your HSA to pay for eligible out-of-pocket costs, including your deductible and prescription coinsurance.
• Preventive medications are covered at 100 percent under the GW HSP. Coinsurance and deductible do not apply.

Maintenance Choice with Opt-out for the GW PPO and HSP plans:

If you have a condition that requires ongoing prescription medication, you will receive the lowest total copay possible by requesting that your doctor provide a prescription for a 90-day supply of your medication. Below are the options available to you under the Maintenance Choice Program:

1. Fill your prescription via mail order (90-day supply mailed directly to you)
2. Fill your prescription via retail store that participates in the program (pick up 90-day supply at participating pharmacies)
3. Opt-out* and continue to pick up 30-day supply at in-network pharmacy

If choosing Option 1 or 2, to fill your 90-day prescription:

• Mail Order Service - Learn more about this option by clicking here.
• Select Retail Pharmacies - Login at Caremark.com/pharmacylocator, enter your zip code and filter by "90-day supply" to find a participating pharmacy near you (e.g., CVS, Kroger, Costco).

*To opt-out of maintenance choice and continue filling a 30-day supply at your local in-network pharmacy or for other questions about this program, please call 1-877-357-4032. If you do not opt out, and you continue filling your medications at a retail pharmacy after the initial three 30-day fills, you will be responsible for 100% of the medication's cost.acy.

Save Money by Using Freestanding Facilities

Prices vary significantly for imaging and lab work—even if you go in-network.

Not only do prices vary, but you will pay a lower coinsurance when you use a freestanding network facility instead of a hospital for healthcare services or treatments that do not require an overnight hospital stay. A freestanding facility performs outpatient services and submits claims separately from any hospital affiliation. GW offers a preferred network* for labs, X-ray and major diagnostics. When you go to a preferred network freestanding facility for these services, you will pay 20 percent coinsurance under the GW HSP. If you go to a facility that is not in the preferred network, you will pay 40 percent coinsurance under the GW HSP. LabCorp and Quest Diagnostics will continue to be GW's preferred vendors for lab work.

When you do need outpatient lab tests and imaging, refer to the checklist on the right outlining what to ask.

For instructions on how to compare costs and locate a preferred provider for networks and labs, call the Aetna Concierge at 1-844-989-8811.

*In-network freestanding facilities and GW hospital.

When using outpatient lab tests and imaging, ask:

• Do you know the cost of the tests you are ordering?
• Is the provider or laboratory in my network?
• Since my share of the cost is less for services performed at a freestanding facility that is not connected to a hospital, can the test or service be performed at a freestanding facility?
• Can you recommend a freestanding facility in the Aetna network?