Medical Benefits

United Healthcare

In today’s world, it’s more important than ever to be in control of your health care choices. So take an active role in making the right coverage decisions for your personal situation. Making good decisions about your care – from choosing the coverage that meets your health care needs to requesting generic prescription drugs – is essential to getting the most out of every health care dollar you spend. When considering your health care options, look beyond the per-pay-period cost and seriously consider whether you’re getting the coverage you actually need.

We offer two different plan designs to choose from. Both are with UnitedHealthcare (UHC):

A plan comparison chart (PDF) may be helpful to review both plan designs. UHC also offers a health cost comparison worksheet 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").

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GW PPO 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 UHC network.

The national network is always at your fingertips! 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.

In addition to comprehensive benefits, this plan offers:

  • In-network infertility 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). 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.

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GW Health Savings Plan (HSP)

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 vast network for most services.  You are not responsible for handling paperwork, including claims and pre-notifications for services rendered within the network. Remember, you have access to a national network – your coverage spans from coast to coast.

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 and are then covered by co-ninsurance until the out of pocket maximum is reached. (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.

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How to Locate In-Network Providers and Preferred Labs & Freestanding Medical Imaging Centers:

  • UnitedHealthcare's Preferred Labs and LabCorp and Quest Diagnostics.  You can find a location closest to you by visiting www.uhc.com
  • Learn how you can save money by using freestanding facilities (PDF)

Radiology and Cardiology Prior Authorization

Prior authorization (PDF) for advanced outpatient imaging procedures and cardiology services are required to support medical necessity.  

Behavioral Health

Your Behavioral Health benefit, covered under both GW PPO and GW HSP Plans, includes counseling and substance abuse recovery services.  It can help you effectively deal with stressful and challenging situations.  Accessing your Behavioral Health benefit is easy and available 24 hours a day.  A specialist will help you identify the nature of your problem and the appropriate resource to address it: 

Virtual Visits

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)

Helpful Resources

Claims Forms

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