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Health & Welfare Frequently Asked Questions
Q: How do I find an in-network provider where I live?
A: Visit UnitedHealthcare (UHC) and register as a new user, then search for a provider in your area by either specialty city or ZIP code. You can also call UHC at 877-706‐1739 for assistance on your search.
Q: How do I update my address?
A: You need to contact the GW Payroll office and fill out a new W-4 form; once you have done that, your new address will be sent to your medical carrier. You can e-mail firstname.lastname@example.org or visit Payroll Forms to download a W-4.
Q: How does the UHC Choice Plus - Basic (PPO) plan work out-of-network?
A: Generally, you may choose any covered health care provider, but your cost will typically be higher and you have certain added responsibilities. For example: Every year, you must pay part of your eligible out-of-network expenses before the PPO plan begins to pay a benefit. This payment is called the deductible. After you pay the deductible, the PPO plan will reimburse you for a percentage of your eligible expenses and you will pay the balance. The percentage you pay is called a coinsurance percentage. You must get preauthorization for certain covered expenses such as elective surgery. If you do not get the required pre-authorization, the amount of benefits available may either be reduced or not covered at all. You must complete claim forms and file claims with your health care company to receive payment of benefits. The plan will not cover any benefit reductions due to failure to preauthorize certain treatments.
Q: What are the advantages of getting care from in-network providers?
A: There are many advantages when you go in-network. Typically you may not need to pay a deductible, or your deductible will be lower than if you are treated by an out-of-network provider. Your in-network provider is already pre-authorized by the insurance carrier. You receive a higher level of benefits at participating providers (doctors, hospitals and other health care facilities) who have agreed to provide their services at reduced fees. Some plans provide preventive care services in-network that are not covered out-of-network. Some plans limit covered services out-of-network, but offer no limits to these services when the care is provided in-network.
Q: What is a co-payment?
A: A co-payment, or co-pay, is the amount you pay up-front for your visit (e.g., $25).
Q: What is a deductible?
A: A deductible is the amount you pay before the plan starts to pay. For example, the UHC Choice Plus - Basic (PPO) requires a $850 deductible for an individual using in-network services. This means that you pay the first $850 in medical care you use (please note, the deductible is applicable to all services).
Q: What is a preferred provider organization (PPO) plan, and how does it work?
A: A preferred provider organization (PPO) plan works in two ways:
- Through a network of physicians and service providers, or
- Through providers you select that are not in the network.
Every time you or a covered family member needs care, you can choose an in-network or an out-of-network provider.
Network providers are listed on the UHC website. When you use an in-network provider, you generally receive a higher level of benefits. This happens because the providers and the network have negotiated to accept reduced fees for certain services.
Q: When are claim forms used? Do I file them myself?
A: You may not need to file a claim form when you see in-network providers.
When you do need to file a claim form for out-of-network services, most doctors require you to pay the bill at the time of service. In this case, get a receipt and file it with a claim form. If the expense is covered, you will be reimbursed as per your coverage levels. If you have more than one health insurance plan and have received an Explanation of Benefits (EOB) form from another health care plan, be sure to include a copy with your claim.
If the doctor is willing to wait for payment, they may file the receipt and completed claim form to your health care provider. The health care provider will pay the doctor for the part of your bill the plan will cover. The doctor will then bill you directly for the remaining portion, if any.
Q: With the Choice Plus - Basic (PPO) plan, do I select a primary care physician (PCP)?
A: You do not need to select a PCP under this plan.
Q: Am I limited to use specific dentists and specialists, or do I have the option to choose?
A: With the Aetna PPO plans (High and Low), you and your family members are free to visit any network or non-network dentist or specialist for your dental care. When network dentists are used, you will receive higher levels of reimbursement. For the Aetna DMO, you need to visit the Aetna website, register as a new user, and choose a DMO-specific provider in the DMO network. There are no out-of-network benefits in the DMO plan.
Q: How can I find a network dentist or specialist in my area?
A: You can locate a participating dentist using Aetna’s on-line directory. Register as a new user, then search for a provider in your area by specialty, city or ZIP code. You can also call Aetna directly at 877-238-6200 for assistance on your search.
Q: How do I update my address?
A: You need to contact the GW Payroll office and fill out a new W-4 form; once you have done that, your new address will be sent to your dental carrier. You can e-mail email@example.com or visit Payroll Forms to download a W-4.
Q: What is predetermination of benefits?
A: Predetermination of benefits is the process where the dental insurance company reviews the proposed treatment and tells you what procedures are eligible for reimbursement. It is a good idea to obtain a predetermination of benefits before services are performed. Have your dentist complete a form detailing the proposed treatment and submit it to Aetna. Aetna will send your dentist an explanation of what benefits will be covered and what you would have to pay out of your pocket. You can then discuss your treatment options with the dentist.
Q: I haven’t received my UHC Vision (Buy-Up) ID card. How do I obtain one?
A: UHC Vision ID cards are not required to receive coverage and are therefore not issued. Participants who prefer an ID card can print one by logging-in to the UHC Vision website.
User ID Note: Participants may use their Social Security number; employees enrolled in a UHC medical plan can use their medical plan ID number in lieu of the Social Security number.
Q: What is the difference between UHC Vision Buy-Up and UHC Vision Discount?
A: The UHC vision buy-up plan will pay a defined amount for eligible services and items. UHC medical plan participants are eligible for discounted fees on vision care services and purchases received by a network provider or facility. In addition, in-network eyes exams for Choice Premium (In-Network Only), Choice Plus - Medium and Choice Plus - Basic participants are covered at 100% every 24 months.
Note: The $25 Primary care or $50 specialist co-payments apply to eye exams. A Comparison of Vision plans (PDF) is available for download.
Flexible Spending Accounts
Dependent Care & Health Care FAQs
Q: Do I need to sign up to contribute to a Flexible Spending Account (FSA)?
A: Yes, you must sign up if you want to participate in any FSA. To continue participating after your initial signup, the GW plans require you to re-enroll each year during Annual Open Enrollment.
Q: How do I estimate the amounts I should contribute to my Health Care/Dependent Care Flexible Spending Accounts?
A: To estimate your future expenses, review expenses you've had over the last couple of years. Consider any eligible health care expenses (medical, dental, vision or hearing) and child care expenses that you expect to incur. It is important to carefully estimate your expenses before you decide how much you want to contribute to the Health Care and Dependent care Flexible Spending Accounts each year, because you can reduce the value of these pre-tax opportunities by over- or under-contributing. If you do not use all your funds in the time allotted for both accounts (December 31 for Dependent Care; March 15 for Health Care), you will lose your funds. See the Decision Support Calculator section on the HealthHub website for assistance in determining contributions. Please note, you must be logged in to access the calculator.
Q: How do I update my address?
A: You need to contact the GW Payroll office and fill out a new W-4 form; once you have done that, your new address will be sent to your FSA carrier. You can e-mail firstname.lastname@example.org or visit Payroll Forms to download a W-4.
Q: What are pre-tax contributions?
A: Pre-tax contributions are deducted from your paycheck before federal, FICA, and most state and local taxes are withheld. This gives you an immediate advantage by contributing pretax dollars directly from your paycheck. Each pretax dollar you contribute lowers your current taxable income, so you end up reducing the current federal income tax and FICA tax that you pay.
Q: What is non-discrimination testing for Dependent Care accounts?
A: Non-discrimination testing is an annual audit done on the Dependent Care account to test inequities within the plan. If you are affected by this test, then your Dependent Care account annual amount may be reduced due to the test. This test is done annually, and you will be contacted by the Benefits Administration Department if your account is affected.
The University intends that its Flexible Benefits Plan will comply with the non-discrimination requirements described in the Internal Revenue Code. In keeping with these requirements, if you are a highly compensated individual, your Dependent Care Flexible Spending Account contribution elections may be limited each year based on the results of the annual non-discrimination test.
Q: When do expenses need to be incurred, and what is the grace period?
A: For the Dependent Care account, expenses need to be incurred between January 1st and December 31st each year. For the Health Care account, expenses need to be incurred between January 1st and March 15th of the following year. The Health Care account has a grace period each year from January 1st through March 15. The Dependent Care account does not have a grace period.
Q: Can I use my FSA debit card for over-the-counter (OTC) medication purchases?
A: No. OTC medications are ineligible for FSA healthcare debit card purchases; however, you may file for reimbursement on prescribed OTC medications.