Benefits-eligible employees have the option to choose between two medical plans: the Health Savings Medical Plan (HSP) and the PPO Medical Plan.
GW Medical Faculty Associates Benefit Coverage Tier
Effective January 1, 2021, GW has added a new benefit coverage tier within their medical plans specific to care provided by GW Medical Faculty Associates (MFA) providers. The new tier provides lower copayments and lower employee coinsurance for GW medical plan participants when they are seen by a GW MFA provider.
- 202-677-6000 offers GW medical plan participants a dedicated phone line for easy access to MFA Patient Care Coordinators to gain assistance with scheduling appointments. Telehealth visits are available with all MFA providers. (This phone number is effective 12/28/20).
GW Medical Plans are administered by UnitedHealthcare:
The GW PPO Plan is designed to give you freedom and flexibility. You have the ability to visit your doctor of choice. When using a participating provider, you receive greater benefits, while coverage is also available for doctors and facilities that do not participate in the UHC network.
There’s no requirement to select a Primary Care Physician or to obtain referrals for specialty care; you simply select your health care provider of choice and benefits will be determined based on the status of the provider selected.
Please remember that services received with a participating provider are covered in full after a $30 copayment (or $50 copayment for a specialist). Most out-of-network services are covered at 60% of allowable charges after deductible.
- Summary of Benefits and Coverage (SBC) (PDF): What the GW PPO Plan covers and costs
- GW PPO Summary Plan Description (SPD) (PDF): An extensive description of the Health Benefits available to you and your covered family members, including summaries of who is eligible, services that are covered, exclusions, how Benefits are paid, and your rights and responsibilities under the Plan.
- SMM for GW PPO SPD
In addition to comprehensive benefits, this plan offers:
- In-network Fertility benefits
- Hair prosthetic, up to $350 per year
- Hearing aids and testing for adults and children
- Low in-network deductibles - $750 per individual, $1500 per family
- Small copayments for PCP and specialty care ($30/$50)
- The freedom to use non-network provides, routine eye exams are covered once every 24 months with an applicable copay (typically a Specialist Office Co-Pay). Discounts on hardware/frames/contacts are available at participating eye centers. You are subject to the annual deductible and coinsurance if you go out-of-network in the GW PPO. You can also purchase additional Vision coverage through UHC Vision Buy-Up Plan.
The GW HSP Medical Plan is designed to put you in the driver's seat when paying for healthcare costs and save for your future.
The GW HSP is a lower-premium, high deductible health insurance plan, which means you pay less out of your paycheck for premiums and more out-of-pocket at the point of care—before the plan pays for services that are not considered preventive.
- Summary of Benefits and Coverage (PDF): What the GW-HSP covers and costs
- GW HSP Summary Plan Description (PDF): An extensive description of the Health Benefits available to you and your covered family members, including summaries of who is eligible, services that are covered, exclusions, how benefits are paid, and your rights and responsibilities under the Plan.
- Preventive Drug List for HSP Plan
- SMM for GW HSP SPD (PDF)
The GW-HSP covers in and out-network services.
- There is no need to select a Primary Care Physician or to obtain a referral. It’s as simple as visiting a practitioner from UHC’s national network – your coverage spans from coast to coast. You are not responsible for handling paperwork, including claims and pre-notifications for services rendered within the network.
- In addition to comprehensive benefits, this plan offers:
- Option to elect a health savings account (HSA). Visit our HSA page for additional information.
- How to use the HSP with the HSA (PDF).
- No PCP, Specialist and hospital copayments.
- Most preventive drugs are covered at 100%. View the HSP Preventive Drug List (PDF).
All medical (excluding in-network child and adult wellness exams and preventive care) and prescription drug services will apply to the deductible. When the deductible is met, services are then covered by co-insurance until the out of pocket maximum is reached.
Here are a few more HSP tips:
- You are responsible for paying for the cost of care up to the deductible.
- This plan does not have copays for medical or prescription services.
- Once the deductible is satisfied, you will pay your portion of coinsurance until the out of pocket maximum has been reached.
- If you have elected coverage for yourself and one or more dependents, a ‘true’ family deductible and out of pocket maximum applies. This means that one or some family members must meet the deductible before coinsurance is initiated.
You can also purchase additional Vision coverage through UHC Vision Buy-Up Plan.
See a doctor from the convenience of your computer or mobile device with UHC's Virtual Visits (PDF). Virtual Visits are available to members 24/7 - no appointment necessary. During your visit, the doctor can give you a diagnosis and prescription, if needed. The costs of Virtual Visits are below:
- GW PPO - $10 copay (deductible does not apply)
- GW HSP - 20% coinsurance (after deductible)
- Due to the pandemic GW is temporarily waiving costs for medical Virtual Visits for employees covered on the GW PPO and GW HSP Medical Plans through September 30, 2020.
The Virtual Visits must be provided by the following UnitedHealthcare vendors in order to be covered at 100%: Teladoc, AmWell, and Doctor on Demand. Costs will be covered for all appointment types (e.g., sore throats, allergies, seasonal flu) and suspected or confirmed COVID-19 cases.
Please note: Virtual appointments provided by your primary care physician that are non-COVID related are still subject to the applicable copay or deductible/coinsurance rates.
- Castlight is a free tool for GW faculty and staff, and their dependents, covered on a university medical plan through UnitedHealthcare. The app helps you locate doctors, see a breakdown in coverage and costs, and view updated balances, such as your FSA or HSA.
Health Advocate is the nation’s leading independent healthcare advocacy and assistance company.
As a special benefit paid for by GW, the service can help you:
- Personally resolve your healthcare and insurance issues, promptly and reliably.
- Help evaluate which medical plan is the best fit for you and your family
- Provide clinical advocacy (PDF):
- Clarify diagnoses
- Arrange expert second-opinions
- Coordinate care and services after a hospital stay
- Health Advocate calls are unlimited and is available 24/7. Contact Health Advocate at (866) 695-8622 or visit healthadvocate.com/gwu.
Tools to help you make decisions about your medical coverage:
A Plan comparison chart (PDF) to review both plan designs.
The UHC health cost comparison worksheet (PDF) to help you compare your coverage options and estimate your potential costs
You may also check the UHC cost estimator tool to compare our plans' coverage at myuhc.com (under "Links and Tools")
Visit UnitedHealthcare to find their Preferred Labs and LabCorp and Quest Diagnostics.
Learn how you can save money by using freestanding facilities (PDF).
Advocate4Me from UnitedHealthcare for personalized answers about your benefits and claims.
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