2025 Open Enrollment Period: October 7 - October 25, 2024 at 8pm ET.
Medical Plan Highlights
Note: The GW medical plan offerings use the UHC Choice Plus network | GW Health Savings Plan (HSP) | ||
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MFA Provider† | In-Network | Out-of-Network | |
Deductible | |||
Individual |
-- | $2,000 | $3,000 |
Family | -- | $4,000†† | $6,000† |
Out-of-Pocket Maximum (OOPM)†† | |||
Individual | -- | $4,000 | $6,000 |
Family | -- | $8,000 | $12,000 |
Coinsurance | |||
After deductible |
GW - 90% |
GW - 80% Employee - 20% |
GW - 60% Employee - 40% |
Lifetime Maximum | |||
Unlimited | |||
Office Visit | |||
Primary Care Physician (PCP) |
After deductible: |
After deductible: GW - 80% Employee - 20% |
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% |
Virtual Visits and Telemental Health Visits* | |||
100% covered In-Network Only by the GW PPO and GW HSP through 12/31/24 | |||
Imaging and Labs†††† LabCorp and Quest Diagnostics are GW's preferred vendors for lab work. |
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Preferred | Non-Preferred | ||
Diagnostic Test (x-ray, blood work) |
-- | After deduction: GW - 80% Employee - 20% |
After deduction: GW - 60% Employee - 40% |
Imaging (CT/PET scans, MRIs) |
-- | After deduction: GW - 80% Employee - 20% |
After deduction: 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) |
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In-Network | Out-Of-Network | |
Hospital Care | ||
Inpatient |
After deductible: |
After deductible: GW - 60% Employee - 40% |
Outpatient | After deductible: GW - 80% Employee - 20% |
After deductible: GW - 60% Employee - 40% |
Urgent Care | After deductible: GW - 80% Employee - 20% |
After deductible: GW - 60% Employee - 40% |
Emergency Room | After deductible: GW - 80% Employee - 20% |
After deductible: GW - 80% Employee - 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% Employee - 40% |
Prostate Ex | GW covers 100% if part of wellness exam | After deductible: GW - 60% Employee - 40% |
Well Child and Well Adult Exams* | GW covers 100% | After deductible: GW - 60% Employee - 40% |
Applied Behavior Analysis (ABA) | ||
Covered | Covered | |
Chiropractic Care | ||
After deductible: GW - 80% Employee - 20% up to 60 visits per year (combined in-and out-of-network) |
After deductible: GW - 60% Employee - 40% up to 60 visits per year (combined in-and out-of-network) |
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Acupuncture | ||
After deductible: GW - 80% Employee - 20% up to 20 visits per year (combined in-and out-of-network) |
After deductible: GW - 60% Employee - 40% up to 20 visits per year (combined in-and out-of-network) |
Preventive care guidelines are based on recommendations of the U.S. Preventive Services Task Force and other health organizations.
Visit uhc.com/health-and-wellness/preventive-care for additional details on ALL preventive care guidelines based on your age and sex.
GW HEALTH SAVINGS PLAN (HSP) |
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In-Network | Out-Of-Network | ||
Vision | |||
After deductible: |
After deductible: GW - 60% Employee - 40% |
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Durable Medical Equipment (DME) | |||
After deductible: GW - 80% Employee - 20% |
After deductible: GW - 60% Employee - 40% |
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Prescription Drug Deductible | |||
Included in overall plan deductible ($2,000 individual / $4,000 family) |
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Prescription Out-of-Pocket Maximum | |||
Individual | Combined with medical | ||
Family | Combined with medical | ||
Preventive Drugs | |||
Covered at 100% | |||
Retail Prescription Drugs | |||
Generic |
After deductible: |
After deductible: |
|
Brand Formulary | After deductible: GW – 80% Employee – 20% |
After deductible: GW – 60% Employee – 40% |
|
Brand Non-Formulary | After deductible: GW – 80% Employee – 20% |
After deductible: GW – 60% Employee – 40% |
|
Mail-Order Prescription Drugs | |||
Generic
Vacation Exception |
After deductible: GW – 80% Employee – 20% |
After deductible: GW – 60% Employee – 40% |
|
Brand Formulary Vacation Exception Additional 30-day supply one time per year |
After deductible: GW – 80% Employee – 20% |
After deductible: GW – 60% Employee – 40% |
|
Brand Non-Formulary | After deductible: GW – 80% Employee – 20% |
After deductible: GW – 60% Employee – 40% |
Summaries of Benefits and Coverage (SBC) will soon be available at hr.gwu.edu/affordable-care-act. Please review for additional plan coverage information. To review 2024 contribution rates for Medical Coverage, please refer here.