Washington University offers eligible employees up to five 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 five options provide coverage for the same medical services, are administered by UnitedHealthcare and include prescription drug coverage through Express Scripts. 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 five health plan options.
2022 Health Plan Options: IN-NETWORK BENEFITS
|EPO||POS||HDHP PPO||Excel PPO||Basic PPO|
|Annual Calendar Year Deductible|
|Annual Out-of-Pocket Maximum*|
|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%|
|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%|
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|
|Office Visits: |
|Office Visits: Specialist||$25||$25||10%||10%||10%|
Inpatient facility charges will apply
|No cost to member||No cost to member||0% after deductible||0% after deductible||0% after deductible|
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%|
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).
Need Help? ALEX, a benefit education tool, is available to assist you with deciding which benefit plans are best for you.
Walk through plans with this benefit education tool.
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.
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.
Prescription drug benefits are included as part of your health care package when you are enrolled in a university health plan. Learn More
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.
You may be eligible for personalized continuation of coverage packet after your employment is terminated at the university. Learn More