PLAN LEARN EXPLORE COMPARE DECIDE - GW Benefits · Benefit What you’ll have in 2017 if you don’t act during Open Enrollment: Retiree Choice Plus Basic plan (including pharmacy)

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PLAN LEARN EXPLORE COMPARE DECIDE

RETIREES

2 | Table of Contents

CONTENTSPLAN

3 Introduction

5 Building a Healthy Community

LEARN

7 What is Open Enrollment?

8 What’s Staying the Same for 2017?

8 What’s New and What’s Changing for 2017?

10 Plan Features

12 How to Utilize Your Care

14 Retiree Health Savings Plan

15 Retiree Health Savings Account

16 10 Healthy Habits of a Good Healthcare Consumer

EXPLORE

19 Explore Ways to Tour Open Enrollment Information

20 Fight the Flu for a Healthier GW

COMPARE

22 Comparing the Medical Plans

25 Your Prescription Drug Benefits

27 Choosing a Medical Plan

28 Your Vision Coverage Options

30 Your Dental Coverage Options

32 Life Insurance

33 Dental Coverage Rates

33 UHC Vision Coverage Rates

DECIDE

35 How to Enroll

36 Important Contact Information

Start Planning | 3

What: Mark your calendar for Open Enrollment, the annual opportunity for you to make

health and welfare benefits changes and to add or drop coverage for eligible

dependents. And, be sure to bookmark the Benefits Open Enrollment website

https://benefits.gwu.edu/annual-open-enrollment, your destination for all

employee open enrollment benefit-related information!

Who: All GW faculty and staff retirees and their eligible dependents.

When: November 1 through 15

Why: Even if you are happy with your elections from last year, it’s always a good practice

to review and confirm that you’ve signed up for the right plan for you and your

family. If you choose not to take action, coverage will either “roll over” or default

into a new plan.* So take the time to review your options; otherwise, you’ll have

to wait until the next Open Enrollment period unless you experience a qualified

life event (such as getting married, having a baby) to make changes.

*The cost of the coverage will reflect 2017 contribution amounts.

Changes of Address or Personal Contact Information Please be sure to provide your current address and phone number to

PayFlex. We periodically mail information to retirees, and may be unable

to contact you without this information. In the event that you relocate in

the future, please be sure PayFlex is notified of your new address and

any change to your phone number. Contact: PayFlex 1-800-359-3921

START PLANNING

ATTENTION: The Retiree Choice Plus Basic plan will be discontinued, and replaced with the Retiree Health Savings Plan (HSP). If you are in the Basic plan and you do not update your medical election, you’ll be defaulted into the new Retiree HSP.

You have two weeks to complete your Open Enrollment elections. For more information, see page 22.

WHAT:

WHO:

WHEN:

WHY:

https://benefits.gwu.edu/annual-open-enrollment

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Building a Healthy Community | 5

Over the years, GW has been working proactively to help employees and retirees get on a path toward

improved health and wellness by implementing a number of strategies:

Preventive Care and Telemedicine• 100% of preventive services are covered in network

for those enrolled in the UHC medical plans.

• Telemedicine, also referred to as Virtual Visits, was introduced

in 2016 and provides participants convenient access to

providers to assist with a wide range of conditions and

questions, getting the help and prescriptions they need

while avoiding the waiting room!

Financial Fitness• Retirement consultants from Fidelity and TIAA are available on

campus and at their local offices by appointment to assist with:

understanding the plans and available investments, creating

individualized plans and reviewing account balances. Learn

more by visiting: https://benefits.gwu.edu/retirement-counseling

BUILDING A HEALTHY COMMUNITY

https://benefits.gwu.edu/retirement-counseling

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Open Enrollment and What's Included | 7

WHAT IS OPEN ENROLLMENT?Open Enrollment is your annual

opportunity to reflect on your and your

family’s needs and fine tune your benefits

package to match. Many life events can

occur over the course of the year that can

impact the types of plans and amount of

coverage you need. Take this opportunity

to think about the changes you and

your family have experienced in the past

year, or anticipate in the coming year.

Then, determine which benefit plans and

programs will best meet your needs.

Benefit What you’ll have in 2017 if you don’t act during Open Enrollment:

Retiree Choice Plus Basic plan (including pharmacy)

You will be automatically enrolled in the NEW! Retiree HSP.

Retiree Health Savings Account

If you enroll in the Retiree HSP, you may open a Health Savings Account (HSA) at the institution of your choice at any time during the year.

Blue 65 PPO (including pharmacy)

Dental Plan

Vision The same plan you have now.

Life Insurance

WHAT’S INCLUDED?The benefits below are part of Open Enrollment, which will run November 1 through 15 and can only be changed once per year unless you have a qualified life event:

These benefits are part of Open Enrollment, and can only be changed once per year unless you have a qualified life event.

LEARN

8 | What's Staying the Same, What's New and What's Changing for 2017

WHAT’S STAYING THE SAME FOR 2017For Retirees and their dependents who are age 65 or older or Medicare eligible, GW will continue to offer the UHC Blue 65 PPO plan. There are no changes to the premiums, deductibles, or benefits of this plan.

Pharmacy CoverageIf you participate in one of GW’s health plan options, you

will continue to have pharmacy coverage through CVS

Caremark. There will be no changes to the plan coverage

including coinsurance amounts.

Dental and VisionGood dental and vision care contribute to overall health

and wellness, and both continue to be part of our

comprehensive healthcare benefits. Costs will increase

slightly for the High and Low dental PPO plans, while the

DMO dental plan, Basic and Enhanced Vision plans will

have no changes to employee contributions. There will be

no changes in plan coverage.

Free-Standing Imaging and LabsPrices vary significantly for imaging and lab work—even if

you go in-network! The Retiree HSP will continue to offer a

preferred network including a lower coinsurance when you

use a freestanding network facility instead of

a hospital for labs, X-rays and major diagnostics

Tuition Remission As a GW retiree you are eligible for tuition remission

benefits. There will be no changes to these programs

for 2017. For more information please visit

https://benefits.gwu.edu.

WHAT’S NEW AND WHAT’S CHANGING FOR 2017Information about the new 2017 benefit programs and changes is outlined below. For details on plan coverage, please review the

plan comparison chart beginning on page 27.

Here are the highlights of the changes and details:

Retiree Health Savings Plan (HSP) with

Health Savings Account (HSA) for

Pre-Medicare Retirees and Dependents

Basic Plan Discontinued

• For retirees and their dependents who are under 65

years of age or who are not Medicare eligible, the Retiree

Choice Plus Basic Plan will be discontinued and replaced

with the GW Retiree Health Savings Plan (HSP) with

Health Savings Account (HSA).

• This plan 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.

• The network for the HSP is identical to the Choice Plus

Basic Plan, and there is no need to designate a Primary

Care Physician or to obtain specialist referrals.

• The GW Retiree HSP covers in- and out-of-network

services (you’ll pay more for out-of-network providers).

In-network preventive services and medications are

covered at 100%.

• For all other services, you are responsible for paying

the full cost of care until you reach the plan’s deductible.

You are then responsible for a portion of the cost of

care (your coinsurance) until you reach the plan’s

out-of-pocket maximum

If you or your dependent(s) are currently enrolled in the Retiree Choice Plus Basic Plan, you will be moved to the GW Retiree HSP, unless you waive benefits for 2017.

If you choose to do nothing, you will be defaulted into the NEW Retiree HSP PPO.

NEW!

https://benefits.gwu.edu

MORE OF WHAT’S NEW AND WHAT’S CHANGING FOR 2017Health Savings Account (HSA)The HSA contribution limit:

• For those with individual Retiree HSP coverage,

the limit $3,400.

• The family limit is $6,750 or;

• If you are age 55 or older there is an additional

$1,000 catch up allowed.

Acupuncture

• Acupuncture will now be covered under both the Retiree HSP and Blue 65 PPO up to 20 visits per year.

(combined in- and out-of-network).

Transgender Coverage• GW will add coverage for surgery and commonly used

medications for gender reassignment.

BlueStar• The GW prescription plans now cover a new digital

therapy for adults living diagnosed with type 2 diabetes.

The digital therapy is called BlueStar and enables

personalized coaching based on your individual

treatment plan, through the use of your cell phone and/or

computer. BlueStar is a prescribed therapy. To learn more,

please contact a BlueStar Customer Care representative

at 888-611-4794.

Centers of Excellence• In 2017 GW will offer UHC's Centers for Excellence for

Cancer. These Centers of Excellence provide access to

leading healthcare facilities, physicians and services to

support safe, specialized and cost-effective care. UHC’s

nurse consultants provide the information you need to

make informed decisions about your care and help guide

you to a Centers of Excellence Networks program that

meets your specific needs.

Online Middle and High School

Tuition Discount • Beginning September 15, 2016, retirees, along with their

extended family, may enroll students in grades 6–12 in

the George Washington University Online High School

(GWUOHS) through an exclusive 20% off tuition discount.

• This benefit may be applied to enrollment in either the

full-time, diploma-granting program or part-time AP®

courses.* Retirees and their extended family may

take advantage of this discount at any time during the

year regardless of when the GW Open Enrollment

window occurs.

Visit gwuohs.com/discount for more information or to begin the enrollment process.

* Discount may not be combined with any other offer or discount.

NEW!

NEW!

NEW!

What's New and What's Changing for 2017 | 9

http://gwuohs.com/discount

10 | Plan Features

PLAN FEATURESBenefits have a language all their own. Understanding how your insurance plans work is something everyone

needs to understand to make the most out of your coverage.

Know Before You GoBecome familiar with these commonly used benefits terms to help you compare plans and decide!

Total Out-of-Pocket CostsHere’s a simple equation that shows how much you’ll pay out-of-pocket for your health insurance each year.

Understanding your DeductiblesYour deductible is tied to your premium. Just like car insurance, a plan with a low deductible will cost you a higher premium.

On the flip side, a health savings plan with a higher deductible will have a lower premium.

PREMIUMS

+ DEDUCTIBLE + COPAYS & COINSURANCE (UP TO THE OUT-OF-POCKET MAXIMUM) ___________________ TOTAL RETIREE COSTS

PREMIUMS: The amount you pay for your health insurance every month.

DEDUCTIBLE: The amount you pay out-of-pocket for healthcare before plan starts to pay. (Please note, the deductible may not be applicable to all services. Please see page 25). Separate in-and-out of network deductibles apply.

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.

OUT-OF-POCKET MAXIMUM: This is a “cap” on your costs for the year; it is the most you’ll pay for healthcare services. Once you reach your out-of-pocket maximum, the plan pays 100% of your covered medical expenses for the balance of the year. Separate in- and out-of-network out-of-pocket maximums do apply.

Once you meet your plan's Out-of-Pocket Maximum, the plan pays 100% of your covered medical expenses for the balance of the year.

Decoding your DeductibleNot all deductibles are created equal. Here are a couple of common types:.

Network DeductiblesGW’s health plans have separate annual deductibles for when you get in-network care and out-of-network care.

These are usually different for individuals and families.

Family DeductiblesWith some plans, you’ll need to meet the deductible for each covered family member up to the family cap.

For example, under the Blue 65 PPO, each person will need to meet the in-network individual deductible of $500 (capped at $1,000 per family). Once an individual meets the $500 deductible, coinsurance begins for that person.

Note, the deductible for the Blue 65 PPO includes medical expenses only.

With the Retiree HSP, one family member can meet the

deductible for the entire family. For example, if you elect coverage for yourself and one or more dependents, the full family deductible (in-network family deductible is $4,000) will need to be met before coinsurance begins for any family member. Remember, the Retiree HSP deductible includes both medical and pharmacy expenses.

When you cover your family, review your family deductible closely.

Glossary of TermsCovered Services: Those services deemed by your plan to be medically necessary for the care and treatment of an injury or illness.

Formulary: Sometimes referred to as a preferred drug list, a list of prescription medications that are covered by a pharmacy plan. Drugs not on a formulary may not be available, may carry a higher cost-share amount or may be accessible only with prior authorization.

Generic: An FDA-approved drug, composed of virtually the same chemical formula as a brand-name drug. Ask for generics! Generic medications contain the same active ingredients as brand-name drugs but cost less. Talk to your doctor about getting generics and making sure medications are on your plan’s formulary.

Specialty Drugs: Low-volume, high-cost medication prescribed for chronic and complex illnesses such as multiple sclerosis, hepatitis C and hemophilia as well as some common diseases such as rheumatoid arthritis. Specialty drugs often require special storage and handling and are not readily available at the typical local retail pharmacy.

High Deductible Health Plan (HDHP): A plan with a higher deductible than a traditional insurance plan. These plans typically have lower monthly premiums but you must pay more out of pocket initially (your deductible for pharmacy and medical) before the plan starts to pay. A HDHP can be combined with a health savings account. This allows you to pay for certain medical expenses with pretax dollars. (The GW Retiree HSP is considered one of these plans.)

Network: A group of doctors, labs, hospitals and other providers that your plan contracts with at a set payment rate.

Preventive Care: Preventive care services include services that help you manage your health, such as routine physical exams, screenings and lab tests — these are all covered at 100% by the GW health plans, with no out-of-pocket costs like deductibles or copays as long as the services are received in-network. Be sure your provider codes the services as “preventive.”

Preferred Provider Organization (PPO): A type of health plan that contracts with medical providers, such as hospitals and doctors, to create a network of participating providers. You pay less if you use providers that belong to the plan’s network. You can use doctors, hospitals and providers outside of the network for an additional cost.

Going Digital for Health!Did you know that the GW pharmacy programs now cover a new digital therapy for adults living diagnosed with type 2 diabetes? The digital therapy is called BlueStar and enables personalized coaching based on your individual treatment plan, through the use of your cell phone and/or computer. BlueStar is a prescribed therapy. To learn more, please contact a BlueStar Customer Care representative at 888-611-4794.

Plan Features and Glossary | 11

12 | How to Utilize Your Care

For those on the Retiree HSP:• You must pay all costs for prescription drugs until you meet

your annual deductible.

• Remember, your pharmacy deductible is combined with your medical deductible.

• After you meet your deductible, you will be responsible for coinsurance until you reach the out-of-pocket maximum.

Remember: You can use your HSA to pay for eligible out-of-pocket costs, including your deductible and prescription coinsurance.

Retiree HSP participants, remember: Preventive medications are covered at 100%! Coinsurance and deductible do not apply.

How Prescription Coinsurance Works Coinsurance is your share of the costs of a covered healthcare service,

calculated as a percent (for example, 20%) of the cost for the service

or prescription drug. GW pays the rest of the cost.

For those on the Blue 65 PPO

There is financial protection built into the prescription drug benefit

in that you will never pay more than the “maximum,” outlined in the

table below. In addition, once you reach the out-of-pocket-maximum,

GW pays 100% of prescription drug costs.

George Martha

George is enrolled in the Blue 65 PPO. He isn’t feeling well so he goes to his primary care physician. He has bronchitis and his physician recommends a prescription antibiotic as treatment. George asks his physician if he can prescribe a generic antibiotic.

Martha is also enrolled in the Blue 65 PPO and does not feel well. Martha goes to her primary care physician and also has bronchitis. Her physician writes her a prescription for a preferred brand antibiotic with a similar chemical formula to the antibiotic George received. She gets to the pharmacy and finds out the total antibiotic cost is $400.

Generic Coinsurance 10%

Maximum $30

Cost of Drug $160

GEORGE PAYS $16

GW Pays $144

Preferred Brand Coinsurance 20%

Maximum $50

Cost of Drug $400

MARTHA PAYS $50

GW Pays $350

HOW TO UTILIZE YOUR CARE

How to Utilize Your Care | 13

Prices vary significantly for imaging and lab work – even if

you go in-network.

Not only do prices vary, but if you participate in the Retiree HSP,

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 affiliation.

The Retiree HSP 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%

coinsurance for the HSP plans. If you go to a facility that is

not in the preferred network you will pay 40% coinsurance.

LabCorp will remain the preferred vendor 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/preferred for directions on how to compare costs and locate a preferred provider for networks and labs.

When using outpatient lab tests and imaging, ask:

Do you know the cost of the tests you are ordering?

Is the provider or laboratory in my network?

Since my share of the cost is less for services performed in a freestanding facility that is not connected to a hospital, can the test or service be performed at a freestanding facility?

Can you recommend a freestanding facility in the UnitedHealthcare network? (Your doctor can access a list of participating laboratories by visiting www.unitedhealthcareonline.com)

Save Money by Using Freestanding Facilities

Selected Imaging, X-Ray, Major Diagnostic Service

In-Network Free Standing Facility Total Cost / Member Cost (20% Coinsurance)*

Hospital Total Average Cost / Member Cost (40% Coinsurance)*

MRI ScanTotal - $559 Member - $112

Total - $1,087 Member - $435

Ultrasound – Abdomen

Total - $114 Member - $23


General Blood Health Panel Test



PET Scan with CT Scan



Average costs of imaging and diagnostic services

*Coinsurance after deductible has been met

http://go.gwu.edu/preferred

http://www.unitedhealthcareonline.com

14 | GW Retiree Savings Plan

RETIREE HEALTH SAVINGS PLAN

The Retiree 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.

• There is no need to designate a Primary Care Physician

or to obtain specialist referrals.

• The Retiree HSP covers in- and out-of-network services

(you’ll pay more for out-of-network providers).

• In-network preventive services and medications are

covered at 100%.

• For all other services, you are responsible for paying

the full cost of care until you reach the plan’s deductible.

Then you are responsible for a portion of the cost

of care (your coinsurance) until you reach the plan’s

out-of-pocket maximum.

RETIREE HEALTH SAVINGS ACCOUNTWhen you are covered by a high deductible health plan like the Retiree HSP, you are eligible to participate

in a Health Savings Account (HSA)*.

In 2017, you may contribute up to $3,400 if you have individual coverage, or up to $6,750 if you are covering yourself

and additional family member(s). If you are age 55 or older, you may contribute an additional $1,000 to your account.

Contributions to your HSA accumulate if not used.

You may use the funds to pay for any qualified health expenses incurred after the account is opened. You may pay the

bill directly via the HSA, or you may use the HSA to reimburse yourself for payments that you make.

Payments and withdrawals made from your HSA to cover qualified healthcare expenses are tax-free.

An HSA is an investment tool that helps you save for healthcare expenses, including deductibles and coinsurance.

Contributions to your HSA account are tax deductible, and any interest earned on the account is tax-free.

Contribute to your HSA

HSA is an investment tool

GW Health Savings Account | 15

* Am I eligible for a Health Savings Account?

To be eligible you must meet these few criteria:

• Be covered by a qualified HDHP (like the Retiree HSP)

• Cannot be enrolled in Medicare or TRICARE

• Cannot be claimed as a dependent on someone else’s tax return

• Cannot be covered by another health plan that is not HSA-qualified

Contribute Earn Interest Save Invest

16 | 10 Healthy Habits of a Good Healthcare Consumer

HEALTHY HABITS OF A GOOD HEALTHCARE CONSUMER

Choose In-Network ProvidersUnitedHealthcare 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.

Choose GenericsGeneric prescription medications are nearly identical

to their brand-name equivalents in quality and

composition, but generally cost much less due to the

lower coinsurance. Every time you fill 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 savings in a short time.

Time for a Check-UpPrevention and early detection of disease are the

best ways to live a healthy life. A simple checkup

could mean the difference between treating a

chronic condition for an indefinite amount of time

and making small lifestyle changes to prevent the

onset of disease. The better your health, the lower

your healthcare costs are likely to be. Preventive

health screenings are 100% covered by all GW health

plans if you go to an in-network provider. Need a

provider? Call Health Advocate, a GW-provided

benefit, to help you navigate the healthcare system

at 866-695-8622.

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10 Healthy Habits of a Good Healthcare Consumer | 17

Use the Emergency Room for EmergenciesYou will save money when you visit an in-network

provider or walk-in clinic for routine ailments such

as sore throats, colds, flu, earaches, minor back

pain and tension headaches. If you are not sure if

your condition requires a trip to the ER, call UHC’s

Nurseline any time day or night 877-706-1739.

Choose Freestanding FacilitiesChoose in-network freestanding facilities for lab and

imaging services and save. An MRI at a hospital can

cost the plan more than $1,500 while the same MRI

at a freestanding facility may cost only $500.

Ask Your Doctor QuestionsBecome an active participant in your healthcare

and ask questions about all the services your

physician recommends, including radiological

services, hospital stays, lab tests, medications and

anything else. Talk to your doctor and find out if a

procedure is absolutely necessary. You could lower

your healthcare costs by eliminating an unnecessary

test or procedure. Visit healthadvocate.com/gwu to

create a personal medical visit checklist.

Take advantage of an HSAWith a health savings account (HSA), you choose to

save pre-tax dollars for out-of-pocket medical costs.

These accounts are great for covering expected and

unexpected medical expenses and lowering your

taxable income, which saves you money.

Use Maintenance Mail Order for PrescriptionsIf you have a condition that requires ongoing

prescription medication, you will have the lowest

out-of-pocket costs possible by requesting that your

doctor provide a prescription for a 90-day supply of

your medication. Not only will you save money, you

also save a trip to the pharmacy!

Stay HealthyA great way to save money on your healthcare is

to stay healthy! When you get regular exercise, eat

healthy, drink plenty of water and avoid smoking

or drinking too much alcohol, you’re improving

your health and reducing the likelihood of future

health problems. Lowering your risk for future

health problems not only improves your quality of

life, it also lowers healthcare costs for you and the

university. While tackling all of these at once could

be difficult, taking the first step toward improving

your health might be easier than you think.

Skip the Waiting Room with Virtual VisitsA virtual visit lets you see and talk to a doctor

from your mobile device or computer, any time,

without an appointment! Virtual Visits will cost

you less than using an urgent care facility! It’s

offered to you as part of your GW health plan

benefits. Log in to go.gwu.edu/virtualvisit or

download the UnitedHealthcare Health4Me®

app at go.gwu.edu/Health4Me app to learn

more about virtual visits.

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BECOME A HEALTH CARE CONSUMER!Being an informed consumer is the best way to get the healthcare you need and the most value from your GW benefits.

http://healthadvocate.com/gwu

http://go.gwu.edu/virtualvisit

http://go.gwu.edu/Health4Me

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Explore Ways to Tour Open Enrollment Information | 19

EXPLORE WAYS TO TOUR OPEN ENROLLMENT INFORMATION

Benefits Open Enrollment Office Hours

Refer to the schedule of office hours on the right.

Review Plan Details and Access Other Resourceshttps://benefits.gwu.edu/annual-open-enrollmentTo review plan details and access other benefit resources online!

Return completed and signed enrollment form to PayFlex by November 15, 2016.

Office Hours During the Open Enrollment period, Benefits

Administration staff will be available to answer

questions and assist with your enrollment.

Foggy Bottom Campus: Wednesday, November 9 10:00 a.m. – 4:00 p.m. Marvin Center, Room 311

Virginia Science and Technology Campus: Friday, November 11 10:00 a.m. – 4:00 p.m. Enterprise Hall, Room 175


Benefits Open Enrollment Events | 20

Fight the Flu for a Healthier GW Flu season is here, and it’s more important than ever for you to take care of your health. A flu shot can protect you against the seasonal flu, and other forms of the flu virus. Take a positive step to help reduce your chances of catching this season’s viruses and get a flu vaccine.

Flu shots are available at CVS/pharmacy, RiteAid Pharmacy, Target Pharmacy and Walgreens Pharmacy at no cost for faculty and staff who participate in any of GW’s medical plans. This also includes your spouse/domestic partner and dependent children if they are covered under your GW retiree health plan.

Just present your UnitedHealthcare card, and your shot is 100% covered.

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Comparing the Medical Plans | 22

For more details about your coverage options, read the Comparing the Medical Plans chart, which follows.

COMPARING THE MEDICAL PLANS

Retiree Health Savings Plan (HSP) Blue 65 PPO

In-Network Out-of-Network In-Network and Out-of Network

Deductible

Individual $2,000 $3,000 $500

Family $4,000† $6,000† $1,000

Out-of-Pocket Maximum††

Individual $4,000 $6,000 $4,000

Family $7,150 $12,000 $8,000

Coinsurance

GW – 80%Retiree – 20%



Lifetime Maximum

Unlimited Unlimited

Office Visit

PCP After deductible:GW – 80%Retiree – 20%

After deductible:GW – 60%Retiree – 40%

After deductible:GW – 80%

Retiree – 20%

SpecialistAfter deductible:GW – 80%Retiree – 20%



Retiree – 20%

Virtual Visit



Retiree – 20%

Imaging and Labs†††

Preferred Non-Preferred

Diagnostic Test (x-ray, blood work)




Retiree – 20%

Imaging (CT/PET scans, MRIs)




Retiree – 20%

† 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 OOP max. (Only allowed charges will count towards the OOP max 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)

Percentages in the accompanying chart represent the percentages of allowed benefit covered by the plan (GW) as well as the employee responsibility.

Note: The GW medical plan offerings use the UHC Choice Plus network.

23 | Comparing the Medical Plans


In-Network Out-of-Network In-Network and Out-of-Network

Hospital Care

Inpatient After deductible:GW – 80%Retiree – 20%



Outpatient After deductible:GW – 80%Retiree – 20%


After deductible:GW - 80%Retiree – 20%

Urgent Care After deductible:GW – 80%Retiree – 20%



Emergency Room After deductible:GW – 80%Retiree – 20%



Preventive

Mammography* 100% for one preventive mammogram per year, age 40 and over

Pap Test* GW covers 100% if part of wellness exam


GW covers 100% if part of wellness exam

Prostate Exam* GW covers 100% if part of wellness exam



Well Child and Well Adult Exams*

GW covers 100% After deductible:GW – 60%Retiree – 40%


Chiropractic CareAfter deductible:GW – 80%Retiree – 20%up to 60 visits per year (combined in- and out-of-network)

After deductible:GW – 60%Retiree – 40%up to 60 visits per year (combined in- and out-of-network)


up to 60 visits per year

AcupunctureAfter deductible:GW – 80%Retiree – 20%up to 20 visits per year (combined in- and out-of-network)

After deductible:GW – 60%Retiree – 40%up to 20 visits per year (combined in- and out-of-network)


up to 20 visits per year

Hearing Aids**Not Covered Not Covered After deductible:



* Preventive care guidelines are based on recommendations of the U.S. Preventive Services Task Force and other health organizations. Visit www.uhcpreventivecare.com for additional details on ALL preventive care guidelines based on your age and sex.

** Up to a single purchase (including repair/replacement) per hearing impaired ear every 36 months.

Comparing the Medical Plans | 24


In-Network Out-of-Network In-Network and Out-of-Network

Cochlear ImplantsNot Covered Not Covered Covered

Obesity Surgery***Not Covered Not Covered Up to $60,000 lifetime limit

VisionAfter deductible:GW – 80%Retiree – 20%


Routine eye exams are covered once every 24 months with applicable copay. 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 Blue 65 PPO.

Durable Medical Equipment (DME)After deductible:GW – 80%Retiree – 20%



Retiree – 20%

Prescription Drug DeductibleIncluded in overall plan deductible ($2,000 individual / $4,000 family)

N/A

Prescription Out-of-Pocket Maximum

Individual Combined with medical $3,600

Family Combined with medical $7,200

Preventive DrugsCovered at 100% Subject to coinsurance

Retail Prescription Drugs

Generic After deductible:GW – 80%Retiree – 20%


10% Coinsurance (Minimum $15, Maximum $30) 30-day supply

Brand Formulary After deductible:GW – 80%Retiree – 20%



Brand Non-Formulary




Mail-Order Prescription Drugs

GenericVacation Exception Additional 30-day supply one time per year



10% Coinsurance (Minimum $37.50, Maximum $75) 90-day supply

Brand FormularyAdd vacation exception Additional 30-day supply one time per year




Brand Non-Formulary




*** Notification is required six months prior to surgery. Please contact UHC for plan details.

To review 2017 contribution rates for Retiree Medical Coverage, please refer to https://benefits.gwu.edu/annual-open-enrollment.

25 | Your Prescription Drug Benefits

YOUR PRESCRIPTION DRUG BENEFITSCoverage for Retirees When you enroll in the Retiree HSP or the Blue 65 PPO medical plan option, you are automatically enrolled in the

prescription drug coverage through CVS Caremark. You have access to prescription medications through both retail

pharmacies and a mail-order program. Under the prescription plan, generic, brand formulary and brand non-formulary

drugs are paid by fixed percentage of the total cost each time you fill a prescription with caps to limit the amount you will

spend on a prescription, referred to as a maximum.

Your Prescription Drug Benefits | 26

Coverage for GW HSP Participants When you enroll in the Retiree HSP, you are automatically

enrolled in the prescription drug coverage below through

CVS Caremark. You have access to prescription medications

through both retail pharmacies and a mail-order program.

You must pay all out-of-pocket costs for prescription drugs

until you meet your annual deductible (combined with

medical, please see chart on page 27). After you meet the

deductible, you will be responsible for 20% in-network

coinsurance until you reach the out-of-pocket maximum.

Please see chart on page 22 for additional details.

You can use your HSA to pay for your prescriptions.

Preventive medications are covered at 100% and the deductible and coinsurance do not apply. To review a list of preventive drugs please visit https://benefits.gwu.edu/prescription-benefit-high-deductible-health-plan-hdhp.

TipIt’s a good idea to occasionally check up on your medications’ coverage

tier (generic, brand formulary and brand non-formulary) as sometimes

drugs change tiers. To be certain which tier your medication is on, call

CVS Caremark at (877) 357-4032, visit www.caremark.com or download

the CVS Caremark Mobile App.

https://benefits.gwu.edu/prescription-benefit-high-deductible-health-plan-hdhp

https://benefits.gwu.edu/prescription-benefit-high-deductible-health-plan-hdhp

http://www.caremark.com

27 | Choosing Your Medical Plan(s) - Examples

George and Martha

EXAMPLE 1:Status:

George, a Retiree, is Medicare eligible; however,

his spouse Martha is not Medicare eligible.

Plan:

George would like to enroll himself and Martha in medical

coverage during Open Enrollment. George would need to

choose Retiree Only coverage under UHC BLUE 65 PPO

for himself and choose Spouse Only coverage under the

Retiree HSP for Martha.

EXAMPLE 2:Status:

Neither George, a Retiree, nor Martha, his spouse,

is Medicare eligible.

Plan:

George would like to enroll both himself and Martha

in medical coverage during Open Enrollment. George

would need to choose Retiree + One coverage under

the Retiree HSP.

EXAMPLE 3:Status:

George, a Retiree, and Martha, his spouse,

are both Medicare eligible.

Plan:

George would like to enroll both himself and Martha

in medical coverage during Open Enrollment. George

would need to choose Retiree + One coverage under

the UHC BLUE 65 PPO plan.

EXAMPLE 4:Status:

George, a Retiree, and his spouse Martha

are both Medicare eligible.

Plan:

They have two dependent children who are not Medicare

eligible. George would like to enroll himself, Martha, and

their children in medical coverage during Open Enrollment.

George would need to choose Retiree + One coverage

under the UHC BLUE 65 PPO plan for himself and Martha

as well as 2 Children Only coverage under the Retiree HSP

for their two children.

CHOOSING YOUR MEDICAL PLAN(S) - EXAMPLES

If you are a retired employee age 65 or older and are not enrolled in Medicare Part B, the GW plan will apply the deductibles, copayments and other plan limits and pay the remaining charges minus what Medicare Part B would have paid. You will be responsible for any charges not covered by the GW plan. Please refer to your medical plan’s SPD for additional details on Coordination of Benefits with Medicare.

If you are eligible for Medicare Part B and visit a provider who has opted out of Medicare, the GW plan will estimate the allowable expense based on usual, customary and reasonable charges, and pay as if this allowable expense was covered by Medicare. In other words, if you visit a provider who has opted out of Medicare, the GW plan will pay only a small portion of the charges.

28 | Your Vision Coverage Options

Caring for your eyes and

keeping your eyesight

healthy will benefit you

in all aspects of life. All

Retirees are eligible to

choose from voluntary

vision plans.

YOUR VISION COVERAGE OPTIONS

UHC VOLUNTARY VISION PLAN OPTIONS: BASIC PLAN VS. ENHANCED PLAN

GW offers a choice of voluntary vision plans through UnitedHealthcare (UHC).

Basic Enhanced

Copays for In-Network Services

Exam $0 $0

Materials $20 $20

Benefit Frequency

Comprehensive Exam Once every 12 months Once every 12 months

Spectacle Lenses Once every 12 months Once every 12 months

Frames Once every 24 months Once every 12 months

Contact Lenses in Lieu of Eye Glasses

Once every 12 months Once every 12 months

Frame Benefit

Private Practice Provider $130 $130

Retail Chain Provider $130 $130

Lens Options

For both the basic and enhanced plans, standard scratch-resistant coating lenses are covered in full. (Discount varies by provider.) The Enhanced Plan covers the following additional lens options in full: standard progressive lenses, standard anti-reflective coating, polycarbonate lenses, ultraviolet coating, glass coating, tints.

Contact Lens Benefit

Covered-in-full elective contact lenses: The fitting/evaluation fees, contact lenses and up to two follow-up visits are covered in full (after copay). If you choose disposable contacts, up to four boxes are included when obtained from a network provider. For the Enhanced Plan, up to six boxes are covered.

Laser Vision Benefit

UnitedHealthcare Vision has partnered with the Laser Vision Network of America (LVNA) to provide our members with access to discounted laser vision correction providers. Members receive 15% off usual and customary pricing, 5% off promotional pricing at over 500 network provider locations and even greater discounts through set pricing at LasikPlus locations. For more information, call 888-563-4497 or visit us at www.uhclasik.com.

Take a look at the table to evaluate which of the options may be

right for you.

Out-of-network benefits are available with fixed reimbursement directly to you after submission of legible, detailed paid-in-full receipt. (Please be sure to include your ID number, name, home address, and patient’s name and date of birth with claim submission.)

Please note: You will incur less out-of-pocket expense if you see an in-network vision provider. To find an in-network vision provider, please visit www.myuhcvision.com.

http://www.myuhcvision.com

In-network, covered-in-full benefits (after applicable copay) include:• a comprehensive exam

• eye glasses with standard single vision

• lined bifocal or lined trifocal lenses

• standard scratch-resistant coating and

the frame or contact lenses in lieu of

eye glasses

Refer to the chart on the previous page, it provides a summary of some of the in-network

services and costs.

Please visit https://benefits.gwu.edu for additional details.

Nearly 1 out of every 2 adults experience at least one chronic condition, many of which an eye exam can help diagnose.

Getting an eye exam plays a critical role in your overall health!

Learn more about the vision options available: https://benefits.gwu.edu/vision-benefits

DID YOU KNOW?

Your Vision Coverage Options | 29


https://benefits.gwu.edu/vision-benefits

https://benefits.gwu.edu/vision-benefits

30 | Your Dental Coverage Options

Caring for your teeth and

keeping your smile healthy

can help ensure the rest of

your body stays healthy as

well. Retirees are eligible

to choose from three

dental plan options.

The GW dental plans are

“stand-alone” plans, so

you can enroll in dental

coverage whether or

not you have medical

coverage through GW.

YOUR DENTAL COVERAGE OPTIONS

AETNA DENTAL PPO PLANS — HIGH AND LOW OPTIONSGW offers a choice of three voluntary dental plans through Aetna. Review and compare the details below to find out which option may be right for you.

As with any PPO plan, the Aetna Dental PPO plans are designed to provide you with a greater level of coverage for using service providers within the Aetna network. Some coverage is available for providers outside the Aetna network; however any services you receive from an out-of-network provider will be paid only at the “Reasonable and Customary” amount.

The High Option provides you with a greater level of coverage, and therefore carries a higher premium. The Low Option provides you with preventive and basic coverage and has a lower premium. Take a look at the table below to evaluate which of the PPO options may be right for you.

Percentages in the accompanying chart represent the percentages of the negotiated amounts (in-network) and reasonable and customary amounts (out-of-network) covered by the plan.

High Option Dental PPO Low Option Dental PPO

In-Network Out-of-Network In-Network Out-of-Network

Annual Deductible(Individual)

$50 $50 $50 $50

Annual Deductible(Per Family)

$50(Max 3 per family)




Annual Maximum Coverage*(Per Person Per Year Combined In- and Out-of-Network)

$1,500 $1,500 $1,000 $1,000

Preventive Care**oral examinations, cleanings, x-rays, etc.

100% 100% 100% 100%

Basic Care**silver/composite fillings, root canals, stainless steel crowns, some extractions, some oral surgery, general anesthesia, etc.

90% 80% 80% 70%

Major Care**inlays, onlays, crowns, full & partial dentures, denture repairs, pontics, implants*** core build-up, etc.

50% 50% Not Covered Not Covered

Orthodontia(Children only combined in- and out-of-network)

50%(Lifetime max $1,500)

50%(Lifetime max $1,500)

Not Covered Not Covered

* Under the Aetna PPO High or Aetna PPO Low plans, preventive care services do not apply toward your annual maximum.

** Services shown are a partial list. For a complete list, see your Dental Plan Benefits Summary, available at https://benefits.gwu.edu.

*** Implants are covered under the PPO High Option Only.

To review 2017 contribution rates for Dental Coverage, please refer to page 34.

Take a look at the table to evaluate which of

the PPO options may be right for you.


Aetna Dental Maintenance Organization (DMO)

You also have the option of selecting coverage

through the Aetna DMO, which provides benefits

in a similar manner to an HMO medical plan.

You must elect a Primary Care Dentist (PCD) from

within the Aetna network to coordinate all your

dental care.

To be effective on the first of the month, Primary

Care Dentist (PCD) selections must be received

by Aetna by the 15th of the month prior. In order

to schedule an appointment with your PCD, your

name must appear on his/her monthly roster.

If your PCD believes you need to visit a dental

specialist, he or she will refer you to a specialist in

the DMO network.

The DMO does not provide coverage outside the

Aetna network. There is no deductible to meet

under the DMO, nor is there an annual maximum

coverage amount. Office visits require a $5 copay.

Orthodontic services are available for both adults

and children, and require a $2,300 copay.

REASONABLE AND CUSTOMARY:Dental providers who

participate in the Aetna

network have agreed

to accept a standard

level of payment for

their services. This is

called the “Negotiated”

amount. Providers who

are not in the network

may charge more than

the “Reasonable and

Customary” amount,

however, your coverage

will not pay more than

that amount. You will

be responsible for the

difference.

Your Dental Coverage Options | 31

Preventive dental

care can help

reduce health risks.

Periodontal disease

has been linked

to heart disease,

diabetes and

preterm birth.

DID YOU KNOW?

32 | Life Insurance

Active faculty and staff receive group term life insurance in an amount equal to their annualized salary, rounded to the next highest thousand dollars. The maximum amount of coverage is one times salary or $500,000, whichever is less.

Please note: age reduction provisions apply for active employees age 70 and older. Please see the life insurance certificate for details.

• On your retirement date, the life insurance coverage is reduced to 80% of the life insurance in effect on your last full day of active work, rounded up to the nearest $1,000.

• On July 1 coinciding with or next following the anniversary of retirement, the life insurance coverage is reduced to 60% of the life insurance in effect on your last full day of active work (not rounded), or $2,500 if age 70

• On July 1 coinciding with or next following the second anniversary of retirement, the life insurance coverage is reduced to 40% of the life insurance in effect on your last full day of active work (not rounded) or $2,500 if age 70

• On July 1 coinciding with or next following the third anniversary of retirement, the life insurance coverage is reduced to 20% of the life insurance in effect on your last full day of active work (not rounded) or $2,500 if age 70

• On July 1 coinciding with or next following the fourth anniversary of retirement, the life insurance coverage is reduced to $2,500

Example 1: An employee with a life insurance benefit of $104,000 prior to retirement at age 60:

• On the date of retirement the benefit reduces to $84,000

• On July 1 following the 1st anniversary of retirement the benefit reduces to $62,400

• On July 1 following the 2nd anniversary of retirement the benefit reduces to $41,600

• On July 1 following the 3rd anniversary of retirement the benefit reduces to $20,800

• On July 1 following the 4th anniversary of retirement the benefit reduces to $2,500

Example 2: An employee with a life insurance benefit of $104,000 prior to retirement at age 68:

• On the date of retirement the benefit reduces to $84,000 (age 68)

• On July 1 following the 1st anniversary of retirement the benefit reduces to $62,400 (age 69)

• On July 1 following the 2nd anniversary of retirement the benefit reduces to $2,500 (age 70)

Premiums for retiree group term life insurance are fully paid by the university. Premiums paid by GW for benefits in excess of $50,000 are taxable to active employees and to retirees, and are reported on form W-2 each year. While you are an active employee, this information appears on your regular W-2 from GW. Once you are retired GW will generate and mail to you a special W-2 for the purposes of reporting this benefit.

For additional details on the coverage available (including age reduction provisions), and to determine when EOI applies, please visit https://benefits.gwu.edu/life-insurance.

LIFE INSURANCE

https://benefits.gwu.edu/life-insurance

CONTRIBUTION RATES

Dental and UHC Vision Coverage | 33

To review the 2017 Retiree Medical Contribution Rates, please visit https://benefits.gwu.edu/annual-open-enrollment (Scroll down and select "Retirees").

Dental Coverage

Coverage Categories Monthly

DMO

Retiree Only $21.64

Retiree + One $49.45

Retiree + Family $59.84

High PPO

Retiree Only $53.05

Retiree + One Dependent $115.04


Low PPO

Retiree Only $31.74



UHC Vision Coverage

Coverage Categories Monthly

Basic

Retiree Only $4.99

Retiree + One $9.24


Enhanced

Retiree Only $7.24




34 | Page Info Name

Plan

Discove

r

Decide

Explo

re

DECIDE

PlanLe

arn

Compare

Decide

Explo

re

Compare

November 15, 2016 is the LAST day to make changes for 2017. Remember: Open Enrollment is the only time you can make changes to your benefits or covered dependents unless you have a qualified life event.

HOW TO ENROLL

ADDING A DEPENDENTIf adding a dependent for the first time, submit your dependent documentation to the GW Benefits Administration Department, 45155 Research Place, Suite 160, Ashburn, VA 20147 by Wednesday, November 30, 2016. Please note that dependent enrollment is pending until documentation is received and verified.

ENROLLMENT DEADLINE

To make the most of your GW benefits, you’ll need to make informed choices using

the information in this guide. You will receive an enrollment packet from PayFlex.

PayFlex will be mailing you an Open Enrollment packet.

• Included in this packet will be a cover letter and an enrollment form.

• Please be sure to review this information, change or select new benefits,

and return your completed information to PayFlex.

• Please note: Your enrollment form must be returned to PayFlex and

postmarked no later than November 15, 2016.

• If you have any questions regarding the enrollment process, premiums, or

billing, please contact PayFlex at (800) 359-3921, visit www.payflex.com, or

send correspondence to the address below:

PayFlex Systems USA, Inc.

P.O. Box 953374

St. Louis, MO 63195-3374

• Reminder: All of your eligible 2016 benefit elections (medical, dental,

and vision) will roll over to 2017; if you are currently in the Choice Plus

Basic Plan, you will be automatically enrolled in the Retiree HSP. If you

do not wish to make any changes, no action is needed; however, we

do recommend that you review your current elections to ensure they

still provide the coverage you need. Please remember that changes

made during this period become effective January 1, 2017.

• Please note that if you choose not to continue medical coverage, you

will not be eligible to participate in the GW medical plan in the future.

• Please contact the GW Benefits Call Center at (888) 4GWUBEN (449-8236) with any questions you have during the Open Enrollment period.

Using the EasyEnroll System | 35

36 | Important Contact Information

IMPORTANT CONTACT INFORMATION

Who to Call Contact InformationPlan Information (if applicable)

Medical

UnitedHealthcare (Customer Service & Nurseline)

877-706-1739 • www.myuhc.com Nurseline: (800) 846-4678

Group# 730193

Dental

Aetna 877-238-6200 • www.aetna.com Group# 622758

Prescription Drug

CVS Caremark877-357-4032 • www.caremark.comFastStart for maintenance prescriptions 800-875-0867

Group# RX6475

Vision

UnitedHealthcare VisionCustomer Service: 800-638-3120 Provider Locator: 800-839-3242 www.myuhcvision.com

Enrollment Process, Premiums and Billing

PayFlex 800-284-4885 • www.payflex.com

Retirement Plans https://benefits.gwu.edu/retirement-savings

Fidelity Investments 800-343-0860 • www.NETBENEFITS.com/GW

TIAA-CREF 800-842-2776 • www.tiaa.org/gwu

Life Insurance

The Standard855-554-2918www.standard.com

Number: 649377

Wellness Benefits

Wellbeing Hotline 866-522-8509 • go.gwu.edu/well

Health Advocate 866-695-8622 • healthadvocate.com/gwu

http://www.myuhc.com

http://www.aetna.com

http://www.caremark.com

http://www.myuhcvision.com

http://www.payflex.com

https://benefits.gwu.edu/retirement-savings

http://www.NETBENEFITS.com/GW

http://www.tiaa.org/gwu

http://www.standard.com

http://go.gwu.edu/well

http://healthadvocate.com/gwu

IMPORTANT CONTACT INFORMATION

Who to Call Contact Information

GW Departments

Benefits Call Center 888-4GWUBEN (449-8236)

Benefits Administration Department 571-553-8382 • https://benefits.gwu.edu

Important Contact Information | 37


38 | Notes

NOTES

Notes | 39

40 | Page Info NameBEN_1617_1

Documents

PLAN LEARN EXPLORE COMPARE DECIDE - GW Benefits · Benefit What you’ll have in 2017 if you don’t act during Open Enrollment: Retiree Choice Plus Basic plan (including pharmacy)