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
GW offers a GW Medical Faculty Associates (MFA) benefit coverage tier within their medical plans for MFA. The new tier provides lower copayments and lower employee coinsurance for GW medical plan participants. The tier applies to professional charges by MFA providers; MFA behavioral health providers continue to be out-of-network.
- MFA Patient Care Coordinators are available to assist GW medical plan participants for appointments by calling 202-677-6000. Telehealth visits are available with all MFA providers.
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.
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 providers, routine eye exams are covered once every 24 months with an applicable copay (typically a Specialist Office Co-Pay). 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.
- No PCP, Specialist and hospital copayments.
- 100% of certain preventative care is covered by the HSP when you use a network doctor.
- 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.
- At myuhc.com®, you’ll be able to access tools that help you estimate what a treatment or procedure typically costs. Log in to www.myuhc.com > Find Care & Costs > Estimate Cost.
You can also purchase additional Vision coverage through UHC Vision Buy-Up Plan.
With 24/7 Virtual Visits, employees can conveniently connect to a doctor by phone or video through myuhc.com or the UnitedHealthcare app. 24/7 Virtual Visits are fully integrated with your medical plan administered by UnitedHealthcare.
Virtual Visits through UnitedHealthcare may treat many of the same conditions as in-person urgent care, so it may be a good alternative option for you—particularly in times when their primary care provider isn’t available. No appointments are necessary.
The costs of Virtual Visits are below:
GW PPO - $10 copay (deductible does not apply)
GW HSP - 20% coinsurance (after deductible)
The Virtual Visits must be provided by the following UnitedHealthcare vendors in order to be covered at 100%.
Optum Virtual Care will continue to be UnitedHealthcare's promoted provider on myuhc.com. You can also access Teladoc, Doctor On Demand, AmWell, and Walmart Health Virtual Care on myuhc.com in the FAQ section on the Virtual Care page, as well as below the 'Connect to care' button. Find instructions on how to access the additional virtual visit providers in the FAQ section on myuhc.com under related links for additional information.
Review the 24/7 Virtual Visits internal FAQ under related links for additional information.
Telemedicine visits scheduled with your primary physician or specialist are subject to the applicable co-pay under the GW PPO plan and deductible/co-insurance under the GW HSP plan.
- 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.
*In order to comply with the Transparency in Coverage Final Rule, we are providing machine readable files containing the following sets of costs for items and services: (i) In-Network Rate File: rates for all covered items and services between the plan or issuer and in-network providers, (ii) Allowed Amount File: allowed amounts for, and billed charges from, out-of-network providers. Congress and federal agencies intended these “machine readable files” to be used by researchers, regulators, lawmakers, patient and consumer advocates, etc., in order to develop tools and information to support consumer choice. Note: Ctrl+F to search for “The-George-Washington-University” Plans.
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