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Human Resource Management & Development

 

Medical Benefits

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. 

Mental Health

Your emotional well-being is critical to your overall health and well-being. Employees enrolled in a GW medical plan have access to a variety of Aetna behavioral health resources. For more information on how you can access mental health support, visit our Behavioral Benefits webpage.

Aetna One Choice Program -

Ongoing nurse support when you need it most

Your health, both physical and mental, is everything. Whether you’re managing an acute issue or dealing with other complex health challenges, Aetna's nurses can help. A nurse can work with you to put together a plan, help you understand your benefits offerings and answer your health-related questions.

  • One-on-one personalized nurse support: Aetna's clinical nurses can collaborate with service teams to help you achieve your health goals. Aetna nurses are supported with a multidisciplinary team, including a dietitian, pharmacist and transgender and gender-diverse advocate.
  • Local support: With CVS® and MinuteClinic® locations inside select CVS Pharmacy® and Target® stores, you have a broad range of services to keep you and your family healthy.
  • Tools, tips and support centers: Through your Aetna® member website, you’ll be able to locate a doctor, review your personal health record and watch informational health videos. And for specific health needs, you can explore member resources like the Cancer Support Center, Maternity Support Center, Back and Joint Care Support Center and Transgender and Gender-Diverse Support Center.

Access to information — whenever, wherever:

Always on the go? No problem. Your member website is fully mobile. Remember, this is your one-stop shop for getting the help you need. And when you download the Aetna Health℠ app, you can access it all from the palm of your hand. Get started with these resources today. Go to Aetna.com to log in to your member website. You can also call 833-691-1071 (Monday through Friday between 8:00am and 4:30pm EST).

GW Medical Plans are administered by Aetna:

GW PPO Medical Plan

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 Aetna 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.

PPO Resources:

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.
GW HSP Medical 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.

HSP Resources

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 Aetna’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 Aetna.com, you’ll be able to access tools that help you estimate what a treatment or procedure typically costs. Log in to www.aetna.com > Find Care & Pricing. 

You can also purchase additional Vision coverage through UHC Vision Buy-Up Plan.

Virtual Visits

With 24/7 Virtual Visits, employees can conveniently connect to a doctor by phone or video through www.aetna.com or the Aetna Health app. 24/7 Virtual Visits are fully integrated with your medical plan administered by Aetna. 

Virtual Visits through Aetna 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:

  • Under the GW PPO plan, virtual visits scheduled with Aetna designated providers (CVS Health Virtual Care) will have a $10 copay.
  • Under the GW HSP plan, virtual visits scheduled with Aetna designated providers (CVS Health Virtual Care) will be subject to 20% coinsurance after the deductible is met.
  • 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.
Health Advocate

Health Advocate is the nation’s leading independent healthcare advocacy and assistance company. 

This service is a GW benefit that eligible faculty and staff can use to:

  • 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. 
Locate Preferred Labs

Aetna's Preferred Labs are LabCorp and Quest Diagnostics. 

You can find a location closest to you by visiting Aetna's website.

Tools to help you make decisions about your medical coverage:

  • A Plan comparison chart to review both plan designs.
  • You may check the Aetna cost estimator tool at aetna.com (Navigate to Individuals and Families/Using your Aetna benefits/Manage your health care costs).)
  • Visit Aetna's website to find their Preferred Labs and LabCorp and Quest Diagnostics.
  • Aetna Concierge 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.