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Open Enrollment Guide

 

open enrollment guide for LTD participants

 2025 Open Enrollment begins October 7, 2024 and ends on October 25, 2024 at 8pm (ET).

You are viewing the 2025 open enrollment information for Long Term Disability (LTD) recipients currently enrolled in a plan via bswift.

Coordination of Benefits With Medicare

The GW LTD PPO will pay secondary to Medicare if:

You are enrolled in Medicare Part A and Part B:

  • If you are enrolled in Medicare and you go to a provider that accepts Medicare, the allowable expense will be the Medicare approved amount.
  • If you go to a provider that does not participate in Medicare but still agrees to take a payment from Medicare, the allowable expense will be the Medicare limiting charge. The limiting charge means the highest amount Medicare will pay a provider that does not participate in Medicare.
  • Some providers choose to opt-out of Medicare, which means that the provider is not allowed to bill Medicare. If you go to a provider that opts out of Medicare, the allowable expense will be the Medicare approved amount as determined by UnitedHealthcare.
  • UnitedHealthcare may treat the provider’s billed charges as the allowable expense for Medicare when estimating the Medicare approved amount. Any determinations by UnitedHealthcare will be final, binding and not subject to review.
     

GW LTD PPO Medical Plan Pre-Medicare and Medicare Rates

You are Medicare eligible but have not enrolled in Medicare Part A and Part B:

  • If you are Medicare eligible but do not participate in Medicare, your benefits will be determined as if you timely enrolled in Medicare and obtained services from a Medicare participating provider. Thus, the allowable expense under the Plan will be the Medicare approved amount as determined by UnitedHealthcare.
  • UnitedHealthcare may treat the provider’s billed charges as the allowable expense for Medicare when estimating the Medicare approved amount. Any determinations by UnitedHealthcare will be final, binding and not subject to review.
  • Medicare payments combined with your benefit under the Plan will not exceed 100 percent of the allowable expense. You will be responsible for any charges in excess of the allowable expense.

For more information on Medicare benefits, please contact Medicare at (800) MEDICARE or visit their website at medicare.gov.

The GW LTD PPO has different rates for plan participants depending on the Medicare eligibility of the LTD recipient and dependents.

If you and/or your dependents are eligible for Medicare, are paying the higher GW LTD PPO Pre-Medicare rates and would like to be enrolled at the GW LTD PPO Medicare rates, please contact GW Benefits at [email protected] or (571) 553-8382 for further assistance.
 

Get Personalized Help Through the Healthcare Maze!

Health Advocate, the nation’s leading independent healthcare advocacy and assistance company, is a special benefit paid for by GW that can help you personally resolve your healthcare and insurance issues, promptly and reliably.

Health Advocate is designed to help cut through the barriers that often create frustration and problems. Health Advocate can also help you determine your Medicare eligibility status and review how Medicare coordinates with the GW LTD PPO.

To reach Health Advocate, call (866) 695-8622 or visit healthadvocate.com/gwu.

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