1. Use Preventive Care Services
Routine preventive care exams can prevent disease and detect disease early. Obtaining regular preventive care exams and screenings is key to achieving and maintaining good health. In accordance with preventive care guidelines established by the U.S. Preventive Services Task Force and other health organizations, the following routine screenings and immunizations* are recommended for adults age 18 and older:
|Blood pressure||Regular screening|
|Cervical cancer screening (Pap Smear)||Every 3 years for women beginning at age 21|
|Cholesterol (Lipid) test||Regular screening for men age 35 & older; women age 45 & older; or younger if increased risk of coronary heart disease|
|Colorectal screening||Routine screening beginning at age 50|
|Diabetes screening||Regular screening for asymptomatic adults with sustained blood pressure greater than 135/80|
|Gestational diabetes screening||Screening for asymptomatic pregnant women after 24 weeks of gestation|
|Hepatitis C Screening||Screening for persons at high risk for infection|
|HIV Screening||Screening for all pregnant women; adolescents and adults ages 15 to 65|
|Mammography||Screening for adult women of standard risk every one to two years beginning at age 40|
|Osteoporosis screening||Routine screening for women age 65 and older|
|Zoster (shingles) vaccine||For those over age 60|
To illustrate the university’s commitment to promoting the prevention and early detection of disease and helping employees and their family members achieve and maintain a healthy lifestyle, the university’s health, dental, prescription drug and vision benefits plans include coverage for preventive care services. The university’s health plans cover preventive health exams, screenings, immunizations and women’s preventive health services, as defined by federal law, with no in-network cost sharing. The university’s prescription drug plan covers certain preventive prescription and over-the-counter medications, vaccines, and contraceptives with no cost sharing, subject to age and gender restrictions. Additional information on covered preventive health services can be found in the plan documents for our health, dental, prescription drug and vision plans.
2. Use In-Network Providers
Make sure that your doctor, dentist, retail pharmacy, vision provider, or the medical facility you visit is an in-network provider. In-network providers have rate agreements with the insurance vendors for services rendered. If you use an in-network provider, our plans will pay a greater share of the total costs. If you use an out-of-network provider and you’re enrolled in a PPO plan or the POS plan or High Deductible Health Plan (HDHP), your health plan will pay a smaller share of the total costs, and you’ll be responsible for charges above the network rate agreements. If you use an out-of-network provider and you’re enrolled in the HMO/EPO plan, you’ll be responsible for the total charges unless it is a medical emergency and you’ve contacted UHC within 48 hours of receiving emergency care at an out-of-network hospital emergency room. If you use an out-of-network dental provider, the dental plan will pay a smaller share of the total costs, and you’ll be responsible for charges that exceed Delta Dental’s maximum allowable cost. If you use an out-of-network vision provider, you will need to pay for the services/products in full and then file a claim with VSP for reimbursement up to certain amounts.
To locate in-network providers, do a provider search on the applicable insurance vendor website:
myUHC.com – select UnitedHealthcare Choice or UnitedHealthcare Choice Plus as plan
- Delta Dental
- Express Scripts
Express-scripts.com – select Locate a Pharmacy
- Vision Service Plan
3. Use WUDirect© Providers
WashU health plan participants have priority access for initial appointments with Washington University’s network of over 1300 physicians. Seeing a WUDirect© physician will help lower your out-of-pocket costs through reduced co-pays and co-insurance. A listing of the WUDirect© physicians is available at WUdirect.wustl.edu.
4. Urgent Care Centers vs. Hospital Emergency Rooms
You can save both time and money by visiting an urgent care center rather than going to a hospital emergency room for non-emergency medical conditions like the flu, sore throat, ear or sinus infections, minor cuts, sprains, strains, and minor broken bones. Hospital emergency rooms should be utilized only in cases of severe or life-threatening illnesses or injuries such as severe head injury, chest pain, major burns or broken bones, breathing difficulty, excessive bleeding or extreme pain that arises suddenly. The medical staff at urgent care centers can treat injuries or illnesses that require immediate care but are not serious enough to be considered life-threatening. Visits to hospital emergency rooms for non-emergency situations can result in very lengthy waits for service and in greater out-of-pocket expense, compared to urgent care center visits. Under the HMO/EPO and POS plans, the co-pay for a visit to a participating urgent care center is just $35, compared to the $150 emergency room visit co-pay. While the in-network co-insurance rate under the HDHP and PPO plans is the same for urgent care center and hospital emergency room visits (20% after the applicable plan deductible has been satisfied), the charge on which the co-insurance rate is based will be much lower at an urgent care center than a hospital emergency room.
5. Convenience Care Clinics
These clinics, often located in malls or retail drug stores, are staffed with nurse practitioners and physician assistants who can diagnose and provide immediate limited treatment for minor illnesses such as colds, seasonal allergies, bronchitis, ear or sinus infections, minor cuts and skin rashes. No appointments are necessary at these convenient walk-in clinics, which are frequently open 7 days a week, including evenings and weekends. Under the HMO/EPO and POS plans, the co-pay for a visit to a participating walk-in health care clinic is $25. Under the HDHP and PPO plans, such visits are subject to the applicable plan deductible and co-insurance rates (20% in-network/40% out-of-network).
6. Establish a relationship with a Primary Care Physician
Although Washington University’s health plans do not require you to designate a primary care physician or obtain a referral from a primary care physician to see a specialist, establishing a relationship with a primary care physician is an important step in promoting good health. Your primary care physician can provide both a first contact for you with an undiagnosed health concern as well as continuing care for varied medical conditions, not limited by cause, organ system, or diagnosis. Your primary care physician can educate and advise you on health-related conditions, healthy behaviors, self-care skills and treatment options, as well as provide health screenings and immunizations.
7. Resources/Tools You Can Use
WashU’s Wellness Connection is an initiative of the Office of Human Resources to promote evidence-based, data-driven wellness programs for faculty, staff, postdoctoral appointees and clinical fellows. Our goal is to design and deliver wellness initiatives that meet you where you are, while fostering holistic growth: physically, emotionally, financially, socially and spiritually. We aim to provide ample opportunities for you to set high standards for personal health decision-making, to promote consistent community support, and to advocate for public health policies that will be a positive example for our students and our community. Learn more
8. Resources Available Through Your Health Plan and Prescription Drug Plan Carriers
Washington University in St. Louis Health Plan Participants (claims administered by UHC)
Register on myUHC.com to find in-network providers, to view your benefits and claims, and to:
- Set up and manage a personal health record for you and your family members.
- View a list of discounts on health-related products and services available to UHC participants
- Enroll in the Healthy Pregnancy Program for access to nurses and educational resources 24 hours a day, 7 days a week
- Use the treatment cost estimator to obtain an estimate of the costs of various procedures in your area
You can find preventive care guidelines specific to your age and gender by visiting UHCpreventivecare.com.
Express Scripts Prescription Drug Plan Participants
If you are enrolled in any of our health plans, you are automatically covered under the Express Scripts Prescription Drug Plan. Register on Express-scripts.com to locate a participating retail pharmacy, to view your benefits and claims, and to:
- Price a medication for determining your co-pays or co-insurance for retail and mail-order supplies
- Access My Rx Choices to review potential lower-cost alternatives to your medications.
- Find information on a variety of diseases and conditions through the Health Resource Center
- View detailed drug information
- Use the resources and tools in the “For Your Doctor Visit” section to gather information to assist your doctor in choosing the medications that are right for you