The 2025 Open Enrollment that began October 7, 2024 and ended on October 25, 2024 at 8pm (ET) is now closed.
Medical Plan Highlights
| Note: The GW medical plan offerings use the UHC Choice Plus network | GW Health Savings Plan (HSP) | ||
|---|---|---|---|
| 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% Employee - 10% | GW - 80% Employee - 20% | GW - 60% Employee - 40% |
| Lifetime Maximum | |||
| 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% |
| Specialist | After deductible: GW - 90% Employee - 10% | After deductible: GW - 80% Employee - 20% | After deductible: GW - 60% Employee - 40% |
| Virtual Visits* | |||
| After deductible: GW - 80%, Employee - 20% | |||
| Telehealth Visits** | |||
| After deductible: GW - 90% Employee - 10% | After deductible: GW - 80%, Employee - 20% | After deductible: GW - 60% Employee - 40% | |
| Imaging and Labs†††† LabCorp and Quest Diagnostics are GW's preferred vendors for lab work. | |||
| 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. 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 HEALTH SAVINGS PLAN (HSP) | ||
| In-Network | Out-Of-Network | |
| Hospital Care | ||
| Inpatient | After deductible: GW - 80% Employee - 20% | 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) | |
| 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) | |||
|---|---|---|---|
| In-Network | Out-Of-Network | ||
| Vision | |||
Up to one routine exam every 24 months Note: Materials are NOT covered | After deductible: GW - 80% Employee - 20% | After deductible: GW - 60% Employee - 40% | |
| Durable Medical Equipment (DME) | |||
| After deductible: GW - 80% Employee - 20% | After deductible: GW - 60% Employee - 40% | ||
| Prescription Drug Deductible | |||
| Included in overall plan deductible ($2,000 individual / $4,000 family) | |||
| Prescription Out-of-Pocket Maximum | |||
| Individual | Combined with medical | ||
| Family | Combined with medical | ||
| Preventive Drugs | |||
| Covered at 100% | |||
| Retail Prescription Drugs | |||
| Generic | After deductible: GW – 80% Employee – 20% | After deductible: GW – 60% Employee – 40% | |
| 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% | |
| Specialty under Brand Non-Formulary | After deductible: 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% 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% | |
*** HSP participants must meet their combined medical/prescription deductible before the out-of-pocket cost will be $0.
Summaries of Benefits and Coverage (SBC) will soon be available at hr.gwu.edu/affordable-care-act.
Medical Plan Programs
- UHC Virtual Visits: Virtual Visits will remain a health plan feature for 2025, 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.
- Real Appeal: Real Appeal is a virtual weight-loss support program offered through the GW HSP medical plan. The program supports members with a body mass index (BMI) of 23 or more—at no cost. Weekly online coaching sessions and tools, includes food and weight scales, a blender, healthy recipes, digital workouts, and more are included. If you are currently enrolled in the GW HSP medical plan, you may enroll at any time if you meet BMI eligibility requirements. If you are newly electing the GW HSP during 2025 Open Enrollment, you may enroll beginning January 1, 2025.
Visit gwu.realappeal.com for more information.
- Freestanding Imaging and Labs Preferred Network: A freestanding network facility performs outpatient services and submits claims separately from any hospital affiliation, and may be a lower cost option for certain medical services. For GW employees and their dependents enrolled in the GW HSP plan, GW will continue to offer 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 will continue to be GW’s preferred vendors for lab work.
*In-network freestanding facilities and GW Hospital