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," outlined in the tables below. Once you reach the out-of-pocket maximum (OOPM), GW will pay 100 percent of prescription drug costs thereafter.

 George is enrolled in the GW PPO. He isn’t feeling well so he goes to his Primary Care Physician. He has bronchitis and his physician recommends a prescription antibiotic as treatment. George asks his physician if he can prescribe a generic antibiotic.

 Martha is enrolled in the GW PPO and does not feel well. Martha goes to her Primary Care Physician and has bronchitis. Her physician writes her a prescription for a preferred brand antibiotic with a similar chemical formula to the antibiotic George received. She gets to the pharmacy and finds out the total antibiotic cost is $400.

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 if you participate in the GW LTD PPO, 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 LTD PPO. If you go to a facility that is not in the preferred network, you will pay 40 percent coinsurance under the GW LTD PPO. LabCorp and Quest Diagnostics will continue to be GW's preferred vendors for lab work.

For instructions on how to compare costs and locate a preferred provider for networks and labs view UHC's flyer for freestanding facilities.

*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 UnitedHealthcare network?
   

Non-Preferred Lab/Hospital Cost/Member Cost (40% Coinsurance)**