The 2025 Open Enrollment that began October 7, 2024 and ended on October 25, 2024 at 8pm (ET) is now closed.
Faculty and Staff: Comparing the Medical Plans
Comparing the Medical Plans
| Note: The GW medical plan offerings use the UHC Choice Plus network | GW Health Savings Plan (HSP) | GW PPO | ||||
| MFA Provider† | In-Network | Out-of-Network | MFA Provider† | In-Network | Out-of-Network | |
| Deductible | ||||||
| Individual | $2,000 | $3,000 | $750 | $2,000 | ||
| Family | $4,000† | $6,000† | $1,500 | $4,000 | ||
| Out-of-Pocket Maximum (OOPM)†† | ||||||
| Individual | $4,000 | $6,000 | $3,000 | $6,000 | ||
| Family | $8,000 | $12,000 | $6,000 | $12,000 | ||
| Coinsurance | ||||||
| After deductible: GW - 90%, Employee - 10% | GW - 80% Employee - 20% | GW - 60% Employee - 40% | After deductible: GW - 90%, Employee - 10% | GW - 80% Employee - 20% | GW - 60% Employee - 40% | |
| Lifetime Maximum | ||||||
| Unlimited | Unlimited | |||||
| Office Visit | ||||||
| Primary Care Physician (PCP) | After deductible: GW - 90%, Employee - 10% | After deductible: GW - 80% Employee - 20% | After deductible: GW - 60% Employee - 40% | $10 copay | $30 copay | 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% | $25 copay | $50 copay | After deductible: GW - 60% Employee - 40% |
| Virtual Visits* | ||||||
| After deductible: GW - 80%, Employee - 20% | $10 copay | |||||
| Telehealth Visits** | ||||||
| Primary Care Physician (PCP) | After deductible: GW - 90%, Employee - 10% | After deductible: GW - 80%, Employee - 20% | After deductible: GW - 60%, Employee - 40% | $10 copay | $30 copay | 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% | $25 copay | $50 copay | After deductible: GW - 60% Employee - 40% |
| Imaging and Labs††† (LabCorp and Quest Diagnostics will continue to be GW's preferred vendors for lab work.) | ||||||
| Preferred | Non-Preferred | Preferred | Non-Preferred | |||
| Diagnostic Test (x-ray, blood work) | After deductible: GW - 80% Employee - 20% | After deductible: GW - 60% Employee - 40% | After deductible: GW - 80% Employee - 20% | After deductible: GW - 60% Employee - 40% | ||
| Imaging (CT/PET scans, MRIs) | After deductible: GW - 80% Employee - 20% | After deductible: GW - 60% Employee - 40% | After deductible: GW - 80% Employee - 20% | After deductible: GW - 60% Employee - 40% | ||
*Virtual visits are those provided by a UHC Designated Virtual Visit Providers (i.e. Teladoc, Doctor on Demand, Amwell.)
**Telehealth Visits include medical and behavioral health care and are provided via phone or video by Primary Care Providers and Medical or Behavioral Health specialists. 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 PPO | |||
| In-Network | Out-of-Network | In-Network | Out-of-Network | |
| Hospital Care | ||||
| Inpatient | After deductible: Participant - 20% | After deductible: GW - 60% Participant - 40% | After deductible: GW - 80% Participant - 20% | After deductible: GW - 60% Participant - 40% |
| Outpatient | After deductible: GW - 80% Participant - 20% | After deductible: GW - 60% Participant - 40% | After deductible: GW - 80% Participant - 20% | After deductible: GW - 60% Participant - 40% |
| Urgent Care | After deductible: GW - 80% Participant - 20% | After deductible: GW - 60% Participant - 40% | $30 copay | After deductible: GW - 60% Participant - 40% |
| Emergency Room | After deductible: GW - 80% Participant - 20% | After deductible: GW - 80% Participant - 20% | After deductible: GW - 80% Participant - 20% | After deductible: GW - 80% Participant - 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% Participant - 40% | GW covers 100% if part of wellness exam | After deductible: GW - 60% Participant - 40% |
| Prostate Exam* | GW covers 100% if part of wellness exam | After deductible: GW - 60% Participant - 40% | GW covers 100% if part of wellness exam | After deductible: GW - 60% Participant - 40% |
| Well Child and Well Adult Exams* | GW covers 100% | After deductible: GW - 60% Participant - 40% | GW covers 100% if part of wellness exam | After deductible: GW - 60% Participant - 40% |
| Applied Behavior Analysis (ABA) | ||||
| Covered | Covered | Covered | Covered | |
| Chiropractic Care | ||||
| After deductible: GW - 80% Participant - 20% up to 60 visits per year (combined in-and out-of-network) | After deductible: GW - 60% Participant - 40% up to 60 visits per year (combined in-and out-of-network) | $50 copay per office visit, up to 60 visits per year (combined in-and out-of-network) | After deductible: GW - 60% Participant - 40% up to 60 visits per year (combined in-and out-of-network) | |
| Acupuncture | ||||
| After deductible: GW - 80% Participant - 20% up to 20 visits per year (combined in-and out-of-network) | After deductible: GW - 60% Participant - 40% up to 20 visits per year (combined in-and out-of-network) | $50 copay per office visit, up to 20 visits per year (combined in-and out-of-network) | After deductible: GW - 60% Participant - 40% up to 20 visits per year (combined in-and out-of-network) | |
| Fertility Benefits | ||||
| Not Covered | Not Covered | Covered through Progyny | Not Covered | |
| Breast Reduction Surgery** | ||||
| Not Covered | Not Covered | Covered | Covered | |
| Hearing Aids*** | ||||
| Not Covered | Not Covered | After deductible: GW - 80% Participant - 20% | After deductible: GW - 60% Participant - 40% | |
* Preventive care guidelines are based on recommendations of the U.S. Preventive Services Task Force and other health organizations. Visit myuhc.com for additional details on ALL preventive care guidelines based on your age and sex.
**Covered when considered medically necessary - Please see GW PPO SPD for criteria. Note: Depending upon where the Covered Health Service is provided, Benefits will be the same as those stated under each covered Health Service category in this Benefit Summary. For example, for services provided in the Physician’s Office, a Copayment will apply to the office visit. All other services would be deductible and then co-insurance.
*** Up to a single purchase (including repair/replacement) per hearing impaired ear every 36 months.
| GW PPO | |||||
| In-Network | Out-of-Network | In-Network | Out-of-Network | |||
| Cochlear Implants | ||||||
| Inpatient | Not Covered | Not Covered | Covered | Not Covered | ||
| Bariatric Surgery* | ||||||
| * Notification is required six months prior to surgery. Please contact UHC for plan details. | Not Covered | Not Covered | Up to $60,000-lifetime limit | Not Covered | ||
| Vision | ||||||
Up to one routine exam every 24 months Note: Materials are NOT covered | After deductible: GW - 80% Participant - 20% | After deductible: GW - 60% Participant - 40% | $30 copay | After deductible: GW - 60% Participant - 40% | ||
| Prescription Drug Deductible | ||||||
| Included in overall plan deductible ($2,000 individual/$4,000 family) | N/A | |||||
| Prescription Out-of-Pocket Maximum | ||||||
| Individual | Combined with medical | $3,600 | $7,200 | |||
| Family | Combined with medical | $7,200 | $14,400 | |||
| Preventive Drugs | ||||||
| Covered at 100% | Subject to coinsurance | |||||
| Retail Prescription Drugs | ||||||
| Generic | After deductible: GW - 80% Participant - 20% | After deductible: GW - 60% Participant - 40% | 10% Coinsurance (Minimum $15, Maximum $30) 30-day supply | |||
| Brand Formulary | After deductible: GW - 80% Participant - 20% | After deductible: GW - 60% Participant - 40% | 20% Coinsurance (Minimum $30, Maximum $50) 30-day supply | |||
| Brand Non-Formulary | After deductible: GW - 80% Participant - 20% | After deductible: GW - 60% Participant - 40% | 25% Coinsurance (Minimum $60, Maximum $100) 30-day supply | |||
| Specialty under Brand Non-Formulary | After deductible: 30% for PrudentRx eligible specialty prescriptions filled at CVS Specialty, $0*** when enrolled in PrudentRx | 30% for PrudentRx eligible specialty prescriptions filled at CVS Specialty, $0 when enrolled in PrudentRx | ||||
| Mail-Order Prescription Drugs** | ||||||
| Generic Vacation Exception Additional 30-day supply one time per year | After deductible: GW - 80% Participant - 20% | After deductible: GW - 60% Participant - 40% | 10% Coinsurance (Minimum $37.50, Maximum $75) 90-day supply | |||
| Brand Formulary Vacation Exception Additional 30-day supply one time per year | After deductible: GW - 80% Participant - 20% | After deductible: GW - 60% Participant - 40% | 20% Coinsurance (Minimum $75, Maximum $125) 90-day supply | |||
| Brand Non-Formulary Vacation Exception Additional 30-day supply one time per year | After deductible: GW - 80% Participant - 20% | After deductible: GW - 60% Participant - 40% | 25% Coinsurance (Minimum $150, Maximum $250) 90-day supply | |||
* Notification is required six months prior to surgery. Please contact UHC for plan details.
** Mandatory Maintenance Choice with Opt Out provisions apply. Please see page 22 for more information
*** HSP participants must meet their combined medical/prescription deductible before the out of pocket cost will be $0.
Summaries of Benefits and Coverage (SBCs) provide additional plan coverage information - hr.gwu.edu/medical_benefits.
Medical Plan Programs
- UHC Virtual Visits: Virtual Visits will remain a health plan feature for 2024, allowing UHC members to connect with a doctor via mobile device or computer—24/7, no appointment needed. Get timely care, including diagnosis and prescription, and pay less out-of-pocket. To access a UnitedHealthcare Virtual Visit provider, log on to www.myuhc.com or download the UHC App. Find instructions on how to access the additional virtual visit providers in the FAQ section on myuhc.com under related links for additional information.
- Telemental Health: Telemental Health is available through your UHC medical benefit. The service uses secure, video-calling technology to provide real-time access to a behavioral health professional, and features a network of over 3,000 providers in all 50 states. Learn more or schedule a visit at myuhc.com.
- Freestanding Imaging and Labs Preferred Network: A freestanding network facility performs outpatient services and submits claims separately from any hospital affliation, and may be a lower cost option. GW offers a preferred network,* including a lower coinsurance, for usage of freestanding facilities in lieu of hospitals for lab tests, radiology services, major diagnostics and other services. LabCorp and Quest Diagnostics are GW’s preferred vendors for lab work. The cost for visiting a GW-preferred network facility will remain the same for 2025:
- GW HSP: 20 percent coinsurance after deductible
- GW PPO: 20 percent coinsurance after deductible
*Search for an outpatient center or laboratory on myuhc.com or in the Castlight app. Choose "Freestanding Facility" to help reduce out-of-pocket costs. * In-network freestanding facilities and GW Hospital.