Faculty and Staff: Comparing the Medical Plans | Open Enrollment Guide

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
	10% after deductible	GW - 80% Employee - 20%	GW - 60% Employee - 40%	10% after deductible	GW - 80% Employee - 20%	GW - 60% Employee - 40%
Lifetime Maximum
	Unlimited			Unlimited
Office Visit
Primary Care Physician (PCP)	10% after deductible	After deductible: GW - 80% Employee - 20%	After deductible: GW - 60% Employee - 40%	$10 copay	$30 copay	After deductible: GW - 60% Employee - 40%
Specialist	10% after deductible	After ded: GW - 80% Employee - 20%	After ded: GW - 60% Employee - 40%	$25 copay	$50 copay	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			100% covered In-Network Only by the GW PPO and GW HSP through 12/31/24
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. 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)		GW PPO
	In-Network	Out-of-Network	In-Network	Out-of-Network
Hospital Care
Inpatient	After deductible: GW - 80% 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	Up to $30,000 lifetime medical benefit and up to a $8,000 pharmacy benefit	Not 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.
** Artificial insemination and in vitro fertilization are covered as well as other services. Limitations apply. Please review the Fertility Benefit Overview PDF at hr.gwu.edu/benefits.
*** Up to a single purchase (including repair/replacement) per hearing impaired ear every 36 months.

	GW Health Savings Plan (HSP)		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
	After deductible: GW - 80% Participant - 20%	After deductible: GW - 60% Participant - 40% Materials are NOT covered $30 copay / 24 months	Routine eye exams are covered once every 24 months with applicable copay. Not applied to deductible or co-insurnace: Discounts on hardware/frames/contacts are available at participating eye centers. You are subject to the annual deductible and coinsurance if you go out-of-network in the GW PPO.
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
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