2024 Open Enrollment Period: October 9 - 27, 2023
Medical Plan
Percentages in the accompanying chart represent the percentages of allowed benefit covered by the plan (GW) as well as the retiree responsibility.
The GW Retiree HSP medical plan offerings use the UHC Choice Plus network.
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GW RETIREE 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 | $8000 | $12,000 | |
| Coinsurance | |||
| 10% after ded | GW - 80% Retiree - 20% |
GW - 60% Retiree - 40% |
|
| Lifetime Maximum | |||
| Unlimited | |||
| Office Visit | |||
| Primary Care Physician (PCP) | GW - 90% Retiree - 10% |
After deductible: GW - 80% Retiree - 20% |
After deductible: GW - 60% Retiree - 40% |
| Specialist | GW - 90% Retiree - 10% |
After deductible: GW - 80% Retiree - 20% |
After deductible: GW - 60% Retiree - 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 will continue to be GW's preferred vendors for lab work. | |||
| Preferred | Non-Preferred | ||
| Diagnostic Test (x-ray, blood work) |
After deductible: GW - 80% Retiree - 20% |
After deductible: GW - 60% Retiree - 40% |
|
|
Imaging |
After deductible: GW - 80% Retiree - 20% |
After deductible: GW - 60% Retiree - 40% |
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*The MFA tier applies to professional charges by MFA providers; MFA behavioral health providers continue to be out-of-network.
**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.
† 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)
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GW RETIREE HEALTH SAVINGS PLAN (HSP) |
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| In-Network | Out-Of-Network | |
| Hospital Care | ||
| Inpatient |
After deductible: |
After deductible: GW - 60% Retiree - 40% |
| Outpatient | After deductible: GW - 80% Retiree - 20% |
After deductible: GW - 60% Retiree - 40% |
| Urgent Care | After deductible: GW - 80% Retiree - 20% |
After deductible: GW - 60% Retiree - 40% |
| Emergency Room | After deductible: GW - 80% Retiree - 20% |
After deductible: GW - 80% Retiree - 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% Retiree - 40% |
| Prostate Exam* | GW covers 100% if part of wellness exam | After deductible: GW - 60% Retiree - 40% |
| Well Child and Well Adult Exams* | GW covers 100% | After deductible: GW - 60% Retiree - 40% |
| Applied Behavior Analysis (ABA) | ||
| Covered | Covered | |
| Chiropractic Care | ||
| After deductible: GW - 80% Retiree - 20% up to 60 visits per year (combined in-and out-of-network) |
After deductible: GW - 60% Retiree - 40% up to 60 visits per year (combined in-and out-of-network) |
|
| Acupuncture | ||
| After deductible: GW - 80% Retiree - 20% up to 20 visits per year (combined in-and out-of-network) |
After deductible: GW - 60% Retiree - 40% up to 20 visits per year (combined in-and out-of-network) |
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* 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.
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GW RETIREE HEALTH SAVINGS PLAN (HSP) |
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| In-Network | Out-Of-Network | |
| Vision | ||
|
After deductible: |
After deductible: GW - 60% Retiree - 40% |
|
| Durable Medical Equipment (DME) | ||
| After deductible: GW - 80% Retiree - 20% |
After deductible: GW - 60% Retiree - 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% Retiree - 20% |
After deductible: GW - 60% Retiree - 40% |
| Brand Formulary | After deductible: GW - 80% Retiree - 20% |
After deductible: GW - 60% Retiree - 40% |
| Brand Non-Formulary | After deductible: GW - 80% Retiree - 20% |
After deductible: GW - 60% Retiree - 40% |
| Mail-Order Prescription Drugs | ||
| Generic Vacation Exception Additional 30-day supply one time per year |
After deductible: GW - 80% Retiree - 20% |
After deductible: GW - 60% Retiree - 40% |
| Brand Formulary Vacation Exception Additional 30-day supply one time per year |
After deductible: GW - 80% Retiree - 20% |
After deductible: GW - 60% Retiree - 40% |
| Brand Non-Formulary | After deductible: GW - 80% Retiree - 20% |
After deductible: GW - 60% Retiree - 40% |
To review 2024 contribution rates for retiree medical coverage, please visit go.gwu.edu/2024OE.