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Benefits
Eastern Washington University
Cheney, WA 99004
phone: 509.359.2488
fax: 509.359.2874

Choosing a Medical Plan

During the first 31 days of eligibility and at the annual open enrollment, EWU employees may choose among the managed care plans and the preferred provider plan (Uniform Medical Plan). Benefits for the managed care plans are for the most part standardized to make plan selection easier. Be sure the plan you want is available where you live.

The main differences among the managed care plans are:

  • the affiliated doctors and hospitals,
  • if the plan offers what are called Extended Network Benefits,
  • the premium deduction from the employee's pay, if any, for the coverage, and
  • where in the state the plan offers services.

If you choose a medical plan because you were covered by that plan with another employer, the coverage will not be the same. The contracts are specific to the employer. It is your responsibility to know the limits of your coverage under the state insurance contracts.

To add or remove a dependent from your health insurance, you must complete a new Medical/Dental enrollment form and return it to the Benefits Office. Be sure to complete the form in its entirety - this will replace all previous forms. Usually this must be done within 30 days of the qualifying event.

Managed Care Plans vs Uniform Medical Plan

Managed Care Network Plans require that you receive services through your primary care physician. This physician must be in the plan's network of providers, and will coordinate all of your referrals for service beyond his or her care.

Managed Care Extended Network Plans allow more flexibility for self-referral with an extended network of benefits. There may be additional costs if you choose to use the extended network of benefits, such as a deductible or additional copays. However you can access the extended network without a referral from your primary care physician.

Uniform Medical Plan is a preferred provider medical plan. There are preferred providers available to encourage you to choose lower-cost providers and services. The plan is self-insured by the State of Washington, which uses a third party administrator to provide claims services. The Uniform Medical Plan allows you to choose when to go to the doctor and who to see. However this flexibility makes it more expensive than the managed care plans.

The Managed Care plans have been standardized for the most part, so your initial comparison when making a choice of plans should be between the Managed Care Plans or the Uniform Medical Plan. If you believe a Managed Care plan will work best for you, the next level of choice is between the managed care plans themselves.

Doctors
A primary distinction between medical plans is the doctors and facilities available on the plan. If your doctor, hospital or clinic elects to join a plan's preferred provider network, you can obtain services from that doctor subject to the limits of the plan contract. If you have a specific doctor you wish to use, contact that doctor for information about the plans with which he or she is affiliated. If there is more than one of the plans available through that doctor, ask which plan the doctor prefers.

Claims
Managed care medical plans use very few claim forms. The doctors, labs, and pharmacies, file most necessary claims directly.

The Uniform Medical Plan provides this service if you are using a preferred provider. A non-preferred provider may or may not file claims for you. You can either download the Uniform Medical claim form from the Uniform Plan Web Site or request the form be sent via the mail.

Click here to contact your Medical Plan.

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