Open Enrollment is your annual opportunity to reflect upon your current benefit elections and make any needed changes for the upcoming year. During this period, you may add or remove eligible dependents, and change your benefit elections, with most changes going into effect on January 1, 2020.
With this year’s Open Enrollment period fast approaching, you may be reevaluating your current medical plan. Keep reading to learn more about GW’s medical plans and identify what questions to ask when deciding which plan to choose.
Medical Plan Options:
GW offers two medical plan options: GW Preferred Provider Organization (PPO) and GW Health Savings Plan (HSP). Both plans share the UnitedHealthcare (UHC) Choice Plus network, featuring more than 930,000 professionals*, 195,000 counselors and mental health practitioners**, and 5,600+ hospitals.
Both the GW PPO and the GW HSP allow you to visit your doctor of choice, with no requirements for selecting a Primary Care Physician to coordinate your care and no need to obtain referrals for specialty care. Both plans cover in- and out-of-network services (you pay less out-of-pocket for services received in-network), and include 100 percent coverage for in-network preventive care. Take a closer look at the coverage for some of the most common services provided under the GW PPO and GW HSP with this medical comparison chart (PDF).
There are a couple of things to keep in mind when examining the two medical plans. Carefully review the Summaries of Benefits and Coverage (SBCs) and Summary Plan Descriptions (SPDs) for both plans to understand what’s covered (and what’s not) under both plans. Moreover, while premiums may be lower for the GW HSP, your annual deductible and out-of-pocket maximum will be higher:
2019 Deductibles (In-Network)
- GW HSP: $2,000 (individual) and $4,000 (family)
- GW PPO: $750 (individual) and $1,500 (family)
2019 Out-of-Pocket Maximums (In-Network)
- GW HSP: $4,000 (individual) and $7,900 (family)
- GW PPO: $3,000 (individual) and $6,000 (family)
Making Decisions
There are several factors that you may be thinking about when it comes to your medical plan. For example, would you prefer to pay less per paycheck but pay more out-of-pocket at the time of a medical service (your deductible for medical and prescription under the HSP), or pay more per paycheck and less out-of-pocket at point of service (under the PPO)? Remember, under both plans, you’ll pay less if you use providers that belong to the plan’s network. Tip: Check out this health costs worksheet (PDF) to compare your coverage options and estimate your potential costs.
In addition, depending on which plan you choose, you may be eligible to elect a Health Care Flexible Spending Account (FSA) or a Health Savings Account (HSA) to help offset the cost of qualified expenses.
FSAs and HSAs
The Health Care FSA and HSA allow you to set aside money from your paychecks on a pre-tax basis to pay for eligible out-of-pocket expenses. You are only eligible to participate in the HSA if you are covered under a high deductible health plan, such as the GW HSP. In contrast, you do not need to be covered under a GW health plan in order to elect the Health Care FSA.
Other major differences between the Health Care FSA and the HSA include the following:
- GW makes a matching contribution to your HSA (but not to your Health Care FSA). If you have individual HSP coverage, GW will match your HSA contribution on a dollar-for-dollar basis up to $600; if you have family HSP coverage, GW will match your HSA contribution on a dollar-for-dollar basis up to $1,200.
- FSAs are “use to or lose it,” meaning that you forfeit any unused balance at the end of the plan year, and you must re-enroll in the FSA each year. In contrast, HSA contributions will accumulate as they roll over from year to year and an HSA is employee-owned, meaning it stays with you even if you change medical plans, jobs or move to another state.
- HSA contribution amounts can be changed at any point throughout the year, while FSA contribution amounts can only be changed during Open Enrollment or if you experience a Qualified Life Event (QLE).
As you begin to prepare for Open Enrollment 2020 and start thinking about which medical plan may be right for you for, take into consideration whether the Healthcare FSA or the HSA would be a good fit for you and your family.
*As of September 30, 2018
**Optum national behavioral provider network count as of July 2018
