Guide 2021 Open Enrollment - u r - GW HR
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Open
Enrollment
Guide 2021
For Staff & Faculty
ts . You r Choice. Your
e n ef Well
bei
rB
You ng.
Contents
Plan Compare
4 "Your Choice" Approach to Benefts 31 Comparing the Medical Plans
5 Start Planning 34 Prescription Drug Benefts
6 Tools to Build a Life of Wellbeing 36 Choosing a Medical Plan
Learn
38 Finding High Quality and
Affordable Doctors
9 What is Open Enrollment? 40 Vision Coverage Options
10 What’s Staying the Same for 2021 42 Dental Coverage Options
12 What’s New and What’s Changing 44 Life and Accidental Death and Dismemberment
for 2021 (AD&D) Insurance
14 Voluntary Benefts 45 Disability Insurance Options
16 Plan Features and Glossary 47 Contribution Rates
18 How to Utilize Your Care 55 Dental and Vision Coverage Rates
20 GW Health Savings Plan (HSP) 56 Life and AD&D Rates
21 GW Health Savings Account (HSA) 57 Long-Term and Short-Term
Disability Rates
22 GW HSA Matching Contribution
23 GW Flexible Spending Accounts (FSAs) Decide
24 10 Healthy Habits of a Good 58 Using the EasyEnroll System
Healthcare Consumer
60 Contact Information
Explore
27 Explore Open Enrollment Information
28 Open Enrollment Virtual Events
28 Flu Shots
2 | Table of Contents
Start Planning
Start Planning | 3 Page Info Name | 3
“Your Choice”
Approach to Benefts
The 2021 Open Enrollment period will take place from October 5, 2020, through
October 23, 2020.
GW values the time and talent you invest at the university, and we also recognize the
importance of providing a variety of plans and programs to allow you to choose the
benefts that are right for you.
During Open Enrollment you have the opportunity to choose among a variety of benefts
plansand programs. Your choices help build security and support your family’s health and
fnancial goals. Please take some time to review the information about enhancements and
changes to our current benefts programs for the 2021 Open Enrollment season provided
in this Guide.
4 | "'Your Choice' Approach to Benefts
Start Planning
WHAT Open Enrollment is your annual opportunity to make health and welfare
benefts changes and to add or drop coverage for eligible dependents.
Be sure to bookmark the Annual Open Enrollment webpage,
go.gwu.edu/2021OE - your destination for all Open Enrollment-
related information!
WHO Full- and part-time faculty and staff in benefts-eligible positions and
their eligible dependents.
WHEN Monday, October 5, 2020, until Friday, October 23, 2020 at 8 p.m. (ET)
(3 weeks only!).
WHY Even if you are happy with your elections from last year, it’s always a
good practice to review and confrm that you’ve signed up for the right
plan for you and your family. If you choose not to take action, your
existing coverage options will roll over into the next year,* with the
exception of the fexible spending accounts (FSAs).
Please note: Health Care FSA and Dependent Day Care FSA options
do not roll over and require you to re-enroll.
Take some time to review your options; otherwise, you cannot make
changes until the next Open Enrollment period unless you experience
a Qualifed Life Event (QLE), such as a change in marital status, the
birth or adoption of a child, etc.
* The cost of coverage will refect 2021 contribution amounts.
Start Planning | 5
Tools To Help Create a Life of
Wellbeing
As a GW employee, you have access to a number of different resources and tools that make it easier to get on - and stay on - the path
towards improved well-being - physical, fnancial, emotional and social.
Physical Financial
• Castlight is a free service for GW employees and their spouses/ • Fidelity and TIAA offer monthly educational programs to support
domestic partners and adult dependents covered under a your fnancial wellbeing journey. Boost your fnancial IQ with free
university health plan. Find a high-quality doctor for an affordable webinars (both live and recorded) and other resources on topics
price before you make an appointment from the convenience of such as Budgeting, College Planning, Family Finances, Retirement
your phone or computer! Compare nearby physicians, facilities Planning, Social Secuirity and many more. Visit the Fidelity and
prescriptions, and review past medical and pharmacy spending. TIAA websites to register today.
Current GW medical plan participants: If you haven't already,
• Meet with retirement consultants from Fidelity and TIAA to learn
register for Castlight at mycastlight.com/GW during October for
more about your GW retirement plans. Get assistance with
a chance to win a Fitbit Charge 3*.
enrollment, account balances and savings plans. Learn more by
• Skip the waiting room with UnitedHealthcare's Virtual Visits. visiting.
Gain convenient access to a doctor from a mobile device or
• Bike and save! Benefts-eligible faculty and staff are eligible for
computer - no appointment needed! During a Virtual Visit, a
a discount on Capital Bikeshare, metro DC's bikeshare service.
doctor can diagnose and treat a wide range of non-emergency
Enjoy an annual membership of only $25 (regular price: $85) for
conditions as well as write prescriptions (if needed), which you
less than 50 cents a week.
may subsequently pick up at your local pharmacy.
• Take advantage of exclusive GW discounts and save. Visit the
• Time for a check-up! GW employees covered by a university
HR Wellbeing and Discounts page for a comprehensive list
medical plan can continue to receive preventive services at no
of wellness programs, resources and discounts available to GW
cost—just be sure to go in-network.
employees and their families.
* Value of winnings is taxable and will be included in employee's taxable wages. Learn more
about Castlight by visiting hr.gwu.edu/castlight.
• Visits the Voluntary Benefts section on page 14 of this Guide to
learn more about group rates on items such as pet insurance and
identity theft protection.
6 | Tools to Build a Life of Wellbeing
Social Emotional
• Get active! GW Campus Rec is providing free group exercise • The Wellbeing Hotline provides confdential assistance when
classes on Zoom through December 6, 2020. Try classes such as planning for life events, such as expanding a family. Receive
HIIT, yoga or Zumba®. personal counseling from highly trained clinicians and let work-
life specialists fnd solutions such as childcare searches. Call
• Employees are eligible for discounted gym memberships
toll free: (866) 522-8509 or log in to my.gwu.edu and select
at Lerner Health and Wellness Center as well as The Fitness
Wellbeing Hotline under the Working tab.
Equation at One Loudoun. Due to COVID, gyms may be closed
and/or operating under a limited schedule. • Headspace, the mindfulness app, is available at no cost to
benefts-eligible faculty and staff. The app offers meditation,
• Join a free lunch-n-learn GWell Webinar this fall. Hosted by the
sleep, exercises and kids programs. Join Headspace in October
Wellbeing Hotline, employees can gain tips on topics such as
and be entered into a FitBit raffe. Value of winnings is taxable
resilience, avoiding burnout and nutrition basics.
and will be included in employee’s payroll.
• Your behavioral health beneft through UnitedHealthcare includes
Virtual Visits. They provide quick and easy access to behavioral
health professionals from your mobile device, tablet or computer
in the comfort of home. Costs and coverage may vary.
Tools to Build a Life of WellbeingLearn
8 | Learn
Page Info NameWhat is Open Enrollment? What’s Included?
Open Enrollment is your annual The benefts below are part of Open Enrollment, which runs October 5–23, 2020, and can
opportunity to refect on you and your only be changed during this period unless you experience a Qualifed Life Event (QLE):
family’s needs and fne-tune your benefts
package to match. Many life events Beneft What you’ll have in 2021 if you don’t act
can occur over the course of the year during Open Enrollment:
that can impact the types of plans and
amount of coverage you need. Take this No money will be deposited into your Health
opportunity to think about the changes Care or Dependent Day Care fexible
Flexible Spending Accounts
spending accounts (you must re-enroll every
you and your family have experienced in
year).
the past year, or anticipate in the coming
year. Then, determine which beneft plans
Your 2020 annual election will roll over
and programs will best meet your needs
into 2021. For example, if you elected to
and make your selections online using Health Savings Account
contribute $1,000 for 2020, you would have
EasyEnroll: go.gwu.edu/openenrollment. an automatic election of $1,000 for 2021.
While the following benefts are not part
Medical and Prescription
of Open Enrollment, we encourage you to
review them during this time:
Vision
• 403(b) Retirement Plan The same plan you have now.
Dental
• Tuition Remission
• Parking Legal
Don’t miss out on taking advantage of
Voluntary Short-Term Disability
these valuable programs! For details, visit
hr.gwu.edu/benefts.
Long-Term Disability Buy-Up
The same plan you have now.
Life Insurance
Accidental Death and Dismemberment
These benefts are part of Open Enrollment, and can only be changed once per year
unless you have a qualifed life event.
What is Open Enrollment? | 9Castlight
Maximize the use of your medical plan and spending with Castlight,
which will continue to be a free service for GW employees, spouses
and adult dependents covered under a GW health plan. Search for
doctors, prescriptions, hospitals and medical services and compare
them by cost and quality. Understand what’s covered under your
plan and monitor where you are in reaching your deductible. See
current balances for your Health Care FSA or HSA. You can access
Castlight online and through the mobile app.
GW medical plan participants: If you haven’t already, register for
Castlight during the month of October for a chance to win a Fitbit
Charge 3.* Register now at mycastlight.com/gw.
* Value of winnings is taxable and will be included in employee’s taxable
What’s
wages.
CVS Transform Diabetes Care with Livongo
GW will continue to offer CVS Health’s Transform Diabetes Care
Staying the with Livongo as part of its pharmacy beneft. The total condition
level management program is designed to improve health
outcomes and lower participant pharmacy costs through highly
Same for personalized support and coaching, two comprehensive diabetes
visits at MinuteClinic locations at no out-of-pocket cost (including
A1C checks) and access to digital tools to reduce the complexity
2021 of daily disease management. To enroll, visit livongo.com using
registration code "GW."
NOTE Diabetic medications and supplies must be flled
through CVS Retail or CVS Mail Order.
Vision
GW’s Basic and Enhanced vision plans through UHC will remain
the same, with no changes in plan coverage or employee
contributions. See page 40 for details.
Disability Insurance
Lincoln Financial will continue to be GW's disability insurance
provider. There will be no changes to plan coverage, eligibility, or
buy-up options. See page 45 for details.
Information on enhancements to the waiting period for the
Voluntary Short-Term Disability Beneft is available on page 13.
Legal
GW’s group legal program will continue to be offered through
Legal Resources at the monthly rate of $19. See page 15 for details.
10 | What's Staying the Same for 2021Pet Insurance
Freestanding Imaging and Labs Preferred
Pet Insurance will continue to be offered as a voluntary beneft
through Nationwide®. There will be no changes to the voluntary
Network
beneft plan. See page 14 for details. A freestanding network facility performs outpatient services and
submits claims separately from any hospital affliation, and may be
Identity Theft Protection
a lower cost option. GW will continue to offer a preferred network,*
Allstate Identity Protection (formerly known as InfoArmor) will including a lower coinsurance, for usage of freestanding facilities in
continue to offer a group rate to GW faculty and staff for identity lieu of hospitals for lab tests, radiology services, major diagnostics
protection services. There will be no changes to the voluntary and other services. LabCorp and Quest Diagnostics are GW’s
beneft plan. See page 15 for details. preferred vendors for lab work. The cost for visiting a GW-
Real Appeal preferred network facility will remain the same for 2021:
Real Appeal is a virtual weight loss support program offered • GW HSP: 20 percent coinsurance after deductible
through both the GW HSP and GW PPO. (You must be a UHC plan
• GW PPO: 20 percent coinsurance after deductible
participant to join.) Beginning October 1, the program will support
members with a body mass index (BMI) of 19 or more - at no cost. When searching for an outpatient center or laboratory on
Weekly online coaching sessions and tools, such as a Program myuhc.com or Castlight, choose a facility that is marked as
Success Guide, Nutrition Guide, ftness DVDs and resistance bands, “Freestanding Facility” to help reduce your out-of-pocket costs.
are included.
* In-network freestanding facilities and GW Hospital.
If you are currently enrolled in a UnitedHealthcare medical
plan through GW, you may enroll at any time after meeting BMI UHC Virtual Visits
eligibility requirements. If you are newly electing UnitedHealthcare Virtual Visits will remain a health plan feature for 2021, allowing
for 2021 Open Enrollment, you may enroll beginning January 1, UHC members to connect with a doctor via mobile device or
2021. Visit gwu.realappeal.com for more information. computer—24/7, no appointment needed. Get timely care,
including diagnosis and prescription, and pay less out-of-pocket.
Group Home and Auto
GW employees may continue to take advantage of Group Home There will be no increase to the cost of Virtual Visits for 2021:
and Auto discounts, through Liberty Mutual. Participants can save • GW HSP: 20 percent coinsurance after deductible
up to $782 on auto and home, renters and condo insurance.*
• GW PPO: $10 copay (deductible does not apply)
For details, call (800) 298-8947 or visit
TIP
libertymutual.com/gw-university (mention Client ID# 135234).
Telemental Health is available through your UHC medical beneft.
The service uses secure, video-calling technology to provide
real-time access to a behavioral health professional, and features
a network of over 10,000 providers in all 50 states. Learn more or
schedule a visit at myuhc.com.
What's Staying the Same for 2021 | 11What's New What's
Changing 2021
CHANGE
ENHANCEMENT
Medical Contribution Rates
New! Benefit Coverage Tier for Medical Faculty
The university made an additional investment in the medical
Associates (MFA) Provider Services
plan subsidy for 2021 to offset the total plan costs. As a result,
participating full-time faculty and staff will experience a nominal Beginning in 2021, a new benefit coverage tier for the GW PPO
increase of 1.5 percent in their contributions across all salary bands and HSP medical plans will provide lower copayments and lower
and plans*. employee coinsurance for plan participants who utilize MFA
providers*:
Approximately 75 percent of full-time faculty and staff medical
• Tier 1: New! MFA providers*
plan participants will see an average increase of less than $5 per
month, across all salary bands and plans. The monthly employee • Tier 2 (no change): UHC in-network (other than MFA
providers)
contribution increase will range from less than $1 to about $12,
depending on your plan, coverage level and salary band. • Tier 3 (no change): Out of network
• For example, a full-time benefits-eligible employee with a salary When you choose to receive care from an MFA provider, your
between $50k and $90k who enrolls in the GW PPO or HSP for medical expense dollars will go further because a greater portion
individual coverage will see an increase of under $2 per month of your care will be covered by the Plan. Please review the
for 2021. abbreviated medical plan comparison chart for details.
• On the other hand, an employee enrolled in the GW HSP with The MFA benefit coverage tier is not limited to office visits. For
family coverage, will see an increase of about $4 per month. example, a PPO plan participant who sees an MFA cardiologist
Participants in the GW PPO with family coverage will see an for an office visit pays the lower copayment of $25. If the MFA
increase of about $9 per month. cardiologist performs surgery, the participant also pays the lower
coinsurance for the cardiologist’ professional services. (facility or
*Please note: There are no changes to the current salary bands and other charges are paid at the regular rate).
both the GW PPO and GW Health Savings Plan (HSP) will continue
*The MFA tier applies to professional charges by MFA providers, MFA behavioral
to be offered. UnitedHealthcare will continue to be the medical
health providers continue to be considered out-of-network.
benefits administrator for both plans. Details available on page 47.
CHANGE
Dental Contribution Overview
Dental contributions will increase 4.5 percent across all three dental
plan options for each tier. The monthly contribution increase will
depend on the plan and coverage level you elect:
• High PPO participants will see increases ranging from just
over $2 to about $6 per month.
• Low PPO participants will see increases ranging from just
over $1 to about $3.50 per month.
• DMO participants will see increases ranging from about $1 to
just under $2 per month.
For example an employee enrolled in the Low PPO dental plan with
“employee +1” coverage will see an increase of less than $3 per
month.
12 | What's New and What's Changing for 2021ENHANCEMENT
Voluntary Short-Term Disability Waiting Period GI Amounts for Optional Life Insurance (Cont.)
Decreased During Open Enrollment, employees who have optional employee
The waiting period for voluntary short-term disability benefits is life insurance coverage below $250K, or are not yet enrolled, can elect
being decreased from 30 days to 14 days, shortening the amount up to an additional $250K of coverage without EOI*. Employees with
of time an employee waits to receive paid benefits by two weeks. $250K or more in optional employee life insurance can increase their
There will be no impact on the cost of voluntary short-term coverage up to the new GI of $500K without EOI. Here are a couple of
disability coverage. examples:
• If you are currently enrolled with $100K, you can elect up to
CHANGE
$350K without EOI.
IRS Account Based Plan Limit Updates • If you are currently enrolled with $350K, you can elect up to
Flexible Spending Accounts (FSAs) $500K without EOI.
The FSA contribution limit
*Anyone previously declined for coverage on the basis of EOI must submit EOI for any increase.
• The annual maximum for the Health Care FSA will increase by
$50, from $2,700 to $2,750. ENHANCEMENT
• The annual maximum for the Dependent Day Care FSA will Increased Optional Life/AD&D Maximums
remain the same at $5,000 (or $2,500 if you and your spouse
In addition to the basic life and AD&D coverage provided by GW, you
file separate tax returns).
can purchase optional coverage under GW’s group policy through
Health Savings Account (HSA) Lincoln Financial. For 2021, the maximum amounts available for
The HSA contribution limit (combined employee + GW optional life and AD&D insurance will be increasing as noted below.
contribution) You will now have the option to purchase:
• For those with individual Health Savings Plan (HSP) coverage, • Optional life and AD&D insurance coverage for yourself in
the annual maximum for the HSA will increase by $50, from increments of $10,000, up to a maximum of $1,000,000.
$3,550 to $3,600.
• Optional life and AD&D insurance coverage for your spouse or
• For those with family HSP coverage, the annual maximum for domestic partner in increments of $5,000, up to a maximum of
the HSA will increase by $100, from $7,100 to $7,200. $500,000 or 50% of your coverage (whichever is less).
• GW's HSA matching contribution will continue. GW will match • Optional life for your dependent children up to age 26 in
up to $600 for individuals who contribute at least $600, and increments of $2,000, up to a maximum of $20,000 or 50% of
up to $1,200 for those covering dependents who contribute your coverage (whichever is less).
at least $1,200.
ENHANCEMENT NOTE If you are newly electing or changing your election,
Evidence of Insurability (EOI) provisions may apply. Visit hr.gwu.edu/
Guaranteed Issue Amounts for Optional Life benefits for details.
Insurance
Guaranteed issue (GI) is the amount of life insurance available to an
employee without having to provide Evidence of Insurability (EOI).
• In 2021, the optional employee life insurance GI amount for
eligible employees is increasing from $250,000 to $500,000
• The GI amount for optional spouse life insurance is increasing
from $30,000 to $50,000.
What's New and What's Changing for 2021 13Pet Insurance
Voluntary GW faculty and staff can continue to enroll in the My Pet Protection
plans from Nationwide®, a voluntary beneft offering. The plan
provides best-in-show coverage for vet bills, with 90 percent
Benefts reimbursement for accidents, illnesses and much more.
My Pet Protection and My Pet Protection with Wellness will
reimburse a straightforward 90 percent of your vet bill instead of
using a beneft schedule. A $250 annual deductible and $7,500
maximum annual beneft apply to both plans. Pet insurance will
continue to be offered as a voluntary beneft through Nationwide®.
You may enroll in or cancel pet insurance at any time during the
year. Coverage will begin 14 days after enrollment. Payments for
this voluntary program are made directly to Nationwide. Get a
fast, no-obligation quote today at petinsurance.com/gw. Or, by
calling (877) 738-7874 and mentioning the George Washington
University.
14 | Voluntary BeneftsID Theft protection
GW will continue to offer identity protection as part of its voluntary
benefit offerings. InfoArmor is rebranding to Allstate Identity NOTE
Protection on January 1, 2021, without any changes to your Legal Resources®
benefit program. Allstate Identity Protection delivers a powerful
new approach to online privacy with unique tools and proactive • Legal Resources® will choose a law
monitoring that help you see your personal data, manage it with frm from the Legal Resources®
real time alerts, and protect your identity. Monitor your financial network closest to your home zip code.
transactions, social media, and more. If fraud occurs, in-house This exclusive network is made up of
experts fully manage restoring your identity. highly qualifed law frms. Once your
plan becomes effective, you may then
You may enroll in or cancel identity protection at any time during call your law frm directly with your
the year. Coverage begins immediately after enrollment. legal need. If you would like to change
Payments for this voluntary program are made directly to Allstate. your law frm, call (800) 728-5768.
Visit myaip.com/gw to enroll.
• You may not cancel your membership
in the plan until you have participated
for at least 12 months.
Legal Resources Plan
The Group Legal program, provided by Legal Resources® Plan, is For coverage details, please visit
designed to give you access to professional attorneys and provide hr.gwu.edu/benefts.
protection against high legal fees.
You pay for coverage under this plan with after-tax contributions
that you make through payroll contributions.
If you enroll in this beneft, you, your spouse/domestic partner and
your qualifying dependent children will have access to a broad
range of legal services covered under the monthly fee.
Any legal matter not fully covered will be at a 25 percent
attorney fee discount, with one hour of free consultation. For
more information and to identify network providers on the Legal
Resources® Plan, visit legalresources.com.
Voluntary Benefts | 15Total Out-of-Pocket Costs
Here’s a simple equation that shows how much you’ll pay out-of-
pocket for your health insurance each year.
Premiums Once you meet
your plan's Out-of-
+ Deductible Pocket Maximum,
the plan pays
+ Copays & Coinsurance 100% of your
covered medical
___________________
(up to the Out-of-Pocket Maximum)
expenses for the
balance of the year.
Total Employee Costs
Premiums: The amount you pay for your health insurance every
month.
Plan
Deductible: The amount you pay out-of-pocket for healthcare
before plan starts to pay. (Please note, the deductible is not
applicable to all services. Please see page 31.) Separate in-and-out
of network deductibles apply.
Features Copays: A set amount (for example, $30) you pay for a covered
healthcare service.
Coinsurance: The percentage you pay for the cost of covered
healthcare services, after you meet your deductible.
Benefts have a language all their
own. Understanding how your Out-of-Pocket Maximum: This is a “cap” on your costs for the year;
insurance plans work is crucial it is the most you’ll pay for healthcare services. Once you reach your
out-of-pocket maximum, the plan pays 100 percent of your covered
to making the most out of your medical expenses for the balance of the year. Separate in- and out-
coverage. Become familiar with of-network out-of-pocket maximums apply.
these commonly-used benefts
terms to help you compare and Deductibles
choose plans. Understanding Your Deductibles
Your deductible is tied to your premium. Just like car insurance, a
plan with a low deductible will cost you a higher premium.
On the fip side, a health savings plan with a high deductible will
have a lower premium.
Low Deductible = Higher Premium
High Deductible = Lower Premium
Consider if you have enough money in your budget—or in savings—
to cover the deductible.
16 | Plan Features and GlossaryDeductibles (continued) NOTE The deductible for the GW PPO includes medical
Types of Deductibles expenses only.
Not all deductibles are created equal. Here are a few common
With other plans, one family member can meet the deductible for
types:
the entire family. For example, under the GW HSP, if you
Network Deductibles: GW’s health plans have separate annual elect coverage for yourself and one or more dependents, the full
family deductible (in-network family deductible is $4,000)
deductibles for when you get in-network care versus out-of-
will need to be met before coinsurance begins for any family
network care. These amounts are usually different for individuals
member.
and families.
NOTE The deductible for the GW HSP includes both medical
Family Deductibles: With some plans, you’ll need to meet the and pharmacy expenses.
deductible for each covered family member up to the family cap.
When you cover your family, review your family
For example, under the GW PPO, each person will need to meet deductible closely.
the in-network individual deductible of $750 (capped at $1,500 per
family). Once an individual meets the $750 deductible, coinsurance
begins for that person.
Other Terms to Know High Deductible Health Plan (HDHP): A plan with a higher
deductible than a traditional insurance plan. These plans typically
Benefts Salary: Sometimes referred to as a benefts eligible
have lower monthly premiums, but you must pay more out-of-
salary, the salary(ies) of your active benefts eligible primary and
pocket initially (your deductible for medical and pharmacy) before
secondary positions.
the plan starts to pay. An HDHP can be combined with a Health
Covered Services: Those services deemed by your plan to Savings Account (HSA), which allows you to pay for certain medical
be medically necessary for the care and treatment of an expenses with pretax dollars. (The GW HSP is an HDHP.)
injury or illness.
Network: A group of doctors, labs, hospitals and other providers
Formulary: Sometimes referred to as a preferred drug list, a list that your plan contracts with at a set payment rate.
of prescription medications that are covered by a pharmacy
Preventive Care: Preventive care services include those
plan. Drugs not on a formulary may not be available, may carry
that help you manage your health, such as routine physical exams,
a higher cost-share amount or may be accessible only with prior
screenings and lab tests. These services are covered at 100 percent
authorization.
by the GW health plans, with no out-of-pocket costs (such as
Generic: An FDA-approved drug, composed of virtually the same deductibles or copays) if the services are received in-network. Be
chemical formula as a brand-name drug. Ask for generics! Generic sure your provider codes the services as “preventive.”
medications contain the same active ingredients as brand-name
Preferred Provider Organization (PPO): A type of health plan that
drugs, but cost less. Talk to your doctor about switching to generics
contracts with medical providers, such as hospitals and doctors,
and making sure your medications are on your plan’s formulary.
to create a network of participating providers. You pay less if you
Specialty Drugs: Low-volume, high-cost medication prescribed for use providers that belong to the plan’s network. You may still use
chronic and complex illnesses such as multiple sclerosis, hepatitis doctors, hospitals and providers outside of the network for an
C and hemophilia, as well as some common diseases such as additional cost.
rheumatoid arthritis. Specialty drugs often require special storage
and handling and are not readily available at the typical local retail
pharmacy.
Going Digital for Health!
Take the mystery out of your healthcare with Castlight, a one-stop-shop platform for GW medical plan participants to compare
prices on medical services and prescription drug options and read reviews for doctors. Castlight's cost generator provides
estimates based on your location and health plan information, and its step-by-step explanations of past medical and pharmacy
spending help you keep track of your healthcare expenses. Register now at mycastlight.com/GW, or learn more at
hr.gwu.edu/castlight.
Plan Features and Glossary | 17How to Utilize Your Care
How Prescription Coinsurance Works
Coinsurance is your share of the costs of a covered healthcare service, calculated as a percent (for example, 20 percent) of the total cost for
the service or prescription drug. GW pays the remainder of the cost.
There is fnancial protection built into the prescription drug beneft in that you will never pay more than the “maximum,” outlined in the
tables below. Once you reach the out-of-pocket maximum (OOPM), GW will pay 100 percent of prescription drug costs thereafter.
George is enrolled in the Martha is enrolled in the
GW PPO. He isn’t feeling well GW PPO and does not feel well.
so he goes to his Primary Care Martha goes to her Primary Care
Physician. He has bronchitis Physician and has bronchitis. Her
and his physician recommends physician writes her a prescription
a prescription antibiotic as for a preferred brand antibiotic with
treatment. George asks his a similar chemical formula to the
physician if he can prescribe antibiotic George received. She gets
a generic antibiotic. to the pharmacy and fnds out the
total antibiotic cost is $400.
George Martha
Generic Coinsurance 10% Preferred Brand Coinsurance 20%
Maximum $30 Maximum $50
Cost of Drug $160 Cost of Drug $400
George Pays $16 Martha Pays $50
GW Pays $144 GW Pays $350
For those on the GW HSP:
• You must pay all prescription drug costs until you meet Preventive medications are covered at 100 percent under the GW
HSP. Coinsurance and deductible do not apply.
your annual deductible. After you meet your annual deductible,
you will be responsible for 20 percent coinsurance until you NOTE Maintenance Choice provisions apply. After three
reach the out-of-pocket maximum. 30-day retail
flls, you will need to fll a 90-day prescription via CVS Retail or
NOTE Under the GW HSP, your pharmacy deductible is CVS Mail Order in order to continue receiving preventive
medication at no cost. Please see page 35 for details.
combined with your medical deductible.
REMEMBER You can use your HSA to pay for eligible
out-of-pocket costs, including your deductible and
prescription coinsurance.
18 | How to Utilize Your CareSave Money by Using Freestanding Facilities
Prices vary signifcantly for imaging and lab work – even if
you go in-network.
Not only do prices vary, but you will pay a lower coinsurance
when you use a freestanding network facility instead of a hospital
for healthcare services or treatments that do not require an
overnight hospital stay. A freestanding facility performs outpatient
services and submits claims separately from any hospital
affliation. GW offers a preferred network* for labs, X-ray and major
diagnostics. When you go to a preferred network freestanding
facility for these services, you will pay 20 percent coinsurance
under the GW PPO or GW HSP plans. If you go to a facility that is
not in the preferred network, you will pay 40 percent coinsurance
under the GW PPO or GW HSP plans. LabCorp and Quest
Diagnostics will continue to be GW's preferred vendors for lab
work.
When you do need outpatient lab tests and imaging, refer
to the checklist below of what to ask.
Visit go.gwu.edu/uhcfacility for instructions on how
to compare costs and locate a preferred provider for
networks and labs.
*In-network freestanding facilities and GW Hospital
Average costs of imaging and diagnostic services When using outpatient
for the GW PPO lab tests and imaging, ask:
Do you know the cost of the tests
Selected Imaging, X-Ray, In-Network Freestanding Hospital Total Average you are ordering?
Major Diagnostic Service Facility Total Cost / Member Cost / Member Cost
Cost (20% Coinsurance)* (40% Coinsurance)* Is the provider or laboratory in my
network?
Since my share of the cost is
Total - $462 Total - $1,099 less for services performed at a
MRI Scan
Member - $92 Member - $440 freestanding facility that is not
connected to a hospital, can the
test or service be performed at a
Ultrasound – Total - $114 Total - $162
freestanding facility?
Abdomen Member - $23 Member - $165
Can you recommend a freestanding
General Blood Total - $24 Total - $92 facility in the UnitedHealthcare
Health Panel Test Member - $5 Member - $37 network?
PET Scan Total - $1,800 Total - $4,797
with CT Scan Member - $360 Member - $1,919
*Coinsurance after deductible has been met
How to Utilize Your Care | 19GW Health Savings Plan (HSP)
GW Health Savings Plan (HSP)
The GW Health Savings Plan (HSP) with Health Savings Account (HSA) is designed to give you control over your
healthcare dollars and save for your future. It is a lower-premium, high deductible health insurance plan, which means
you pay less out-of-pocket each month and more at the point of care before the plan pays for services that are not
considered preventive.
• The network for the GW HSP is identical to that of the GW • For all other services, you are responsible for paying
PPO, and there is no need to designate a Primary Care the full cost of care until you reach the plan’s deductible.
Physician or to obtain specialist referrals. Then, you are responsible for a portion of the cost
of care (your coinsurance) until you reach the plan’s
• The GW HSP covers in- and out-of-network services
out-of-pocket maximum.
(you’ll pay more for out-of-network providers).
• In-network preventive services and medications are
covered at 100 percent.
20 | GW Health Savings Plan (HSP)GW Health Savings
Account (HSA)
GW Health Savings Account (HSA)
When you are covered by a high deductible health plan like the GW HSP, you are eligible to QUESTION
participate in an HSA. Am I eligible to enroll in a Health
Savings Account?
To be eligible for an HSA, you must
Contribute to your HSA meet the following criteria:
• You must be covered under a high-
deductible health plan (HDHP),
In 2021 you may contribute up to $3,600 if you have individual HSP coverage, or up such as the GW HSP
to $7,200 if you are covering yourself and additional family member(s) under the HSP. • You cannot be covered under a
If you are age 55 or older, you may contribute an additional $1,000 to your account. non-HDHP along with the HSP
Contributions to your HSA roll over from year to year, and accumulate if not used. And • If your spouse has non-HDHP
remember, your HSA contribution + GW's contribution cannot exceed the annual IRS limits. coverage, you cannot be covered
Please see page 22 for details on GW's HSA match. by that plan
You may use HSA funds to pay for any qualifed health expenses incurred after the
• If you elect an HSA, your spouse
account is opened. Bills may be paid directly via the HSA, or you may use the
cannot have a Health Care FSA
HSA to reimburse yourself for payments that you make.
• You cannot be claimed as a
Payments and withdrawals made from your HSA to cover qualifed healthcare expenses dependent on someone else's tax
are tax-free. return.
Other insurance or accounts not
allowed with an HSA:
HSA is an investment tool
• Part A and/or Part B Medicare
(in some cases, drawing Social
Security benefts automatically
enrolls you in Medicare Part A)
An HSA is an investment tool that helps you save for healthcare expenses, including
deductibles and coinsurance. Contributions to your HSA account are pre-tax, and • TRICARE or TRICARE For Life
any interest earned on the account is tax-free. Learn more about HSAs at • Any VA benefts used within
hr.gwu.edu/hsa. previous three months, unless used
for a service-connected disability
NOTE If you are not eligible for
an HSA but participate in the GW HSP,
you can enroll in the GW Health Care
Contribute Earn Interest Save Invest Flexible Spending Account (HCFSA).
GW Health Savings Account (HSA) | 21GW HSA Matching
Contribution
GW HSA Matching Contribution
For 2021, GW will make a tax-free matching contribution to your account. You must
open an HSA through GW's third-party administrator, PayFlex, in order to receive this
funding. As long as you have opened your account, the GW matching contribution will
be deposited coincident with your frst paycheck of 2021:
Employee-only coverage
For every $1 you contribute to your HSA, GW will match your contribution on a one-for-one
basis up to $600!
Covering any dependents (spouse/domestic partner or children)
For every $1 you contribute to your HSA, GW will match your contribution on a one-for-one
basis up to $1,200!
REMEMBER Your HSA contribution + GW’s contribution cannot exceed the annual IRS limits.
No claims to process! How do I access my HSA funds?
Direct payment: When you use the PayFlex Card®, your account debit card, your expense is
automatically paid from your account.
Pay yourself back: Pay for eligible expenses with cash, check or your personal credit card,
then withdraw funds from your HSA to reimburse yourself. You can even have your payment
deposited directly into your checking or savings account. For more details, visit
hr.gwu.edu/hsa.
Pay your provider: Use PayFlex’s online feature to pay your provider directly from your
account.
22 | GW HSA Matching ContributionGW Flexible Spending
Accounts (FSAs)
GW Flexible Spending Accounts (FSAs)
GW faculty and staff are eligible to fund two different types
of FSAs: MARK YOUR CALENDARS
• Health Care FSA (HCFSA) FSAs are "use it or lose it" - choose your
amounts wisely!
• Dependent Day Care FSA (DCFSA)
• For 2021, you can claim health care expenses
FSAs save you money by allowing you to use pre-tax dollars to pay incurred between January 1, 2021, through
for qualifying expenses. When you set aside some of your salary March 15, 2022. You must fle all claims by
into one or both of the FSA options, the contributions are not April 30, 2022.
subject to federal, state, local or FICA taxes.
• For dependent day care, you can claim
Health Care FSA: expenses incurred between January 1, 2021,
You can contribute up to $2,750 for eligible expenses not covered through December 31, 2021. Again, all claims
by insurance: must be fled by April 30, 2022.
• Health expenses
• You must re-enroll in FSAs every year.
• Prescription expenses
• Dental expenses NOTE
• Vision expenses Special Note for 2020 Health Care FSA (HCFSA)
Participants:
These expenses can be for you or your eligible tax dependents,
whether or not they are covered under a GW health plan. You can • If you have funds left in your HCFSA as of
pay for expenses using the PayFlex debit card or submit a claim December 31, 2020, they will carry over
online and be reimbursed. Your full annual election is available to and be available during the FSA grace period,
use as of the beginning of the plan year. which ends on March 15, 2021.
Dependent Day Care FSA: • If you elect the HSA for 2021 and have funds
You can contribute up to $5,000 (per household) for eligible remaining in your HCFSA as of December 31,
expenses that allow you (and if you are married, your spouse) to 2020, your HSA will be effective on April 1,
work: 2021. (Under the plan, participants are not
eligible to have an active HSA and HCFSA at the
• Child day/custodial care expenses
same time.)
• Adult day/custodial care expenses
• If you wish to have your HSA begin as of
These expenses cannot be used for your or your dependents' January 1, 2021, please be sure to have
healthcare expenses. You can submit a claim online and be a zero balance (including no pending claims) in
reimbursed as money is deposited into your account throughout your HCFSA by December 31, 2020.
the year.
• If you have questions regarding your current
NOTE Per IRS regulations, your annual Dependent Day HCFSA, please contact PayFlex at
Care FSA contribution may be reduced based on the level of (800) 284-4885 or access your online account
participation by all faculty and staff. at payfex.com.
GW Flexible Spending Accounts (FSAs) | 23Did you know that GW’s medical and prescription
drug plans are self-insured? Self-insured means that
the institution pays for healthcare claims directly
out of its operating budget. Every one of us plays
an important role in keeping healthcare costs low.
Taking steps to lower healthcare costs will beneft us
as individuals as well as the entire university. What can
you do to reduce healthcare costs?
Check out these 10 money-saving tips:
1
Choose In-Network Providers
UnitedHealthcare negotiates with providers and healthcare
facilities for discounted fees. These providers make up the health
plan’s network. When you visit an in-network provider, you usually
pay a lower copayment, lower deductible and lower coinsurance.
Using an out-of-network provider can cost you more money out-
of-pocket. Use Castlight to discover how much you will pay for
Healthy
a doctor’s visit before you make an appointment. Learn more at
hr.gwu.edu/castlight.
Habits of 2
Choose Generics
a Good Generic prescription medications are nearly identical to their
brand-name equivalents in quality and composition, but generally
Healthcare
cost much less due to the lower coinsurance. Every time you fll a
prescription, you could be saving money by asking for a generic
version of the medicine. The difference in cost can add up to big
Consumer
savings in a short time.
3
Get Regular Check-Ups
Prevention and early detection of disease are the best ways to live a
healthy life. A simple check-up could mean the difference between
treating a chronic condition for an indefnite amount of time and
making small lifestyle changes to prevent the onset of disease. The
healthier you are, the lower your healthcare costs are likely to be.
Preventive health screenings are 100 percent covered by all GW
health plans if you go to an in-network provider. Need help fnding
a provider? Call Health Advocate, a GW-provided beneft, to help
you navigate the healthcare system at (866) 695-8622.
24 | 10 Healthy Habits of a Good Healthcare Consumer4 8
Save the Emergency Room for Emergencies Use Maintenance Mail Order for Prescriptions
Avoid high ER fees by visiting an in-network provider or walk-in If you have a condition that requires ongoing prescription
clinic for routine ailments such as sore throats, colds, fu, earaches, medication, you will have the lowest out-of-pocket costs possible
minor back pain and tension headaches. You may also visit an by requesting that your doctor provide a prescription for a 90-day
urgent care center for an illness or injury that does not appear supply of your medication. Not only will you save money, you will
life-threatening, but also can't wait until the next day. If you are also save a trip to the pharmacy!
unsure whether your condition requires a trip to the ER, call UHC’s
9
Nurseline anytime, day or night: (877) 706-1739.
5 Stay Healthy
A great way to save money on your healthcare is to stay healthy!
Choose Freestanding Facilities When you exercise regularly, eat healthy, drink plenty of water,
Choose in-network freestanding facilities for lab and imaging avoid smoking and limit alcohol consumption, you improve
services and save. An MRI at a hospital can cost the plan more your health and reduce the likelihood of future health problems.
than $1,500, while the same MRI at a freestanding facility may cost Lowering your risk for future health problems not only improves
only $500. your quality of life, but it also lowers healthcare costs for you and
the university. While tackling all of these at once could be diffcult,
6
taking the frst step toward improving your health might be easier
than you think.
10
Ask Your Doctor Questions
Become an active participant in your healthcare by asking
questions about the services your physician recommends,
including radiological services, hospital stays, lab tests, medications Skip the Waiting Room with Virtual Visits
and anything else. Talk to your doctor and fnd out if a procedure A Virtual Visit lets you see and talk to a doctor
is absolutely necessary. You could lower your healthcare costs by from your mobile device or computer, anytime, without an
eliminating unnecessary tests or procedures. Visit healthadvocate. appointment! Virtual Visits will cost you less than using an urgent
com/gwu to create a personal medical visit checklist. care center and are offered to you as part of your GW health plan
benefts. Log in to go.gwu.edu/virtualvisit or download the
7
UnitedHealthcare app.
Take Advantage of an HSA or FSA
With a Health Savings Account (HSA) or a Flexible Spending
Account (FSA), you choose to have pre-tax dollars deducted from
your paycheck for out-of-pocket medical costs. These accounts are
great for covering expected and unexpected medical expenses
TIP
and lowering your taxable income, which saves you money.
Become a Healthcare Consumer!
Being an informed consumer is the best
way to get the healthcare you need and the
most value from your GW benefts.
10 Healthy Habits of a Good Healthcare Consumer | 25Explore
26 | Explore
Page Info NameExplore Ways to Tour Open
Enrollment Information
Virtual Open 1:1 Appointments Extended Call
Enrollment Fair Center Hours
GW Benefts' vendor partners Online Resources From October 5-23, 2020,
Join us for a virtual fair held will be available for ten-minute
throughout Open Enrollment. Visit our Open Enrollment the Benefts Call Center will
1:1 appointments to discuss
GW Benefts’ vendor partners webpage at go.gwu. have extended hours, Monday
questions that may arise
and members of the GW through Friday, 9 a.m. - 8 p.m.
as you make your choices. edu/2021OE to review the
Benefts team will host weekly (ET). Call (888) 4GWUBEN
Appointments can be booked Benefts Overview, Open
webinars to provide details by visiting go.gwu.edu/ (449-8236) for assistance
Enrollment Guide and other
about beneft programs. Visit oevents. with any benefts questions or
resources during the Open
go.gwu.edu/oeevents to view concerns.
Enrollment period.
the schedule and register for
webinars.
Explore Ways to Tour Open Enrollment Information | 27Flu Shot Clinics As we know, the flu viruses and the virus that causes COVID-19 will both likely be spreading this fall and winter. That means that getting a flu vaccine will be more important than ever. The CDC highly recommends all people 6 months and older get a yearly flu vaccine. On-Campus Employees As announced in late August, GW has launched an Occupational Health Program to support the health, safety, and well-being of all employees. For faculty and staff working on campus this fall, flu shots will be administered by Occupational Health. Dates and locations for the October clinics are in the process of being scheduled. Please visit the Occupational Health website for more details. Teleworking Faculty and Staff Flu shot clinics will not be held on campus this year. We encourage you to get your flu shot locally this year at area pharmacies. Employees who are enrolled in a GW Medical Plan through UnitedHealthcare can receive their flu shot at no cost when visiting a convenience care clinic and retail pharmacies across the DC-metro area. to show your healthcare ID card at the time of your appointment. 28 | Open Enrollment Virtual Events
Flu Shots 29
The following pages provide the
Comparing the Medical Plans chart,
which highlights some of the services
provided under the GW PPO and GW
HSP. For additional plan coverage details,
please refer to the Summaries of Benefts
Compare
and Coverage (SBCs) and Plan Summaries
posted at go.gwu.edu/2021OE.
Percentages in the accompanying chart
represent the percentages of allowed
beneft covered by the plan (GW) as well
as the employee responsibility.
30 | Compare
Page Info NameComparing the Medical Plans
Note:
The GW medical plan GW Health Savings Plan (HSP) GW PPO
offerings use the UHC
Choice Plus network.
MFA Provider In-Network Out-of-Network MFA Provider In-Network Out-of-Network
Deductible
Individual $2,000 $3,000 $750 $2,000
Family $4,000† $6,000† $1,500 $4,000
Out-of-Pocket Maximum (OOPM)††
Individual $4,000 $6,000 $3,000 $6,000
Family $8,000 $12,000 $6,000 $12,000
Coinsurance
GW – 80% GW – 60% GW – 80% GW – 60%
10% after ded 10% after ded
Employee – 20% Employee – 40% Employee – 20% Employee – 40%
Lifetime Maximum
Unlimited Unlimited
Office Visit
Primary Care After deductible: After deductible: After deductible:
Physician (PCP) 10% after ded GW – 80% GW – 60% $10 copay $30 copay GW – 60%
Employee – 20% Employee – 40% Employee – 40%
After deductible: After deductible: After deductible:
Specialist 10% after ded GW – 80% GW – 60% $25 copay $50 copay GW – 60%
Employee – 20% Employee – 40% Employee – 40%
Virtual Visit
After deductible:
GW – 80% $10 copay
Employee – 20%
Imaging and Labs††† LabCorp and Quest Diagnostics will continue to be GW's preferred vendors for lab work.
Preferred Non-Preferred Preferred Non-Preferred
Diagnostic Test After deductible: After deductible: After deductible: After deductible:
(x-ray, blood work) GW – 80% GW – 60% GW – 80% GW – 60%
Employee – 20% Employee – 40% Employee – 20% Employee – 40%
Imaging After deductible: After deductible: After deductible: After deductible:
(CT/PET scans, MRIs) GW – 80% GW – 60% GW – 80% GW – 60%
Employee – 20% Employee – 40% Employee – 20% Employee – 40%
†
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)
Comparing the Medical Plans | 31GW Health Savings Plan (HSP) GW PPO
In-Network Out-of-Network In-Network Out-of-Network
Hospital Care
Inpatient After deductible: After deductible: After deductible: After deductible:
GW – 80% GW – 60% GW – 80% GW – 60%
Employee – 20% Employee – 40% Employee – 20% Employee – 40%
Outpatient After deductible: After deductible: After deductible: After deductible:
GW – 80% GW – 60% GW - 80% GW – 60%
Employee – 20% Employee – 40% Employee - 20% Employee – 40%
Urgent Care After deductible: After deductible: $30 copay After deductible:
GW – 80% GW – 60% GW – 60%
Employee – 20% Employee – 40% Employee – 40%
Emergency Room After deductible: After deductible: After deductible: After deductible:
GW – 80% GW – 80% GW – 80% GW – 80%
Employee – 20% Employee – 20% Employee – 20% Employee – 20%
Home Health Care
Up to 100 visits 80% after you 60% after you 80% after you 60% after you
per calendar year meet the annual meet the annual meet the annual meet the annual
deductible deductible deductible deductible
* Preventive care guidelines are based on recommendations of the U.S. Preventive Services Task Force and other health organizations.
Preventive Visit uhcpreventivecare.com for additional details on ALL preventive care guidelines based on your age and sex.
Mammography* 100% for one preventive mammogram per year, age 40 and over
Pap Test* GW covers After deductible: GW covers 100% if part of After deductible:
100% if part of GW – 60% wellness exam GW – 60%
wellness exam Employee – 40% Employee – 40%
Prostate Exam* GW covers After deductible: GW covers 100% if part of After deductible:
100% if part of GW – 60% wellness exam GW – 60%
wellness exam Employee – 40% Employee – 40%
Well Child and GW covers 100% After deductible: GW covers 100% After deductible:
Well Adult Exams* GW – 60% GW – 60%
Employee – 40% Employee – 40%
Applied Behavior
Analysis (ABA) Covered Covered Covered Covered
Chiropractic Care
After deductible: After deductible: $50 copay per After deductible:
GW – 80% GW – 60% office visit, up to GW – 60%
Employee – 20% Employee – 40% 60 visits per year Employee – 40%
up to 60 visits per up to 60 visits per (combined in- and out-of- up to 60 visits per
year (combined in- year (combined in- network) year (combined in-
and out-of-network) and out-of-network) and-out-of-network)
Acupuncture
After deductible: After deductible: $50 copay per After deductible:
GW – 80% GW – 60% office visit, up to GW – 60%
Employee – 20% Employee – 40% 20 visits per year Employee – 40%
up to 20 visits per up to 20 visits per (combined in- and out-of- up to 20 visits per
year (combined in- year (combined in- network) year (combined in-
and out-of-network) and out-of-network) and out-of-network)
Fertility Benefits**
**Artificial insemination and in vitro fertilization are Not Covered Not Covered Up to $30,000 Not Covered
covered as well as other services. Limitations apply. For
additional details, please review the Fertility Benefit lifetime medical benefit
Overview PDF at hr.gwu.edu/benefits. and up to $8,000 pharmacy
benefit
Hearing Aids***
*** Up to a single purchase (including repair/replacement) Not Covered Not Covered After deductible: After deductible:
per hearing impaired ear every 36 months.
GW – 80% GW – 60%
Employee – 20% Employee – 40%
32 | Comparing the Medical PlansGW Health Savings Plan (HSP) GW PPO
In-Network Out-of-Network In-Network Out-of-Network
Cochlear Implants
Not Covered Not Covered Covered Not Covered
Obesity Surgery****
**** Notification is required six months prior to surgery. Not Covered Not Covered Up to $60,000 Not Covered
Please contact UHC for plan details.
lifetime limit
Vision
After deductible: After deductible: Routine eye exams are covered once every 24 months with
GW – 80% GW – 60% applicable copay. Discounts on hardware/frames/contacts
Employee – 20% Employee – 40% 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.
Durable Medical Equipment (DME)
After deductible: After deductible: After deductible: After deductible:
GW – 80% GW – 60% GW – 80% GW – 60%
Employee – 20% Employee – 40% Employee – 20% Employee – 40%
Prescription Drug Deductible
Included in overall plan deductible ($2,000 individual / N/A
$4,000 family)
Prescription Out-of-Pocket Maximum
Individual Combined with medical $3,600 $7,200
Family Combined with medical $7,200 $14,400
Preventive Drugs
Covered at 100% Subject to coinsurance
Retail Prescription Drugs
Generic After deductible: After deductible: 10% Coinsurance
GW – 80% GW – 60% (Minimum $15, Maximum $30)
Employee – 20% Employee – 40% 30-day supply
Brand Formulary After deductible: After deductible: 20% Coinsurance
GW – 80% GW – 60% (Minimum $30, Maximum $50)
Employee – 20% Employee – 40% 30-day supply
Brand Non-Formulary After deductible: After deductible: 25% Coinsurance
GW – 80% GW – 60% (Minimum $60, Maximum $100)
Employee – 20% Employee – 40% 30-day supply
Mail-Order Prescription Drugs
Generic After deductible: After deductible: 10% Coinsurance
Vacation Exception GW – 80% GW – 60% (Minimum $37.50, Maximum $75)
Additional 30-day supply one time per Employee – 20% Employee – 40% 90-day supply
year
Brand Formulary After deductible: After deductible: 20% Coinsurance (Minimum $75,
Vacation Exception GW – 80% GW – 60% Maximum $125)
Additional 30-day supply one time per Employee – 20% Employee – 40% 90-day supply
year
Brand Non-Formulary After deductible: After deductible: 25% Coinsurance
GW – 80% GW – 60% (Minimum $150, Maximum $250)
Employee – 20% Employee – 40% 90-day supply
Summaries of Benefits and Coverage (SBCs) are available go.gwu.edu/2021OE. Please review your SBC for additional plan coverage information.
To review 2021 contribution rates for medical coverage, please refer to page 47.
Comparing the Medical Plans | 33You can also read
