Health Insurance

Washington University offers eligible employees several health plan options from which to choose from. Note: the options available to you depend on whether you are a faculty member, staff member, Clinical Fellow, Postdoctoral Appointee or union employee. See the applicable guide below for information regarding eligibility, rates and the options that may be available to you.

All options provide coverage for the same medical services, are administered by UnitedHealthcare and include prescription drug coverage through Express Scripts.

Health Plan Options

How much you pay out-of-pocket in premiums, deductibles, copays and/or coinsurance varies by option. The following table summarizes the in-network benefits under each of the health plan options.

2024 Health Plan Options: IN-NETWORK BENEFITS

	EPO	POS	HDHP PPO	Excel PPO**	Basic PPO
Annual Calendar Year Deductible
Individual	None	None	$1,600	$500	$750
Family	None	None	$3,200	$1,500	$2,250
Annual Out-of-Pocket Maximum*
Individual	$1,500	$1,500	$3,000	$2,000	$3,250
Family	$3,000	$3,000	$6,000	$4,000	$6,500
Copayments and/ or Coinsurance	You pay	You pay	Annual deductible must be met before coinsurance applies. Then, you pay:	Annual deductible must be met before coinsurance applies. Then, you pay:	Annual deductible must be met before coinsurance applies. Then, you pay:
Office Visits: Primary care	$25	$25	20%	20%	20%
Office Visits: Specialist	$50	$50	20%	25%	25%
Virtual Visits/ Telehealth	$25	$25	20%	20%	20%
Urgent Care Visits	$35	$35	20%	20%	20%
Emergency Room Care	$150 (waived if admitted)	$150 (waived if admitted)	20%	20%	20%
Lab and X-ray Services: Preventive	$0	$0	$0	$0	$0
Lab and X-ray Services: Non-preventive	10%	10%	20%	20%	20%
Lab and X-ray Services: Major radiologic diagnostic	20%	20%	20%	20%	20%
Inpatient: Hospital, Rehab, Skilled Nursing	$500	$500	20%	20%	20%
Surgery: Inpatient	$0	$0	20%	20%	20%
Surgery: Outpatient	$250	$250	20%	20%	20%
Maternity: Prenatal office visit	$0	$0	$0	$0	$0
Maternity: Lab tests/ultrasound	10%	10%	20%	20%	20%
Maternity: Inpatient delivery	$500	$500	20%	20%	20%
Therapy Services***	$50	$50	20%	20%	20%

2024 Health Plan Options: WUDirect Benefits

The following table summarizes the in-network benefits if you use a WUDirect physician:
In-network annual deductible may apply.

Under WUDirect	EPO	POS	HDHP PPO	Excel PPO**	Basic PPO
Copayments and/or Coinsurance	You pay:	You pay:	The annual deductible must be met before coinsurance applies. Then, you pay:	The annual deductible must be met before coinsurance applies. Then, you pay:	The annual deductible must be met before coinsurance applies. Then, you pay:
Office Visits: Primary care	$15	$15	10%	10%	10%
Office Visits: Specialist	$25	$25	10%	10%	10%
Therapy Services*	$25	$25	10%	10%	10%
Bariatric Surgery	10%	10%	10%	10%	10%
Kidney Dialysis Inpatient facility charges will apply	No cost to member	No cost to member	0%	0%	0%
Infertility Lifetime benefit: $30,000 for medical and $15,000 for prescription drugs	20% up to lifetime benefit	20% up to lifetime benefit	20% up to lifetime benefit	20% up to lifetime benefit	20% up to lifetime benefit
Hip and Knee Replacement Inpatient facility charges will apply	No cost to member	No cost to member	10%	10%	10%

Eligibility, Rates & Plan Comparisons

In some cases, employees who would not otherwise be eligible for benefits may become eligible for the university’s health plan under the Affordable Care Act (ACA).

Enrollment Period

Eligible employees may enroll within 31 days after their date of hire, during the annual open enrollment (in November) and/or within 31 days (62 days for birth of baby) after a qualified family status change or life event.

Effective Date

Benefits eligible rehires and new hires become eligible for coverage on their date of rehire/hire. Changes made to benefit coverage due to a life event or job change into a benefits-eligible role will also be effective as of the date of the event. Changes made during the annual Open Enrollment period in November are effective January 1 of the subsequent year.

To Find a UHC Provider

To find a UHC network medical or mental health provider near you, visit the myuhc.com website and follow these instructions:

1. Select Find a Provider
2. Select Medical Directory
3. Select Employer and Individual Plans
4. Select Shopping Around
5. Select the “Choice” network if you are in theEPO health plan; select the “Choice Plus” network if you are in the POS, High Deductible Health Plan (HDHP), Basic PPO or Excel PPO health plan.

Prescription Drug Coverage

Medical Coverage for International Business Travel through GeoBlue

Health Care Benefit Notices

The university is required to provide you with important information regarding eligibility and enrollment, benefit coverage, COBRA rights, HIPAA privacy rules, and whether the university’s prescription drug coverage qualifies as creditable coverage for Medicare.

• View full regulatory benefit notices
• Contact the benefits office to request paper copies

COBRA Insurance

You may be eligible for personalized continuation of coverage packet after your employment is terminated at the university. Learn More