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2017Benefits Guide
Choice Access Service
savings & discount program
Table of ContentsIntroduction 3Enrolling in Your Benefits 4Medical 7Choosing a Medical Plan 12Additional Medical Plan Details 14Health Advocate 15Dental 16Choosing a Dental Plan 17Vision 18Flexible Spending Accounts 20Disability Insurance 22Life Insurance 23Tuition Assistance Program (TAP) 25Retirement Benefits 26When You Leave Georgetown University 28GUAdvantage 29GUWellness 31Legal Notices 32Other Benefits 432017 Insurance Premiums 44Georgetown Benefits Directory Back Cover
TABLE OF CONTENTS INTRODUCTION
We are a service-oriented team providing the global Georgetown community and their families with benefits. We uphold the mission of Georgetown University by promoting a productive workforce, offering varied benefits choices, easy access to information and excellent service in order to meet the individual needs of our community. By doing this, we believe in serving the whole person.
Benefits Service Center, Main Campus, M-31 Darnall Hall8:30 am – 5:00 pm, Monday – Friday
[email protected]://benefits.georgetown.edu
1-202-687-2500
Need support making your benefits decisions?Need help making your elections in GMS?
All benefits and enrollment questions should be directed to the Office of Faculty and Staff Benefits.
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TABLE OF CONTENTS INTRODUCTION
Welcome to your Benefits Guide for 2017Welcome to Georgetown University!
It is a pleasure and an honor to have you join our community. The work you do here will further Georgetown University’s mission of creating and communicating knowledge, educating men and women to be reflective lifelong learners, and to be in service to others. That is important work!
The concept of Cura Personalis, or Care for the Whole Person, is central to who we are as an institution of higher learning and as an employer. Whether you are maintaining good health, managing a chronic illness, planning for retirement, pursuing education, caring for young children or aging parents, the Office of Faculty and Staff Benefits is here to offer you resources and assistance in your endeavors. It’s the privilege of the Office of Faculty and Staff Benefits to support your well-being through the benefits, programs, resources and services we provide.
I invite you to take the time to review this guide and the information available at http://benefits.georgetown.edu. If you have questions, contact our office by phone (1-202-687-2500) or email ([email protected]). We understand that the nitty gritty of health insurance, retirement savings and other benefits can be confusing, complex and, at times, stressful. We will strive to provide you with the information you need to make the best choices for you and your family.
In addition to being Chief Benefits Officer, I consider myself to be the Chief Wellness Officer and invite you to explore the resources available through GUWellness: Mind, Body, Soul and the GUAdvantage savings and discount program. Whether you’re looking for wellness for your body, brain, spirit or wallet, chances are you’ll find something to support you. I encourage you to join me for my weekly wellness walk on Thursday afternoons at 12:30 pm in Healy Circle. I’d love to walk with you!
Thank you for your service to Georgetown University. We look forward to supporting you by providing you with excellent choice, access and service during your time here on the Hilltop.
Be well,
Charles DeSantis Associate Vice President for Benefits, Payroll and WellnessChief Benefits Officer
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ENROLLING IN YOUR BENEFITS
PlanEmployment Category
Faculty AAP Staff* Fellowl Medicall Health Advocate – Receive assistance with wellness, health care and
insurance-related issuesl Dentall Visionl Flexible Spending Accounts (FSAs) – Health Care and Dependent Carel GUAdvantage – Discounts on health and wellness, travel, electronics,
restaurants, movies and more at www.beneplace.com/georgetown
– MetLife Voluntary Insurance Programs: Accident, Auto and Home, Critical Illness and Legal
– Bright Horizons Care Advantage: Find the perfect caregiver for your family
Yes, for those hired to work at least 75% time
Yes, for those working 30+ hours per week
Yes**
l Disabilityl Basic Life/AD&Dl Supplemental, Spouse and Child Lifel Voluntary AD&Dl Business Travel Accident
No
l Tuition Assistance Program (TAP) Yes, for those hired to work at least 90% time
Yes, for those working 36+ hours per week No
l Defined Contribution Retirement Plan (DCRP) Yes, for those hired to work at least 50% time
Yes, for those working 20+ hours per week No
l Voluntary Contribution Retirement Plan (VCRP)***l GUWellness: Mind, Body, Soul Yes
*”Staff” includes all non-Union and Union represented non-academic employees, with the exception of Temporary Employees, Hoya Temps and Student Employees. For information about benefits available to those other groups, visit http://benefits.georgetown.edu. **Only Law Center fellows are eligible for dental insurance. ***If you are already contributing the maximum allowable amount to your VCRP and have a base salary of $200,000 or more, you are also eligible to participate in the 457(b) Retirement Plan. Contact the Office of Faculty and Staff Benefits for more information.
Your Benefits and Eligibility At-a-GlanceEligibility for coverage under the various benefit plans is based upon your employment category, as shown below.
Coverage for your dependent children is described below.Plan Age LimitationMedical*Kaiser Signature HMO – Until age 26CareFirst BlueChoice Advantage POS – Until age 26 (until age 30 if a full-time student)UnitedHealthcare Choice Plus PPO – Until age 26 (until age 30 if a full-time student)CareFirst BlueChoice Advantage CDHP with HSA – Until age 26 (until age 30 if a full-time student)DentalDelta Dental Standard or Enhanced PPO – Until age 19 (until age 30 if a full-time student)Aetna DMO – Until age 19 (until age 30 if a full-time student)VisionEyeMed Vision Care Select – Until age 19 (until age 25 if a full-time student)Dependent LifeMetLife – From 15 days of age until age 23
– Until 25 if a full-time student– Excludes children for whom the employee is the legal guardian
*Patient Protection and Affordable Care Act mandates coverage for married and unmarried dependents to age 26.
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ENROLLING IN YOUR BENEFITS ENROLLING IN YOUR BENEFITS
New EmployeesBenefits orientations are held at 9:00 am each Tuesday in Darnall Hall, M-31. New faculty and staff are encouraged to attend so they can learn about the available benefits and how to enroll. To register for orientation, visit http://benefits.georgetown.edu.
Enrollment in the following benefits is not automatic: medical*, dental, vision, flexible spending accounts, supplemental life insurance, spouse/child life insurance, voluntary accidental death & dismemberment (AD&D), and MetLife voluntary insurance programs through GUAdvantage.* Please refer to the section titled Health Care Reform and Your Health Insurance Options for important information about your medical coverage at Georgetown University and the Patient Protection and Affordable Care Act.
We encourage you to enroll promptly so you have access to your benefits as soon as they take effect. Plan ID cards are usually sent within two to three weeks of enrollment; however, you can seek care before having them in hand. Just call your insurance company or register on the vendor’s member website to obtain your ID number.
Making Benefit Elections in Georgetown Management System (GMS)Log in to the GMS website at http://gms.georgetown.edu using your NetID and password. As an alternative, you can download Georgetown’s mobile app (from the App Store or Google Play) and make your elections directly from the app.
l In your GMS inbox, select the option to enroll in benefits. Open the “Benefit Change Event” in your GMS inbox.
l Elect or waive coverage for each option and select “Continue” when you are sure your selections are accurate.
l You will need the date of birth, Social Security number and address for each dependent and/or beneficiary you wish to include. You will also need to submit documentation via GMS that verifies the eligibility of your dependent (such as a birth or marriage certificate).
l Submit your elections after reviewing and completing each page.
You can also make your retirement plan elections through GMS. After you enroll, you will receive account information from the vendor and can change your allocations any time through the vendor’s website.
Continuing CoverageIf you have insurance coverage that is continuing beyond the effective date of your Georgetown coverage, you may waive the Georgetown-sponsored plans and, when your medical, dental and/or vision coverage terminates, you may enroll as a qualifying event. This allows you to maintain continuous coverage without paying premiums on overlapping coverage. To enroll as a result of a qualifying event, you will need to provide supporting documentation that verifies the loss of other coverage. Supporting documentation should be uploaded into GMS. You will also have the opportunity to enroll in or change plans during Open Enrollment.
Making Changes During the YearGenerally, after you make your medical, dental, vision, flexible spending account, supplemental life insurance, spouse/child life insurance and voluntary AD&D elections, you may change those elections only during Open Enrollment. However, if you experience a qualifying event during the year and you notify the Office of Faculty and Staff Benefits within 60 days of the event, you may change certain benefit plan elections before the next Open Enrollment. For more information on making changes during the year, refer to the Qualifying Events Matrix at https://benefits.georgetown.edu/enrolling/benefitschanges or contact the Office of Faculty and Staff Benefits.
New Hire Enrollment and Effective Date RulesYou have 60 days from your date of hire to enroll in your benefits through the Georgetown Management System (GMS). Medical, dental, vision, flexible spending account, supplemental life insurance, spouse/child life insurance and other voluntary benefits elected will take effect on either: a) the first of the month following your date of hire; or b) on your date of hire (if your date of hire is the first of the month). If your life insurance election requires you and/or your spouse to submit an EOI form (see page 24), coverage above the allowed amount will take effect on the date MetLife approves insurability. Basic life insurance, basic AD&D insurance, business travel accident (BTA) insurance, short term disability/salary continuance, long term disability and retirement benefits are effective on your date of hire.
If you do not enroll for coverage when you are first eligible, you may not do so until a future Open Enrollment except as summarized in the Making Changes During the Year and the HIPAA Special Enrollment Rights sections of this guide. Please note that attending a Benefits Orientation session does not automatically enroll you in any of the University’s benefits.
If you need assistance enrolling in your benefits, contact the Office of Faculty and Staff Benefits.
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Open Enrollment Open Enrollment offers you the opportunity to review and make changes to your benefit elections for the upcoming year. Open Enrollment is held in the fall (typically mid-October through mid-November). During this time you may enroll and make changes to your benefits using GMS.
You Will Need to Take Action During Open Enrollment If:
l You want to make changes to your medical, dental, vision, supplemental life (for you), dependent life (for your legal spouse/child) and/or other voluntary insurance coverage
l You want to add or remove coverage for your dependents
l You want to enroll (or re-enroll) in a flexible spending account (health care or dependent care) or a health savings account
ENROLLING IN YOUR BENEFITS
Enrolling Your DependentsCertain plans allow you to cover your eligible dependents. In this event, if you are covered under a plan, you may also elect coverage for your legal spouse/legally domiciled adult (LDA) and your eligible dependent children.
l Legal spouse.
l LDA. For medical, dental and vision coverage only, instead of covering a legal spouse, you may cover another qualified adult member of your household. A qualified adult member of your household is an LDA if he/she is an individual over age 18 who has for at least six months lived in the same principal residence as you, remains a member of your household throughout the coverage period and who:
– EITHER has a close personal relationship with you (not a casual roommate or tenant), shares basic living expenses and is financially interdependent with you, is neither legally married to anyone else nor legally related to you by blood in any way that would prohibit marriage and is neither receiving benefits from an employer nor eligible for any group coverage, OR
– Is your blood relative who meets the definition of your tax dependent as defined by Section 152 of the Internal Revenue Code during the coverage period and is neither receiving benefits from an employer nor eligible for any other group coverage.
In no event may you have medical, dental or vision coverage for both a legal spouse and an LDA. This applies to both blood and non-blood related LDAs. There may be tax and other legal implications for those who elect coverage for an LDA. You are encouraged to consult with an attorney before electing LDA coverage. Refer to http://benefits.georgetown.edu or page 44 of this guide for more information regarding imputed income.
l Children. Dependent children include your natural children, legally adopted children, children for whom you are the legal guardian, stepchildren who are dependent on you for support and children for whom you are the proposed adoptive parent from the date of placement.
Georgetown reserves the right to require documentation of a dependent’s eligibility at any time.
If you do not enroll your dependents for coverage when you are first eligible, you may not do so until a future Open Enrollment except as summarized in the Making Changes During the Year and the HIPAA Special Enrollment Rights sections of this guide.
Enrolling in your retirement plans: You can enroll in and make changes to your retirement plans at any time during the year. See the Retirement Benefits section of this guide for more details.
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MEDICAL
Medical Plan Options Kaiser Signature HMOwww.kp.org 1-800-777-7902Kaiser Permanente provides and coordinates complete health care services in the Washington, D.C. metropolitan area through new, state of the art medical centers in Capitol Hill in Washington, D.C., Tysons Corner, Virginia, and Gaithersburg, Maryland. The newest medical center (Baltimore Harbor Medical Center) is in the heart of Baltimore City, Maryland and features nine provider offices and 17 exam rooms with clinical services for internal medicine/family practice, pediatrics and OB/GYN, as well as laboratory, pharmacy and general radiology, including mammography.
Care for members is focused on total health and guided by more than 1,100 personal physicians, specialists and teams of caregivers working within Kaiser Permanente’s 29 medical centers. These expert and caring medical teams are supported by industry-leading technology advances, electronic medical records and tools for health promotion, disease prevention, pioneering integrated care delivery and world-class chronic disease management. There are no deductibles or claims to file. Most services are provided for a nominal copayment.
CareFirst BlueChoice Advantage POSwww.carefirst.com 1-877-691-5856 This national point-of-service (POS) plan offers the cost savings of an HMO with the freedom of a PPO. By using an in-network provider, you will receive a higher level of benefits, your out-of-pocket expenses will be lower and you will not be required to fill out any claim forms. Your in-network provider will obtain any precertification you may need.
When you receive non-network benefits, you are responsible for coordinating your own medical care, and you may pay more than you would in-network. You may visit any provider, however, your out-of-pocket costs will be lower if you select a Blue Cross Blue Shield (BCBS) participating provider.
The CareFirst BlueChoice Advantage POS plan is available to participants living anywhere in the United States and allows those participants living and traveling outside of the D.C. metropolitan area to receive in-network benefits from BlueCard® PPO providers.
Kaiser Permanente Video Appointments
You can coordinate secure and private video appointments in Maryland, Virginia, and Washington, D.C. during regular office hours with your primary care physician at no extra cost. Your doctor can send prescriptions to the pharmacy for you, order lab tests and x-rays, and schedule your follow-up appointments. For more information, contact Kaiser Permanente.
CareFirst Patient-Centered Medical Home (PCMH) Program
When you sign up for the PCMH program, your doctor or nurse practitioner will have a more complete view of your health needs. In addition, if you have a chronic condition – such as diabetes, coronary artery disease, or hypertension – or are at risk for one, the PCMH program will provide extra care by creating a care plan based on your health needs. If you have a chronic condition, you will be provided with specific follow-up activities as well as access to a care coordinator (i.e., a registered nurse) so you have the support you need, answers to your questions and information about your care. To learn more about the PCMH program, discuss with your doctor and visit www.carefirst.com/memberpcmh.
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MEDICAL
CareFirst BlueChoice Advantage POS (Continued)www.carefirst.com 1-877-691-5856
How the BlueChoice Advantage POS Plan Works
l If you are a participant receiving care within the local D.C. metropolitan area (Maryland or Northern Virginia) – you may seek in-network care through the BlueChoice network. You also have the option to receive care from non-network providers (both BCBS participating and non-participating) at a higher expense.
l If you are a participant receiving care or traveling outside of the local D.C. metropolitan area (Maryland or Northern Virginia) – you may seek in-network care through a BlueCard® PPO provider. You also have the option to seek non-network care, but it may be at a higher expense.
How Do I Find a BlueCard Provider? When you’re outside of the Maryland, D.C. and Northern Virginia area and need care, call BlueCard Access at 1-800-810-BLUE (2583) to locate the nearest BCBS doctors and hospitals. You can also search for providers electronically using the BlueCard Provider Finder at http://provider.bcbs.com. Why Should I Seek In-Network Care? l Lower out-of-pocket costs
l No balance billing
l No need to file claims
l Free preventive health services
UnitedHealthcare Choice Plus PPO www.myuhc.com 1-888-332-8885The UnitedHealthcare (UHC) Choice Plus plan is a PPO plan that allows you to see any doctor in their network – including specialists – without a referral. UHC has a national network of providers; however, you may use any licensed provider you choose. Your level of coverage is determined each time you receive care, depending on whether you use a network or non-network provider. Your out-of-pocket costs under both levels of coverage may include office visit copayments, deductibles and coinsurance.
UnitedHealthcare Virtual Visits
You can coordinate secure and private virtual visits with a doctor by logging in to your personal account on www.myuhc.com. Most visits take about 10-15 minutes and doctors can write prescriptions, if needed, that you can pick up at your local pharmacy. For more information, contact UnitedHealthcare.
CareFirst Video VisitsAccess a doctor 24/7 when your primary care provider (PCP) is unavailable. CareFirst video visits allow you to securely connect with a doctor whenever and wherever you want with a smartphone, tablet or computer. Video visits cost the same as your PCP office visit copay (up to a maximum of $60). Register today – it’s easy!
1) Visit www.carefirst.com/needcare and click on any of the video visit links, or
2) Download the CareFirst Video Visit app from the App Store.
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MEDICAL
A good practice for those venturing into the high deductible world is to:
l Take the money you are saving on your monthly premium (which can be substantial) and contribute it to your HSA
l Use the money in your HSA to cover your out-of-pocket expenses (medical, prescription drug, dental and vision)
If you don’t have any expenses – i.e., you only require preventive care and no unexpected medical needs arise – your HSA contributions can be saved and accessed when you need them later (there’s no “use it or lose it” with HSAs).
Don’t forget to visit your doctor for your clinically-recommended screenings and annual checkups, and talk to your provider about ways in which you could improve your overall health through preventive measures.
Remember, certain preventive services are covered at 100%, regardless of whether or not you’ve met the deductible when accessed in-network. Contact CareFirst for more information.
CareFirst BlueChoice Advantage Consumer-Directed Health Plan with Health Savings Account www.carefirst.com 1-877-691-5856This Consumer-Directed Health Plan (CDHP) combines your medical coverage with a Health Savings Account (HSA). An HSA is a long-term investment tool that can help you save for health care expenses both now and into retirement.
This plan:
l Offers the same flexible network access as the BlueChoice Advantage POS plan;
l Allows you the freedom to select any doctor;
l Comes at a lower monthly premium cost but has a higher deductible that must be met before the plan’s benefits will begin (the only exception is in-network preventive care, which is covered at 100% by the plan); and
l Provides you with access to a tax-advantaged account, known as a Health Savings Account or HSA, that can be used for qualified health care expenses.
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MEDICAL
What is a Health Savings Account?As the name implies, a Health Savings Account (HSA) allows you to save dollars to pay health care expenses (medical, prescription drug, dental and vision), now or in the future. But these accounts offer even more – here are some highlights:
l If you enroll, your HSA is owned by you and are 100% vested from day one. Any unspent funds will roll over to the next year, thus increasing your total account fund. Your HSA balance earns interest each month, and once you meet the minimum balance, you have the option to invest in nationally recognized mutual fund families. Your HSA dollars are yours to keep even if you change coverage, change employers or retire. You can use your account for retirement expenses when you reach age 65.
l HSAs are tax-advantaged. You do not pay taxes on contributions, interest and investment earnings, nor do you pay taxes on withdrawals for eligible expenses.
l Dollars you use from your account to pay for qualified health care expenses are not taxed and qualified medical and prescription drug expenses can be applied to your deductible. Funds in the account are easily accessed with the health care payment card. Or, you can submit withdrawal requests online when using the card is not convenient.
If you enroll in the CareFirst BlueChoice Advantage CDHP, an HSA will be automatically set up for you through ConnectYourCare, the HSA administrator. The IRS regulates HSAs, therefore, you must meet IRS eligibility rules in order to contribute to an HSA. In 2017, the maximum annual HSA contribution for self-only coverage is $3,400 NEW and $6,750 for family coverage.
For more information, visit http://benefits.georgetown.edu to view the Health Savings Account Enrollment Guide or log in to www.carefirst.com/myaccount.
Important!Unless you are receiving in-network routine preventive care, this plan requires you to meet your deductible before the plan pays for any benefits, including prescription drugs.
Contributing to Your HSAIf you want to contribute to the ConnectYourCare HSA, you must actively enroll through GMS.
If you are already enrolled in the CareFirst CDHP with HSA, GMS requires you take action to re-elect your HSA contribution each year, even if you make no changes to your CDHP coverage. This means that during Open Enrollment, you must enter your desired annual HSA contribution in GMS for the following calendar year if you want to contribute to your HSA.
You cannot enroll in a Health Savings Account if:
l You, or another member of your household, are enrolled in a Health Care Flexible Spending Account (FSA) for 2017; or
l As of January 1, 2017, you have an unused balance in your 2016 Health Care FSA; or
l You are enrolled in Medicare Part A or B.
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MEDICAL
CareFirst BlueChoice Advantage CDHP with HSA Benefits at a Glance
Certain In-NetworkPreventive ServicesThe plan pays 100%.
Preventive Services: Services that are identified as recommended preventive services under federal law, such as routine physicals, mammograms, colonoscopies, immunizations and screenings. Certain in-network services are covered at 100%.
Health Savings Account (HSA)You fund your HSA with pre-tax contributions and you decide when to use HSA dollars toward eligible health care expenses.
HSA: An interest-generating savings account that allows you to use pre-tax contributions to pay eligible health care expenses (medical, prescription drug, dental and vision), now or in the future.
DeductibleThe amount you must pay out of pocket for covered expenses,
including pharmacy, before benefits begin.
Deductible: The amount you must pay out of pocket for covered expenses before plan benefits begin. CDHP participants can use HSA dollars toward eligible health care expenses, while satisfying the deductible.
CoinsuranceOnce the deductible is met, both you and the plan share the
cost. You pay less by using in-network providers.
Coinsurance: The percentage you and the plan pay for covered expenses after the deductible is met. The plan pays a higher percentage (90% of eligible expenses) when you use in-network providers (70% of eligible expenses for non-network providers).
Out-of-Pocket LimitOnce your payments reach a set limit, the plan pays 100% of
eligible expenses for the rest of the calendar year.
Out-of-Pocket Limit: A safety net that limits how much you pay out of pocket for deductibles, coinsurance, and medical and prescription drug copayments ($6,000 for individual only/$12,000 for family) for covered expenses each year.
Manage Your Health Care Budget with CareFirst's Treatment Cost Estimator ToolLog in to your personal account at www.carefirst.com/myaccount to compare costs on various procedures. Once logged in, select "Treatment Cost Estimator" under the "Tools" tab to:
l Receive personalized estimates on your total costs for procedures, office visits, lab tests and surgery
l Avoid surprises and save money by comparing costs from different providers, hospitals and medical facilities
l Plan ahead to keep health care costs under control and make decisions that will improve your health
You should also talk to your providers about the cost of your services as they may be willing to negotiate fees, accept payments in installments, or prescribe less expensive medications or treatment options.
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CHOOSING A MEDICAL PLAN
For all of the Georgetown-sponsored medical plans, certain in-network preventive care (as outlined by the Patient Protection and Affordable Care Act) is covered at 100%. However, if you seek preventive care
services from a non-network provider, charges may apply. Refer to the plan's Summary of Benefits and Coverage on http://benefits.georgetown.edu for more details.
Kaiser Signature
CareFirst BlueChoice Advantage
CareFirst BlueChoice Advantage
UnitedHealthcare Choice Plus
Plan Type HMO POS CDHP with HSA PPO
Key Features Network Network Non-Network* Network Non-
Network* Network Non-Network*
Annual Deductible (ded.)You Pay You Pay You Pay You Pay You Pay You Pay You Pay
l Individual onlyNone None
$1,000 $2,000 $3,000 $500 $1,000l Family $2,000 $4,000 $6,000 $1,000 $2,000Annual Coinsurance Limitsl Individual only
N/A$1,500 $5,000 $1,000 $3,000
N/A N/Al Family $3,000 $10,000 $2,000 $6,000Annual Out-of-Pocket Limits**l Individual only $2,250 $6,000 $6,000 $2,000 $4,000l Family $4,500 $12,000 $12,000 $4,000 $8,000Office Visit, Lab & Testingl Doctor office visit
(primary/specialty)$15/$25 copay $20/$40 copay
30% after ded. 10% after ded. 30% after ded.
$20/$30 copay
25% after ded.l Outpatient surgery $50 copay $50 copay 20% after ded.l X-ray & lab testing No charge $40 copay 20% after ded.l Specialty imaging $50 copay $50 copay 20% after ded.l Diagnostic services No charge $20/$40 copay 20% after ded.Inpatient Servicesl Hospital room &
board No charge$200 copay
30% after ded. 10% after ded. 30% after ded. 20% after ded.20% after ded.
l Physician/surgeon No charge 25% after ded.Emergency or Urgent Carel Emergency room $100 copay
waived if admitted
$100 copay waived if admitted
Paid as in-network
10% after ded.
Paid as in-network
$100 copay waived if admitted
$100 copay waived if admitted
l Ambulance $50 copay $50 copay Paid asin-network
Paid as in-network
20% after ded. Paid as in-network
l Urgent care $25 copay $40 copay $40 copay 10% after ded. $30 copay 25% after ded.Mental Health/Substance Abusel Inpatient services No charge $200 copay
30% after ded. 10% after ded. 30% after ded.20% after ded. 20% after ded.
l Outpatient services $15 copay $20 copay $20 copay 25% ded. waived
The following table provides a quick comparison of the benefits under each medical plan.
This summary is provided for general information only. Since exclusions, dollar, frequency, age limitations and medical necessity guidelines apply, you should refer to the specific plan documents for detailed information. *You are responsible for any non-network charges that exceed the plan’s allowable charge. **The out-of-pocket limit includes deductibles, coinsurance, medical copayments and prescription drug copayments.
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CHOOSING A MEDICAL PLAN
This summary is provided for general information only. Since exclusions, dollar, frequency, age limitations and medical necessity guidelines apply, you should refer to the specific plan documents for detailed information. *You are responsible for any non-network charges that exceed the plan’s allowable charge. **For all services and supplies (with the exception of preventive care), you are responsible for meeting your deductible ($2,000 for individual only/$4,000 for family) before the plan pays for any benefits, including prescription drugs.
Kaiser Signature
CareFirst BlueChoice Advantage
CareFirst BlueChoice Advantage
UnitedHealthcare Choice Plus
Plan Type HMO POS CDHP with HSA PPOKey Features Network Network* Network* Network*
You Pay You Pay You Pay You PayPrescription Drug BenefitsRetail 30-day supply 34-day supply 34-day supply 31-day supplyl Tier 1/Tier 2/Tier 3 $15/$25/$40 copay at
Kaiser facility $20/$45/$60 copay at
participating pharmacy
$10/$30/$50 copay After deductible**, copays apply: $10/$30/$50
$10/$30/$50 copay
Mail Order 30-day/90-day supply 90-day supply 90-day supply 90-day supplyl Tier 1/Tier 2/Tier 3 $13/$23/$38 copay
(30-day); $26/$46/$76 copay (90-day)
$20/$60/$100 copay After deductible**, copays apply: $20/$60/$100
$20/$60/$100 copay
What is a prescription drug formulary, how are drugs placed into a tier and how can it affect my wallet?A formulary is a list of drugs covered by a plan. Every plan creates its own formulary structure, decides which drugs it will cover and determines which tier a drug is on. The determination is based on what the plan pays for the drug after they negotiate pricing with drug companies. If a plan negotiates a lower price on a particular drug, it can place the drug in a lower tier and pass those savings on to its members. In general, the lowest-tier drugs are the lowest cost. It’s important to review the formulary to see whether the plan you have (or the plan you’re interested in) covers your prescriptions and how much they will cost because one plan may cover a drug that another does not. For example, a certain drug may be on tier 2 in one plan’s formulary and on tier 3 (or in some cases, not covered) in a different plan’s formulary.
The following table provides a quick comparison of the prescription drug benefits under each medical plan.
All of Georgetown’s medical plans have individual out-of-pocket limits “embedded” within family coverage (i.e., in the family out-of-pocket limit). This allows for individuals who have satisfied their plan’s individual out-of-pocket limit to have their eligible expenses paid at 100% even if the family out-of-pocket limit has not yet been met. All plans comply with the laws set forth by the Affordable Care Act.
Family Coverage How It WorksIndividual (Embedded) Out-of-Pocket Limit
Each individual has their own annual out-of-pocket limit. Any amount an individual pays toward their individual out-of-pocket limit also applies to the family’s out-of-pocket limit. Once an individual meets their out-of-pocket limit, the plan will pay 100% of their additional eligible expenses. No individual in a family will pay more than their individual out-of-pocket limit.
Family Out-of-Pocket Limit
Additionally, there is an annual family out-of-pocket limit. Once two or more covered family members have met the family out-of-pocket limit (in the aggregate), the plan will pay 100% of additional eligible expenses for the entire family. No family member can contribute more than the individual out-of-pocket limit.
Note: The out-of-pocket limit includes deductibles, coinsurance, medical copayments and prescription drug copayments.
Highest value Lowest value
• Lowestcost• Usuallyincludesgenericdrugs
• Mid-rangecost• Usuallyincludespreferredbrandnamedrugs
and may include higher cost generic drugs
• Highestcost• Usuallyincludesnon-preferredbrand
name drugs and may include some non-preferred generic drugs
Tier 1 Tier 2 Tier 3
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Medical Coverage While TravelingWhether you’re traveling domestically or internationally, participation in a Georgetown-sponsored medical plan will grant you coverage in the event of a true medical emergency. If you are traveling and receive emergency services, remember to retain all your receipts and related documentation. Call your insurance provider at your earliest opportunity to inform them of any emergency services received.
Prescription Drug BenefitsWhen you enroll in a medical plan, you receive comprehensive prescription drug coverage provided under your plan. Your copay varies (as shown in the prescription drug benefits comparison chart) depending on whether you are purchasing a tier 1, tier 2 or tier 3 drug and whether the drug is included in your plan’s formulary.
Save Money by Participating in the Health Care Flexible Spending Account
Don’t forget that you can pay for eligible, out-of-pocket expenses, such as deductibles and copays, with pre-tax dollars. Reminder: You cannot participate in a Health Care FSA if
you are enrolling in the CareFirst BlueChoice Advantage CDHP with HSA.
See the Flexible Spending Accounts section of this guide for more information.
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Mail Order Drug ProgramCosts can be high for prescription drugs taken on a continuing basis. Ordering drugs through the carriers’ mail order programs may help you reduce prescription drug costs for maintenance medications taken for conditions such as high blood pressure, arthritis or diabetes. Mail order programs allow you to receive up to a 90-day supply of medication at the copay shown in the prescription drug benefits comparison chart. Contact your insurance provider for more information.
ADDITIONAL MEDICAL PLAN DETAILS
Save Money with Your Prescription Drug Plan
l Use your plan’s mail order drug program for maintenance medications
l Check with your doctor about a generic option
l Discuss your plan’s preferred drug list (also known as “formulary”) with your doctor
l Determine which medication is most appropriate for you based on your condition and out-of-pocket costs
l Purchase your prescription drugs within your plan’s pharmacy network, as most plans provide limited benefits or don’t cover drugs purchased at non-network pharmacies
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14
HEALTH ADVOCATE
Health Advocate: Make the Most of Your Health Care and Health BenefitsGeorgetown University is excited to provide Health Advocate at no cost to you and your dependents. Dependent eligibility is defined in the program sections below.
Health Advocate, Inc. is the nation’s leading independent health care advocacy and assistance company. They are not affiliated with any insurance or third party provider nor do they replace health insurance coverage, provide medical care or recommend treatment.
Health AdvocacyThe Health Advocacy Program provides you and your eligible dependents (including your parents and parents-in-law) with unlimited phone or email access to a Personal Health Advocate. Personal Health Advocates are typically registered nurses, supported by medical directors and benefits and claims specialists, who can get to the bottom of a wide variety of health care and insurance-related issues.
Health Advocate is designed to help you and your family navigate the often complex health care system. For example, your Personal Health Advocate can help locate the right doctors, answer questions about your health benefits, sort out medical billing issues, research treatment options, secure second opinions, schedule tests and appointments, locate elder care services, facilitate access to Centers of Medical Excellence, and more. Contact Health Advocate today to connect with your Personal Health Advocate.
Medical Bill SaverIf you receive a bill for a service you have received, which has a remaining balance of more than $400 which is not covered by your insurance plan, Health Advocate’s special negotiating team will contact the medical provider and attempt to have your bill reduced. Simply call the toll-free number and ask to talk to a Medical Bill Saver Specialist.
Wellness CoachingThe Wellness Coaching Program provides you and your eligible dependents (your legal spouse and dependent children age 18 and older) with unlimited phone, email and instant messaging access to a certified Personal Wellness Coach. Your Personal Wellness Coach is available to guide you in your path toward better health.
You can also utilize online health tools, including:
l A confidential Personal Health Profile – Provides you with access to take a health risk assessment so that you can identify your health risks and create an action plan
l Wellness programs – Obtain tutorials, tip sheets and progress trackers for your fitness, exercise and weight management goals
l MedChoice SupportTM – Comparative, interactive tools to guide you step-by-step through key decisions about tests, procedures, treatments and medications
In addition, you can participate in interactive fitness competitions, seasonal campaigns and receive discounted gym memberships. All online health tools are available to you 24/7. Contact Health Advocate today to connect with your Personal Wellness Coach.
Learn More Your benefit can be accessed 24/7. Normal business hours are Monday – Friday, 8:00 am – 9:00 pm Eastern
Time. After hours and during weekends, staff is available for assistance. 1-866-695-8622 www.HealthAdvocate.com/georgetown [email protected]
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Find a DentistDelta Dental PPO Aetna DMO
Delta Dental PPO plans provide a dual network advantage. Participants usually save the most money when visiting a Delta Dental PPO dentist, but they also have access to Delta Dental Premier dentists, the largest dental network in the U.S. The Delta Dental Premier network provides additional cost protections for participants when compared to non-Delta Dental dentists because these dentists agree to accept Delta Dental’s determination of fees as payment in full.
Type of Provider ValueDelta Dental PPO best Greatest discounts, best value
Delta Dental Premier betterAccepts negotiated rate as “payment in full,” no paperwork, some discounts
Non-Delta Dental good Some reimbursement, subject to balance billing
When enrolling in the Aetna DMO, you are required tochoose a dentist for yourself and for each dependent youare enrolling. The Office of Faculty and Staff Benefitsrecommends the following when doing so:
l Contact the office of the dentist chosen from the DMO network
l Verify that the dentist is still a participant in the Aetna DMO network, and that he/she plans to participate for the entire year
l Verify that the dentist is still accepting new patients
DENTAL
Aetna DMOwww.aetna.com/docfind 1-800-843-3661The Aetna Dental Maintenance Organization (DMO) is a managed care program offering a network of area dentists. If you enroll in the Aetna DMO, you must select a dentist from the DMO network for all of your dental care. The DMO offers 100% coverage for all preventive care and most other services, with a $10 copay per visit. Orthodontia for dependent children under age 20 is covered at 50% under this plan (exceptions apply for services started under another plan). There is no deductible and no annual maximum on benefits.
DMO Versus PPOImportant considerations regarding the Aetna DMO:
l The DMO network is smaller than the PPO network
l To be effective on the 1st of the month, primary dentist selections must be received by Aetna by the 15th of the month prior; in order to schedule an appointment with your primary Aetna DMO dentist, your name must appear on their monthly roster
l There is no guarantee that your dentist will be participating for the entire year
Dental Plan OptionsDelta Dental PPOSM Plus Premierwww.deltadentalins.com 1-800-932-0783Delta Dental PPO, a preferred provider organization plan, offers Delta Dental’s lowest contracted fees and the greatest opportunities for enrollees to save when visiting network dentists.
Standard PPO PlanThis plan provides basic coverage for routine exams, cleanings and other basic and major services at an affordable premium. The plan pays up to $1,000 per member each calendar year. Orthodontia is not covered under this plan.
Enhanced PPO PlanThis plan provides expanded coverage, for all services, up to $2,000 per member each calendar year. In addition, the plan provides up to a $2,000 lifetime maximum orthodontia benefit for dependent children up to age 19.
CHOOSING A DENTAL PLAN
16
CHOOSING A DENTAL PLAN
Delta Dental dentists will not bill you for the difference between the contracted amount and their usual fee. This practice, known as “balance billing”, may occur with non-Delta Dental dentists.
The following table summarizes the key features of the benefits available under the dental plans.*
Delta Dental Standard PPO Delta Dental Enhanced PPO Aetna DMO
Key Features In PPO Network
Out of PPO NetworkIn PPO
NetworkOut of PPO Network
NetworkIn Premier Network**
Non-Network**
In Premier Network**
Non-Network**
Plan Maximums (Per Person)l Calendar yearl Orthodontia lifetime
$1,000N/A
$1,000N/A
$1,000N/A
$2,000$2,000
$2,000$2,000
$2,000$2,000
NoneNone
Annual Deductible (ded.)You Pay You Pay You Pay You Pay You Pay You Pay You Pay
l Individual onlyl Family
$50$100
$50$100
$50$100
$50$100
$50$100
$50$100 None
Diagnostic & Preventive Services
l Exams, cleanings, x-rays, sealants No charge 20%, no ded. 20%, no ded. No charge No charge
No charge up to the
allowable amt., ded. waived
$10 copay
Basic Services l Fillings, simple
extractions, non-surgical gum treatment
20% after ded.
20% after ded.
20% after ded.
10% after ded.
20% after ded.
20% after ded. $10 copay
Major Servicesl Crowns, inlays,
onlays, cast restorations, bridges, dentures, implants***, surgical gum treatment
40% after ded.
50% after ded.
50% after ded.
40% after ded.
50% after ded.
50% after ded. $10 copay
Orthodontic Services
l Children only Not covered Not covered Not covered 25%, no ded. (child to age 19)
25%, no ded. (child to age 19)
25%, no ded. (child to age 19)
50% (child under age
20)
This summary is provided for general information only. Since exclusions, dollar, frequency, age limitations and medical necessity guidelines apply, you should refer to the specific plan documents for detailed information. *Services and materials may vary from dentist to dentist. Check with your provider regarding coverage before seeking services. **Reimbursement is based on PPO contracted fees for PPO dentists, Premier contracted fees for Premier dentists and Premier contracted fees for non-Delta Dental dentists. ***Implants are not covered under the Aetna DMO plan.
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VISION
EyeMed Vision Care Selectwww.eyemed.com 1-866-723-0514 (members)1-866-299-1358 (non-members)This vision plan promotes preventive care through regular eye exams and early corrective treatment. This plan provides benefits for an eye exam and lenses once every 12 months and frames once every 24 months (see the next page for applicable copays). In addition, various discounts are available for elective contact lenses or other items not covered by the plan. The benefits are higher when you use a network provider.
Determine Your NeedsIf you are covered by a Georgetown-sponsored medical plan, you may be eligible to receive vision benefits through that plan. Depending on the extent of your vision needs, you may find that the benefits offered by your Georgetown-sponsored medical plan are sufficient. Use the below chart to assist you in determining whether EyeMed Vision Care Select is right for you:
In-Network Vision Benefits Through GU-Sponsored Medical Plans
Plan Routine Exam Eyeglass Frames and Lenses Contact Lenses Office Visits for Medical
Conditions of the EyeKaiser $15 per optometrist visit;
$25 per ophthalmologist visit*
25% discount from plan providers
15% discount on initial pair of contact lenses only
$15 per visit (PCP); $25 per visit (Kaiser specialist)
CareFirst POS and CDHP
$10 per visit (limited to one exam per benefit period)
Discounts from participating Davis Vision Centers
Discounts from participating Davis Vision Centers
$20 per visit (PCP); $40 per visit (network specialist)
UHC Not covered* Discounts available through UnitedHealth Allies
Discounts available through UnitedHealth Allies
$20 per visit (primary); $30 per visit (network specialist)
*100% coverage for in-network preventive care well child visits.
Find a ProviderThis plan utilizes the EyeMed Select network. The network includes approximately 40,000 providers at 18,500 locations. To locate a provider call EyeMed or visit www.eyemed.com. Glasses.com (www.glasses.com) and ContactsDirect (www.contactsdirect.com) are also network providers.
EyeMed’s Eye Site on Wellness WebsiteVisit www.EyeSiteOnWellness.com for information on:
l Tips for healthy visionl Eyewear style and carel Vision technologyl Interactive videos, quizzes and infographsl The latest on vision care from EyeMed
Why is Vision Insurance Important?According to the National Eye Institute, more than 11 million Americans have an uncorrected visual impairment that can impact their quality of life. By obtaining an eye exam each year, you can help prevent vision problems before they start. This may lead you to wonder, who should get an eye exam and why?l Babies: About 80% of what babies learn is through their eyes (schedule an eye exam at six months, between two and three
years old and before kindergarten)l Children: One in four children have vision problems that can interfere with learning and behavior (schedule an eye exam
once a year, preferably around the beginning of the school year to give your child a healthy start)l Adults: Even if you had laser vision surgery or have naturally good vision, you can still encounter vision problems (schedule
an eye exam once a year)l Seniors: As we age, we’re more susceptible to cataracts, glaucoma and macular degeneration (schedule an eye exam once a
year)l People with diabetes: Diabetes is the third leading cause of blindness in the United States (most diabetes-related blindness
can be prevented by an annual eye exam)l Contact lens wearers: Contact lenses are medical devices, so regular exams with your eye doctor and review of your
prescription are important (schedule a contact lens evaluation and fitting once a year)
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VISION
The following table summarizes the key features of the benefits available under the EyeMed Select vision plan.
EyeMed Plan Benefits Network Non-NetworkYou Pay Plan Allowance
Exam (with dilation as necessary) – Once every 12 monthsExam $0 copay Up to $35l Retinal imaging benefit Up to $39 NoneContact lens visitsl Standard contact lens fit and follow up Up to $40; then plan pays 100% Nonel Premium contact lens fit and follow up 90% of retail price NoneLenses (glasses or contacts) – Once every 12 monthsStandard plastic lensesl Single vision/bifocal/trifocal $15 copay Up to $25/$40/$55Lens optionsl Standard anti-reflective coating/UV treatment $10 copay Up to $5l Tint (solid and gradient)/standard plastic
scratch coating/standard polycarbonate for adults and kids under 19
$0 copay Up to $5
Contact lenses (material only)l Conventional
l Disposable
No charge if within $130 plan allowance; you pay 85% of balance over $130
No charge if within $130 plan allowance; you pay 100% of balance over $130
Up to $104
Up to $104
l Medically necessary No charge Up to $200Frames – Once every 24 monthsProvider’s available frames No charge if within $130 plan allowance;
you pay 80% of balance over $130Up to $65
Discounts Plan Allowance Plan Allowancel LASIK (or PRK) surgery 15% discount on retail or 5% off promotional
price from U.S. Laser NetworkNone
l Additional discounts 20% discount on items not covered by the plan; 40% discount on complete pair of eyeglasses;
Hearing discount program (see below)
None
This summary is provided for general information only. Since exclusions, dollar and frequency limitations apply, you should refer to the specific plan documents for detailed information. The benefits schedule reflects amounts paid by members for network benefits; however, for non-network benefits, the plan allowance is shown. The plan allowance is the maximum amount reimbursed by the plan.
Hearing Discounts through Amplifon*Did you know 1 in 9 Americans has hearing loss, and hearing and vision loss can go hand in hand? In fact, mature adults and diabetics are more likely to experience both. That’s why EyeMed provides its members with access to affordable hearing care discounts through Amplifon, the world’s largest distributor of hearing aids and services, including:
40% off hearing exams at thousands of convenient locations nationwide
Discounted, set pricing on thousands of hearing aids, including those with the
newest, most advanced technology
Low price guarantee – if you find the same product at a lower price elsewhere,
Amplifon will beat it by 5%
60-day hearing aid trial period with no restocking fees
Free batteries for 2 years with initial purchase
A 3-year warranty plus loss and damage coverage
Call 1-844-526-5432 to find a hearing care provider near you and schedule a hearing exam today.*This is not insurance. EyeMed contracts with Amplifon to provide only discounts for its members.
through Amplifon provides:
60
19
FLEXIBLE SPENDING ACCOUNTS
Flexible Spending Accountswww.connectyourcare.com 1-877-292-4040Flexible spending accounts (FSAs) are unique employer-sponsored tax-advantaged accounts authorized by the federal government that allow you to use pre-tax dollars to pay for out-of-pocket qualified health and dependent care expenses. The FSA plan is administered by ConnectYourCare. You may elect to participate in the Health Care FSA, which reimburses you for qualified health-related expenses that are not covered by your medical, dental or vision plans, and/or a Dependent Care Account, which reimburses you for qualified dependent care expenses that allow you (and your spouse) to work. The Health Care FSA and Dependent Care Account are two distinct accounts and money cannot be transferred between them. Refer to the chart below for details regarding eligible expenses permitted by each account.
Use It or Lose It At the end of the plan year, excess funds are forfeited. However, the IRS allows a grace period during which you may continue to incur expenses and get reimbursed from your previous year’s FSA balance. So, if you have money remaining in your FSA on December 31, 2017, you can use that 2017 balance on eligible expenses that you incur through March 15, 2018. You have until April 30, 2018 to submit those claims for reimbursement.
Health Care FSA Dependent Care AccountAdvantages l Pay for eligible, out-of-pocket expenses with pre-tax dollars
l Reduce your taxable income l Increase your take home pay
What’s Covered In general, health-related expenses that are not covered by a health (medical, dental or vision) plan
In general, dependent care expenses that allow you (and your legal spouse if you are married) to work
Eligible Expenses
Examples include:l Out-of-pocket costs (including deductibles,
copays and coinsurance) l Health care expenses not covered by your plan
and approved by the IRSl Over-the-counter medications that are
prescribed by a physician
Examples include:l Care you must pay for − Child day care for children under age 13 − Adult dependent day care − Dependent day care centers − Preschool expenses − Housekeeping services in your home for your
child or other qualifying individualRestrictions l Medical expenses that are not deductible under
IRS Section 213 may not be reimbursedl Over-the-counter drugs not prescribed by
a physician
l Expenses reimbursed under this plan may not be claimed as a federal tax credit on your tax return
l Important note: Do NOT enroll in this account thinking you can submit your child’s (or other dependent’s) health care expenses for reimbursement – it won’t work and you won’t be able to disenroll!
Maximum Annual Election $2,600 $5,000 (maximum per household)
Access to Funds Immediate access to annual election You may access these funds only as they are accrued
FSA plan contributions do not automatically roll over – you must re-enroll each year.
If you are enrolled in the CareFirst BlueChoice Advantage CDHP with HSA, you and your spouse CANNOT enroll in a Health Care FSA.
Did You Know?There are items that may not be covered under your medical, dental or vision plan, but if they are eligible expenses under the Health Care FSA, you can use your funds to pay for those items (which will save you, on average, 30% since you are contributing on a pre-tax basis).
Eligible ExpensesVisit www.connectyourcare.com/tools/eligible-expenses to view examples of eligible expenses.
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FLEXIBLE SPENDING ACCOUNTS
www.connectyourcare.comAs an FSA participant, you may track your account balances, pending and completed reimbursements, view account statements and much more.
Mobile FeaturesConnectYourCare offers a secure, interactive mobile application for Android, iOS, and Windows devices.
Features include:l View account balance, account alerts
and transaction history l View all claims, claims requiring
action and claims details l Submit a new claim and upload claim
documentationl Online bill pay
You can also register for mobile alerts so that you can be notified immediately if your health care payment card purchase requires additional documentation. Learn more about the mobile features by visiting www.connectyourcare.com/mobilevideo.
Learn more about FSAs at www.connectyourcare.com/fsavideo.
Health Care FSA: How to Pay at the Doctor, Dentist, Eye Doctor, or HospitalWhen you pay for health care at the doctor, dentist, eye doctor, or hospital, be sure to always present your health insurance ID card first to ensure proper processing of your charges.
l Copays: If you are asked to pay a copay, you may pay with your health care payment card, or you may pay out of pocket and request reimbursement from your account. Save your itemized receipt to submit as documentation.
l Additional charges: If you’re asked to pay additional charges, if possible, do not pay your provider until the claim is processed by your health plan and you receive your Explanation of Benefits (EOB) in the mail. This helps avoid overpayment. Compare your EOB with the provider bill to verify the amount being charged by your provider is the same as the patient balance on the EOB. Then, pay with your health care payment card, or pay out of pocket and request reimbursement from your account. You may send in your EOB or itemized provider bill as documentation.
Dependent Care Account: How to Pay Your Dependent Care ProviderIf you have a Dependent Care Account, you should pay for your qualified dependent care expenses out of pocket and request reimbursement from your account. You will need to submit your itemized receipt as documentation. Remember, receipts for these expenses must include the name of the dependent and the tax identification number of the dependent care provider.
Using Your AccountConnectYourCare makes it easy to access and use your account funds. There are two ways to pay for health care:
1. Use your health care payment card: This is the simplest way to purchase health care! Pay using your health care payment card and keep your itemized receipt as documentation, as you may be required to substantiate the expense. Then, log on to your online account to see if documentation is needed. If so, you may upload your supporting documentation directly, or download the manual claim form.
2. Pay out of pocket and request reimbursement: Pay using your own personal credit card, cash, or check and keep your itemized receipt as documentation. Then, log on to your online account to file for reimbursement. You may upload your supporting documentation directly, or download the manual claim form. You can receive reimbursement funds via check or direct deposit.
Set up direct deposit online to receive quicker reimbursements.
TIP
21
Short Term Disability (STD) All Staff
www.matrixabsence.com 1-866-533-3438STD benefits begin after you are unable to work due to an injury or illness and you have satisfied the required elimination period, as summarized in the chart below. This means that you must be disabled for at least 15 continuous business days (3 calendar weeks) before your STD benefits begin.
During the 15 day elimination period, you may use your accrued paid time off (PTO) days or unpaid sick leave days. If you have not accrued enough PTO days to cover your elimination period, the remainder of your waiting period will be unpaid. You must submit a time off request in GMS for your elimination period..
STD Benefits% of Weekly
EarningsElimination
PeriodMaximum
Benefit Period
All Staff 100%
15 continuous
business days (3 calendar
weeks)
10 weeks
Salary Continuance Faculty/AAP
Salary continuance is short term disability leave that is fully paid for, and administered, by your department. In addition to no elimination period, faculty members and AAPs are covered under the plan on the first day of work.
You will be expected to return to work after your disability period ends. Should you exhaust the disability leave period and your physician determines that you are unable to return to work due to disability, you may elect to file for long term disability (LTD) benefits. Contact the Office of Faculty and Staff Benefits for more information.
Long Term Disability (LTD) Faculty/AAP/Staff/SEIU 1199
http://benefits.georgetown.edu 1-202-687-2500 LTD benefits begin after you are unable to work, due to an injury or illness and you have satisfied the required elimination period, as summarized in the chart below.
LTD Benefits% of Base
PayElimination
PeriodMaximum
Benefit Period
Faculty/AAP/Staff
60% up to $15,000
per month90 days
Up to age 65 or Normal Retirement Age as defined
by Social Security Act (24 months for mental/
nervous disorders, substance abuse and self-
diagnosed disabilities)SEIU 1199 Members
60% up to $5,000 per
month
If you have a preexisting medical condition that causes a disability within 12 months after your effective date of coverage, benefits may be denied for that disability. Benefits are coordinated with disability benefits under other plans, such as Social Security and state disability programs.
Filing a Claim?STD claims should be filed directly with Matrix Absence Management. You can initiate your claim by calling 1-866-533-3438 or by visiting www.matrixabsence.com.
You can also file a claim by downloading the Matrix eServices Mobile app on your Apple or Android smart phone or device. After you register for an account, you can submit a claim, view your claim status and details, call and email your examiner, and more.
Need more help? Check out the GU Employee Disability Checklist at http://benefits.georgetown.edu.
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DISABILITY INSURANCE
Having a Baby? Short term disability may be used during your recovery. Maternity claims are approved for a total of eight weeks. Please note that for all STD claims, including maternity claims, your elimination period is 15 continuous business days which is equivalent to three calendar weeks.
After you have met the 15 continuous business days elimination period, typically, for maternity claims, benefits would be payable for five weeks. If you have significant complications and your doctor disables you for a longer period, you may be eligible for additional benefit payments up to two weeks. If your disability continues, you would transition into LTD benefits after the LTD elimination period has been satisfied. Contact the Office of Faculty and Staff Benefits for more information.
22
Basic Life/AD&D Insurance $20,000 / $20,000As an active Georgetown University employee, you are enrolled in MetLife’s Basic Term Life insurance in the amount of $20,000 and up to $20,000 of MetLife Basic Accidental Death & Dismemberment (AD&D) coverage – at no cost to you and with no medical questions asked. Basic AD&D insurance is a benefit payable in the event of your death or if you suffer a significant loss as a result of an accident. Georgetown University pays the entire costs of these benefits and enrollment in these plans is automatic.
Supplemental Life and Voluntary AD&D InsuranceMetLife’s Supplemental Life insurance and Voluntary AD&D coverages are employee-paid benefits that allow you to purchase additional financial protection for your loved ones. You can enroll for coverage within the first 60 days of your employment at Georgetown University and you can update your election(s) during the annual Open Enrollment period. Please refer to the Supplemental Life and Voluntary AD&D Insurance Options chart on the next page for more details.
Will Preparation and Estate Resolution Services (ERS)* If you are enrolled in MetLife’s Supplemental Life plan, you and your legal spouse have face-to-face and telephone access to the Hyatt Legal Plan network of over 14,000 participating plan attorneys – at no cost to you. You and your legal spouse will also have unlimited access to prepare or update a will, living will or power of attorney and your beneficiaries have the same access to probate an estate. You have the option to choose from a participating Hyatt Legal Plan attorney (in which all attorney fees will be fully covered with no claim forms to file) or you may select a non-network attorney and receive reimbursement for covered services according to a set fee schedule. After you are enrolled in MetLife’s Supplemental Life plan, you can contact Hyatt Legal Plan by calling 1-800-821-6400 (mention Georgetown University’s group number: 123529).
Beneficiary DesignationYour life insurance beneficiary serves a very important purpose – making sure your benefits are distributed as you intended. Without a valid beneficiary, the life insurance proceeds payable as a result of your death will be distributed according to the terms of the insurance contract. Please keep in mind that changes in your family situation (such as marriage, divorce, birth or adoption) do not automatically alter or revoke your beneficiary designation. You can change your beneficiary designation at any time throughout the year in the Georgetown Management System (GMS). Visit http://benefits.georgetown.edu for step-by-step instructions.
Important: Since GMS classifies this as a “Benefit Change”, it will take 1 – 2 days before it is reflected on your benefits screen in GMS. You will not need to submit your request multiple times.
LIFE INSURANCE
Did you know MetLife offers additional insurance programs through GUAdvantage? Refer to page 29 for more details.
Tools and ResourcesTo help determine how much coverage you need, use the online insurance calculator at www.metlifeiseasier.net.
8
Hartford Business Travel Accident (BTA)Georgetown understands you may be required to travel for University business purposes from time to time. It is for this reason that the University offers eligible employees access to employer-paid BTA coverage insured through Hartford that can help protect you when you are traveling for eligible business-related purposes. The maximum benefit payable is $750,000, subject to a $3.75 million maximum aggregate amount payable for any single accident. BTA benefits are in addition to your MetLife Basic Life and AD&D coverage, as well as any MetLife Supplemental Life and Voluntary AD&D coverage you may have. For more details, please contact the Office of Faculty and Staff Benefits.
* Included with MetLife Supplemental Life Insurance. Will Preparation and MetLife Estate Resolution Services are offered by Hyatt Legal Plans, Inc., a MetLife company, Cleveland, Ohio. In certain states, legal services benefits are provided through insurance coverage underwritten by Metropolitan Property and Casualty Insurance Company and affiliates, Warwick, Rhode Island. For New York sitused cases, the Will Preparation service is an expanded offering that includes office consultations and telephone advice for certain other legal matters beyond Will Preparation. Tax Planning and preparation of Living Trusts are not covered by the Will Preparation Service. Certain services are not covered by Estate Resolution Services, including matters in which there is a conflict of interest between the executor and any beneficiary or heir and the estate; any disputes with the group policyholder, MetLife and/ or any of its affiliates; any disputes involving statutory benefits; will contests or litigation outside probate court; appeals; court costs, filing fees, recording fees, transcripts, witness fees, expenses to a third party, judgments or fines; and frivolous or unethical matters.
Like most group insurance policies, insurance policies offered by MetLife contain certain exclusions, exceptions, waiting periods, reductions, limitations and terms for keeping them in force. Please contact the Office of Faculty and Staff Benefits or your MetLife Group Representative for costs and complete details.
23
LIFE INSURANCE
Supplemental Life and Voluntary AD&D Insurance OptionsThe following table summarizes the key features of the benefits available under voluntary life and accident insurance.
Plan Description Coverage Amount* Evidence of Insurability (EOI) Required?
Monthly Cost(per $1,000 of coverage
except for child life)Supplemental Life l For you
Complements your basic life insurance by providing additional coverage in the event of your death.Enhanced features include free Will Preparation service.
l 1, 2, 3, 4 or 5 times your salary
If the coverage amount is not a multiple of $1,000, then it is rounded to the next higher multiple of $1,000.
Maximum: $1 million.
If you are age 65 or above in the year 2017, see the automatic benefit reduction clause* below for important information.
During Open Enrollment- Yes, if you are increasing
coverage or enrolling for the first time.
When You Are First Hired- No, if your total election
does not exceed $500,000.- Yes, if your total election
exceeds $500,000.
Your age as of 1/1/2017 Under 25
25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70+
Rate
$0.05$0.06$0.08$0.09$0.10$0.15$0.23$0.29$0.43$0.84$1.36
Voluntary AD&D l For you
Complements your supplemental life coverage in the event of death due to accident or covered disabling injury.
This coverage can help replace lost income and lessen the impact of costs associated with serious injuries.
l $10,000 – $1 million (in increments of $10,000)
l EOI is not required. $0.015
l For you & your family
The amount of insurance for your family is based on a percentage of your insurance coverage amount:Legal Spouse- 50% of your coverage amount
if children are not covered.- 40% of your coverage amount
if children are covered.Children- 15% of your coverage amount
if legal spouse is not covered.- 10% of your coverage amount
if legal spouse is covered.
$0.025
Spouse Life Life insurance for your legal spouse.You must be enrolled in supplemental life if you wish to enroll in spouse life.
l $10,000l $30,000l $50,000l $100,000l $150,000l $200,000l $250,000Maximum: You may choose from the options above, up to a maximum of 50% of your supplemental life amount (rounded down to closest coverage option) or $250,000, whichever is less.
During Open Enrollment- Yes, if you are increasing
coverage or enrolling for the first time.
When You Are First Hired- No, if your total election
does not exceed $30,000.- Yes, if your election
exceeds $30,000.
Legal spouse’s age as of 1/1/2017Under 25
25-2930-3435-3940-4445-4950-5455-5960-6465-6970+
Rate
$0.05$0.06$0.08$0.10$0.12$0.17$0.31$0.49$0.87$1.50$2.37
Child Life Life insurance for your dependent child/ren from age 15 days to 23 years, or 25 years if a full-time student.
l $5,000 l $10,000
l EOI is not required. $0.75 per month$1.50 per month
(Regardless of the number of children covered)
This summary is provided for general information only since exclusions and limitations apply. Evidence of insurability may be required. *Life coverage is reduced according to an age reduction schedule beginning at age 65 (reduced by 35%) and at age 70 (reduced to 50% of the original amount). Although the face value of your coverage will decrease according to the age reduction schedule, your cost for the coverage will increase according to the premium rate associated with your age bracket (refer to the Monthly Cost column in the table above).
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*International institutions are subject to review before TAP-eligibility is determined. Contact [email protected] for more information.
TUITION ASSISTANCE PROGRAM (TAP)
Georgetown University offers tuition benefits to employees and their children through the Tuition Assistance Program (TAP).
These benefits can be used for:
l Studies at Georgetown University
l Other U.S. accredited degree-granting institutions
l Other accredited international degree-granting institutions*
l Undergraduate studies
l Graduate studies
Dependent Child TAP Benefit****At Georgetown
Dependent Child TAP Benefit
l 33% of GU tuition paid in the semester following parent’s completion of three years continuous, active full-time service in benefits-eligible position
l 67% of GU tuition paid in the semester following the parent’s completion of five years continuous, active full-time service in benefits-eligible position
l 100% of tuition paid if employee hired prior to December 31, 1995
Maximum Benefit for Children of Faculty, Staff & AAPs
l 8 semesters
At Other Eligible Academic InstitutionsDependent Child TAP Benefit
l 16.5% of GU tuition paid in the semester following parent’s completion of three years continuous, active full-time service in benefits-eligible position
l 33% of GU tuition paid in the semester following parent’s completion of five years continuous, active full-time service in benefits-eligible position
Maximum Benefit for Children of Faculty, Staff & AAPs
l 8 semesters
****Must qualify for admission independently. Dependent must be enrolled in undergraduate study only and be under 30 years of age.
Employee TAP Benefit**At Georgetown
Employee TAP Benefit
l 100% of tuition paidl Eligible in the semester following
completion of one year continuous, active full-time service in benefits-eligible position
Maximum Benefit for Faculty*** & AAPs
l 8 semesters
Maximum Benefit for Staff l 120 credit hours
At Other Eligible Academic InstitutionsEmployee TAP Benefit
l Based on the 2016-2017 academic year, the maximum benefit is:
- $2,589.58 per semester - $1,726.38 per quarter - $5,179.15 per academic year - $20,716.62 per lifetimeThe benefit amount is calculated using a formula based on Georgetown University’s undergraduate tuition, and therefore is adjusted annually. Visit http://benefits.georgetown.edu for updates.
l Eligible in the semester following completion of three years continuous, active full-time service in benefits-eligible position
Maximum Benefit for Faculty** & AAPs
l 8 semesters
**Must qualify for admission independently.***Faculty may use this benefit for graduate study only.
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RETIREMENT BENEFITS
Defined Contribution Retirement Plan 403(b)Who’s Eligible? l All faculty, staff and AAPs scheduled to work at least
20 hours per week or 50% time
l Staff who actively participate in GURP are not eligible to participate in this plan
l Adjunct faculty, fellows and temporary/on-call/student employees are not eligible to participate in this plan
With this plan, you and Georgetown University work together to invest in your future. Your retirement account balance grows based on:
l Your contributions,
l Georgetown University’s contributions, and
l Investment income on your total account balance.
Contributions to the plan (yours and Georgetown University’s) are made to your account every pay period, giving your account the opportunity to grow throughout the year. You decide how to invest your contributions by choosing among a variety of funds offered by Fidelity Investments, TIAA-CREF and Vanguard. All investment earnings and/or losses are reflected in your account. In-service withdrawals, including loans, are strictly prohibited under this plan.
Georgetown University automatically contributes 5% of your pay to the plan every pay period. You may contribute up to 3% of your eligible pay on a before-tax basis. Georgetown University will also contribute up to an additional 5% of your pay when you contribute to the plan.
If You Contribute:
Then GU Contributes: For a Total of:
0% 5.00% 5.00%1% 6.67% 7.67%2% 8.34% 10.34%3% 10.00%* 13.00%
*Eligible employees hired prior to 1996 and enrolled in the plan prior to 2009, may be eligible to receive a 12% contribution from the University.
Voluntary Contribution Retirement Plan 403(b)Who’s Eligible?All employees of Georgetown University.
This plan is similar to the Defined Contribution Retirement Plan except you do not receive contributions to your account from Georgetown University. Contributions to this plan are only limited by the annual contribution maximums outlined by the IRS; this annual maximum includes your combined contributions to both the Voluntary and Defined Contribution Retirement Plans.
This plan provides an opportunity for you to add to your retirement savings while decreasing current income tax. When you participate in the plan, you contribute to your account on a before-tax basis. You decide how to invest your contributions by choosing among a variety of funds offered by Fidelity Investments, TIAA-CREF and Vanguard. All investment earnings and/or losses are reflected in your account.
457(b) Retirement PlanWho’s Eligible?Employees who are already contributing the maximum allowable amount to their Voluntary Contribution Retirement Plan and have a base salary of $200,000 or more.
Contact the Office of Faculty and Staff Benefits for more information.
Visit http://benefits.georgetown.edu or contact the Office of Faculty and Staff Benefits at
[email protected] or 1-202-687-2500 for additional information.
For both the DCRP and the VCRP, you are immediately 100% vested in your account balance. Therefore, you are entitled to all the funds in your account when you leave the University, regardless of how long
you have been employed at Georgetown.
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To register, or for more information about these benefits and other financial workshops, go to
http://benefits.georgetown.edu.
Additional Retirement BenefitsFinancial CounselingRepresentatives from Fidelity Investments, TIAA-CREF and Vanguard are available to meet with you on-campus or by phone to help you meet your financial and retirement goals.
MetLife Retirewise®Offered twice each year, this comprehensive retirement planning seminar offers practical planning support and guidance. Whether you’re thinking of retiring in a year or ten years – this popular course will answer many of your questions from investing to Social Security to Medicare to the benefits available to you from Georgetown. You’ll also receive a complimentary one-on-one consultation with a specially-trained MetLife representative.
Financial Education ConferenceEach spring semester, the OFSB sponsors a month of seminars and workshops focusing on a variety of financial planning topics. Online education resources and financial wellness workshops are also held throughout the year.
Hoya Federal Credit UnionHoya Federal Credit Union is a member-owned, not-for-profit, financial institution, serving the Georgetown University community. Because HFCU is a not-for-profit financial institution, profits are returned to their membership in the form of low loan rates, low fees and high savings yields.
RETIREMENT BENEFITS
Retirement OrientationsSecond Wednesday of each month
9:30 – 11:00 amWhen you first join Georgetown University, you
attend a thorough orientation where you learn about the benefits available to you and your family. As you consider leaving Georgetown, and if you’re eligible for retiree benefits, you should receive an equally informative orientation on how to navigate the
retirement process. Come learn the basics about the benefits available to you in retirement so you can start
planning for your next chapter.
Taking the Leap Forward: Imagining Your Life After Retirement (Offered Each Fall and Spring)Ready to retire but don’t feel ready to retire? Join Jan Hice from Heart’s Joy Consulting to explore and envision what life after Georgetown might look like. Participants can expect to gain an awareness of the transition process and be engaged in imagining their future after retirement. This workshop addresses the emotions that come up in transition and the alignment required to create the life you’ve imagined. At the end of this 4-part series, you can expect to leave with a vision for this next phase of life and actionable steps to achieve it.
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WHEN YOU LEAVE GU
Terminated or Severance EmployeesAs you leave Georgetown University, you may have questions about what happens to your benefits. The following summarizes your eligibility for continued benefits after you leave. The information only applies to you if you were enrolled in the specific plan(s) upon separation. This summary is intended as a high-level summary and is by no means complete. If you would like more detailed information please contact the Office of Faculty and Staff Benefits.
Health, Dental and Vision InsuranceCoverage ends on the last day of the month in which your employment terminates. Under the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA) you may continue your group health, dental and/or vision insurance coverage for up to 18 months as long as you remit the required premium for the coverage period.
Life/Disability InsuranceCoverage ends on the last day of the month in which your employment terminates. You may be eligible to convert your group coverage to an individual policy with MetLife Insurance Co., the life insurance carrier, and/or Reliance Standard Life Insurance Co., the disability insurance carrier.
Flexible Spending AccountsCoverage ends the day on which your employment terminates. You can be reimbursed for expense incurred through your last day of employment. You have until December 31 (of the year in which your employment terminates) to submit claims. Any unused funds will be forfeited. You may choose to continue your participation in the Health Care FSA for up to 18 months under COBRA as long as you remit the required payment for the coverage period.
Defined Contribution Retirement PlanContributions made to this plan are immediately vested; however, there are rules regarding when and how these funds may be withdrawn. In order to initiate any type of distribution, contact the investment company(ies) for the specific forms.
Voluntary Contribution Retirement PlanContributions made to this plan are immediately vested. Details regarding your options under this plan are the same as those for the Georgetown University Defined Contribution Retirement Plan.
Georgetown University Retirement Plan (GURP)If you are vested in this plan upon termination, please contact the Office of Faculty and Staff Benefits for information regarding your benefits.
Tuition BenefitsIf you or your dependent(s) are using tuition benefits when your employment terminates, you will not be required to repay the benefit if it has already been dispersed.
Retiring Faculty & StaffWhen you terminate from the University after the attainment of age 55 and the completion of 10 years of continuous service in a benefits-eligible position, you are eligible for retiree benefits which include:
l Continuing your medical coverage through one of the retiree plan options (you must be enrolled at the time you retire),
l Voluntary dental insurance (must be enrolled in medical insurance),
l $5,000 face value of life insurance, and
l Tuition benefits for yourself or your dependent children.
All terminating faculty and staff, regardless of their age and years of service, are eligible for a distribution of their vested benefits from the Voluntary Contribution Retirement Plan, the Defined Contribution Retirement Plan and the Georgetown University Retirement Plan (“GURP”), as applicable.
TIAA-CREF: 1-800-842-2776The Vanguard Group: 1-800-523-1188Fidelity Investments: 1-800-343-0860
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The following programs require GMS enrollment within 60 days from your date of hire or during the Open Enrollment period. Premiums are paid through convenient payroll deductions.
MetLife Accident InsuranceAccidents happen frequently and can be very costly. Accident insurance payments can be used to help pay out-of-pocket expenses such as insurance deductibles, copays, transportation to/from medical centers, child care expenses and more. Plus, this coverage features guaranteed acceptance for you and other eligible family members.
MetLife Critical IllnessMetLife Critical Illness Insurance provides coverage for the following conditions: cancer, heart attack, stroke, kidney failure, Alzheimer’s disease, and many more. This insurance complements (does not replace) your existing medical and disability income coverage. It can help you create a plan to manage the costs of certain critical illnesses. These are the expenses your medical insurance, no matter how good, was not designed to cover.
Hyatt Legal Plans through MetLaw Group Legal PlanLegal matters, both planned and unplanned, are part of life. Enrolling in the Hyatt Legal Plan gives you, your spouse and dependents, the financial and emotional peace of mind to know you will be covered for expected and unexpected legal events. Whether you’re buying a new home, drawing up a will or just needing some legal advice, you’ll have easy access to experienced, local network attorneys who are just a phone call away. Save hundreds over typical attorney fees with no deductibles, no copays, no claim forms or usage limits when using a plan attorney. For more information, contact Hyatt Legal Plans at 1-800-821-6400 or visit https://info.legalplans.com and enter “GetLaw” as your Access Code in the “Thinking About Enrolling” section.
The following programs allow enrollment directly with the insurance provider year-round (i.e., you are not limited to the new hire or Open Enrollment period). Premiums vary based on type of coverage.
Veterinary Pet Insurance (VPI)A VPI policy covers a multitude of medical problems and conditions related to accidental injuries, poisonings and illnesses (including cancer) for your pets. Coverage helps pay for: diagnostic tests, office visits, prescriptions, treatments, x-rays, lab fees, hospitalization, and surgeries. To learn more and to enroll, visit the Georgetown Beneplace website (select the “Insurance” tab and scroll down to “Pet Insurance”) or call 1-877-PETS-VPI (1-877-738-7874). Note: No payroll deduction option is available (you will be billed directly each month).
MetLife Auto & Home InsuranceDid you know auto, home, renter’s and other policies can be renewed at any time during the year? MetLife can seamlessly cancel your other policy and get you started with your new coverage once the policy is bound! Protect yourself and your belongings outside of the office by obtaining a policy for your auto, home, renter’s, boat, recreational vehicle, condo, and more. You can pay your premiums through convenient payroll deductions. Contact MetLife at the number below for more information.
GU ADVANTAGE
GUAdvantage Online Discounts Through Beneplace
GUAdvantagesavings & discount program
The GUAdvantage website is your one-stop-shop for voluntary benefits and discounts! Need a new computer? GUAdvantage has deals from top names like Dell, IBM and HP. Going on vacation? GUAdvantage has discounts on car rentals, resorts, cruises and theme park tickets. Planning a night on the town? GUAdvantage can save you money on event tickets and dining out! Check out all that GUAdvantage has to offer by going to www.beneplace.com/georgetown.
Gowww.beneplace.com/georgetownBeneplace
For more information on the MetLife plans, call 1-800-GET-MET-8 (1-800-438-6388).
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GU ADVANTAGE
Bright Horizons Care Advantage
Georgetown University is excited to provide benefits-eligible faculty and staff with a resource to help you accomplish more balance in your work-life equation through America’s largest and most trusted online source for in-home caregivers with over one million nationwide caregiver profiles.
Your Bright Horizons Care Advantage benefit gives you unlimited access to Sittercity and Years Ahead, two nationwide resources for finding self-selected, pre-screened caregivers, every day care (babysitters and nannies) for children of all ages, elder care resources (planning and referrals), pet care (dog walkers and pet sitters), and more.
The program also includes preferred enrollment at Bright Horizons centers as well as tuition discounts at participating extended network centers, which may include La Petite Academy, Children’s Courtyard, ChildTime and Tutor Time.
Annual membership is fully paid by Georgetown University and is completely free to you.
www.careadvantage.com/georgetown Go
To take advantage of your free membership, log in to:
Sittercity is your dependent care benefit to help you find the local caregivers that meet your family’s care needs. You can choose from local pre-screened caregivers for your family, including babysitters (everyday and last minute), nannies, pet sitters and housekeepers.
Take advantage of all that Sittercity has to offer, including: before and after-school care, child care during school holidays, sick child care, infant and young child care, special needs care, last minute care, pet care, and housekeeping.
Years Ahead provides you and your family with several ways for finding the right care solution. For those who are unsure about the type or level of care needed, you will be provided a state-of-the-art Care Path Needs Assessment where you answer questions on the specifics of the senior in need of care, including health care needs, individual preferences, and finances and receive a detailed recommendation on the specific care options that best meet your and your family’s needs. You and your family will be provided your own account on Years Ahead, where you can save your Needs Assessment results, create a shortlist of your favorite care providers, share findings with other family members and more.
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Cura PersonalisOne of the core values at Georgetown University is Cura Personalis, or care of the whole person. GUWellness strives to highlight programs, resources and opportunities that support the overall wellness of faculty and staff. More than that, we seek to contribute to building a culture that puts our people and their well-being at the center of all we do as an institution.
GU WELLNESS
http://wellness.georgetown.eduYou are invited to be part of the wellness movement at Georgetown University. Visit our website to listen to podcasts, view videos or read blogs by community contributors. Sign up for upcoming classes, challenges and events. Join the conversation on social media (Facebook, Twitter, Instagram and Pinterest).
Watch your Inbox!At the beginning of each month, you’ll receive your GUWellness Update newsletter. Keep on top of all the wellness news and events and meet members of our community. Need a little extra dose of wellness? Sign up for the Mid-Month Boost at http://benefits.georgetown.edu.
Creative SparkResearch shows that exercising your creativity muscles has a positive impact on your overall health and wellness. We invite you to try something new, stimulate your senses, explore artistic expression, laugh, challenge yourself and play for the sake of play. Who knows? Practicing creativity may be the spark that ignites your wellness transformation.
Community Wellness, aka, Men and Women for OthersThere are many opportunities to care for ourselves, others and the community-at-large. Participate in the annual Heart Walk or GUWellness 5K to help the American Heart Association fight heart disease; get your free flu shot or health screenings at the GUWellness Fairs; do yourself – and your co-workers – a kindness by de-stressing with weekly free yoga at Yates Field House; or contribute your time, talent or treasure to those in need through community giving and volunteering.
Financial WellnessInvest in your own financial well-being. Decrease stress while increasing your savings, planning for retirement or that next great vacation! Classes, events, financial counseling and challenges are offered throughout the year.
Weekly Walk with CharlesEvery Thursday at 12:30 pm
Meets at Healy Circle
Mind-Body ConnectionsWant to go about your day feeling grounded, less stressed, and more connected to what matters most in your life? This series of mindfulness-based workshops is designed to inspire, recharge, and provide you with practical tools you can use in your everyday living and working for a greater sense of well-being.
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LEGAL NOTICES
Summary of Benefits and CoverageThe Patient Protection and Affordable Care Act (also known as the Health Care Reform law) requires that you receive a Summary of Benefits and Coverage (SBC). The SBC is designed to help you understand and evaluate your health plan choices. To obtain copies of the SBC for each of the Georgetown-sponsored medical plans, please visit the Georgetown Benefits Website at http://benefits.georgetown.edu. Paper copies are also available, free of charge, by calling the Office of Faculty and Staff Benefits at 1-202-687-2500.
Notice of Privacy PracticesEffective September 23, 2013
This notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please review it carefully. If you have any questions about this notice, please contact the Georgetown University Privacy Official, Georgetown University, 202 Healy Hall, 37th & O Streets, N.W., Washington, D.C. 20057-1246, 1-202-687-6457, or by e-mail to [email protected].
Who Must Follow This NoticeThis notice describes the privacy practices of the self-insured health care plan(s) offered by Georgetown University to its employees and retirees (“Georgetown Plans”). The Georgetown Plans are managed for the University by our “business associates,” administrators who interact with the medical care providers and/or handle members’ claims. The Georgetown Plans include the UnitedHealthcare Choice Plus and Medicare Standard Plans and the CareFirst BlueChoice Advantage Plans. This notice does not apply to the health care plans offered by the University that are fully insured.
Our ObligationsWe are required by law to:
l Maintain the privacy of protected health information as required by applicable laws and as set forth in this notice;
l Give you this notice of our legal duties and privacy practices regarding health information about you; and
l Follow the terms of our notice that is currently in effect.
How We May Use and Disclose Health InformationThe following categories describe ways that we may use and disclose health information that identifies you (“Health Information”). Some of the categories include examples, but every type of use or disclosure of Health Information in a category is not listed.
Except for the purposes described below, we will use and disclose Health Information only with your written permission. If you give us permission to use or disclose Health Information for a purpose not discussed in this notice, you may revoke that permission, in writing, at any time by contacting the University Privacy Official.
For Treatment. We may use Health Information to facilitate your treatment or receipt of health care services. We may use or disclose Health Information to doctors, nurses, technicians, or other personnel who are involved in your medical care. For example, we may use or disclose your Health Information to determine your eligibility for services requested by a provider.
For Payment. We may use and disclose Health Information in the course of activities that involve reimbursement for health care, such as determination of eligibility for coverage, claims processing, billing, obtaining payment of premiums, utilization review, medical necessity determinations, health care data processing, and precertifications.
For Health Care Operations. We may use and disclose Health Information for health care operations purposes. These uses and disclosures are necessary to make sure that all of our enrollees receive quality care and for our operation and management purposes. For example, we may use and disclose Health Information to a business associate who on the Georgetown Plans’ behalf performs a function or activity involving the use or disclosure of your medical information, including claims processing or administration, planning, data analysis, utilization review, quality assurance benefits management, referrals to specialists, or provides legal, actuarial, accounting, consulting, data aggregation, management, administrative or financial services that involve individually identifiable Health Information.
Appointment Reminders, Treatment Alternatives, and Health-Related Benefits and Services. We may use and disclose Health Information to contact you as a reminder that you have an appointment. We also may use and disclose Health Information to tell you about treatment options or alternatives or health-related benefits and services that may be of interest to you.
Fundraising Activities. We may use Health Information to contact you in an effort to raise money. We may disclose Health Information to a related foundation or to our business associate so that they may contact you to raise money for us. However, you have the right to opt out of any such communications by contacting the University Privacy Official in writing.
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LEGAL NOTICES
Individuals Involved in Your Care or Payment for Your Care. We may release Health Information to a person who is involved in your medical care or helps pay for your care, such as a family member or friend. We also may notify your family about your location or general condition or disclose such information to an entity assisting in a disaster relief effort.
Research. Under certain circumstances, we may use and disclose Health Information for research purposes. For example, a research project may involve comparing the health and recovery of all patients who received one medication or treatment to those who received another, for the same condition. Before we use or disclose Health Information for research, though, the project will go through a special approval process. This process evaluates a proposed research project and its use of Health Information to balance the benefits of research with the need for privacy of Health Information. Even without special approval, we may permit certain researchers to look at records to help them identify patients who may be included in their research project or for other similar purposes, so long as they do not remove or take a copy of any Health Information.
To Plan Sponsor. The Georgetown Plans may only disclose Health Information to the University, the Plan Sponsor, as is necessary for the use and administration of the Plans. The Plan Sponsor can only use the Health Information as permitted or required in the plan documents and applicable law, and the Plan Sponsor cannot use or disclose the Health Information for employment-related actions and decisions or in connection with any other benefit or employee benefit plan.
Special CircumstancesAs Required by Law. We will disclose Health Information when required to do so by international, federal, state or local law.
To Avert a Serious Threat to Health or Safety. We may use and disclose Health Information when necessary to prevent or lessen a serious threat to your health and safety or the health and safety of the public or another person. Any disclosure, however, will be to someone who may be able to help prevent the threat.
Business Associates. We may disclose Health Information to our business associates that perform functions on our behalf or provide us with services if the information is necessary for such functions or services. For example, we may use another company to perform billing services on our behalf. All of our business associates are obligated, under contract with us, to protect the privacy of your information and are not allowed to use or disclose any information other than as specified in our contract.
Organ and Tissue Donation. If you are an organ donor, we may release Health Information to organizations that handle organ procurement or organ, eye or tissue transplantation or to an organ donation bank, as necessary, to facilitate organ or tissue donation and transplantation.
Military and Veterans. If you are a member of the armed forces, we may release Health Information as required by military command authorities. We also may release Health Information to the appropriate foreign military authority if you are a member of a foreign military.
Workers’ Compensation. We may release Health Information for workers’ compensation or similar programs, to the extent authorized by the laws relating to these programs. These programs provide benefits for work-related injuries or illness.
Public Health Activities. We may disclose Health Information for public health activities. These activities generally include disclosures to prevent or control disease, injury or disability; report births and deaths; report child abuse or neglect; report reactions to medications or problems with products; notify people of recalls of products they may be using; track certain products and monitor their use and effectiveness; notify a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition; and conduct medical surveillance of the hospital in certain limited circumstances concerning workplace illness or injury. We also may release Health Information to an appropriate government authority if we believe a patient has been the victim of abuse, neglect or domestic violence; however, we will only release this information if you agree or when we are required or authorized by law.
Health Oversight Activities. We may disclose Health Information to a health oversight agency for oversight activities authorized by law. These oversight activities include, for example, audits, investigations, inspections, and licensure. These activities are necessary for the government to monitor the health care system, government programs, and compliance with civil rights laws.
Lawsuits and Disputes. If you are involved in a lawsuit or a dispute, we may disclose Health Information in response to a court or administrative order. We also may disclose Health Information in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute, but only if efforts have been made to tell you about the request or to obtain an order protecting the information requested.
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LEGAL NOTICES
Law Enforcement. We may release Health Information if asked by a law enforcement official for the following reasons: (1) in response to a court order, subpoena, warrant, summons or similar process; (2) limited information to identify or locate a suspect, fugitive, material witness, or missing person; (3) about the victim of a crime if, under certain limited circumstances, we are unable to obtain the person’s agreement; (4) about a death we believe may be the result of criminal conduct; (5) about criminal conduct on our premises; and (6) in emergency circumstances to report a crime, the location of the crime or victims, or the identity, description, or location of the person who committed the crime.
Coroners, Medical Examiners and Funeral Directors. We may release Health Information to a coroner or medical examiner for the purposes of identifying a deceased person, determining the cause of death, or performing other duties required by law. We also may release Health Information to funeral directors as necessary for their duties.
National Security and Intelligence Activities. We may release Health Information to authorized federal officials for intelligence, counter-intelligence, and other national security activities authorized by law.
Protective Services for the President and Others. We may disclose Health Information to authorized federal officials so they may provide protection to the President, other authorized persons or foreign heads of state or conduct special investigations.
Inmates or Individuals in Custody. If you are an inmate of a correctional institution or under the custody of a law enforcement official, we may release Health Information to the appropriate correctional institution or law enforcement official. This release would be made only if necessary (1) for the institution to provide you with health care; (2) to protect your health and safety or the health and safety of others; (3) for the administration, safety and security of the correctional institution; or (4) for the law enforcement of the correctional institution.
Your RightsExcept for uses and disclosures described and limited as set forth in this notice, we will use and disclose your health information only with a written authorization from you. This includes, except for limited circumstances allowed by federal privacy law, not using or disclosing psychotherapy notes about you, selling your health information to others, or using or disclosing your health information for certain promotional communications that are considered prohibited marketing communications under federal law, without your written authorization.
Once you give us authorization to release your health information, we cannot guarantee that the recipient to whom the information is provided will not disclose the information. You may take back or “revoke” your written authorization at any time by contacting the University Privacy Official in writing, except if we have already acted based on your authorization.
You have the following rights regarding Health Information we maintain about you:
Right to Inspect and Copy. You have the right to inspect and copy certain Health Information that we maintain about you and that may be used to make decisions about your care or payment for your care. If we maintain your health information electronically, you will have the right to request that we send a copy of your health information in an electronic format to you. You can also request that we provide a copy of your information to a third party that you identify. To inspect and copy your Health Information, you must make your request, in writing, to the University Privacy Official. In certain limited circumstances, we may deny your request to inspect and copy your health information. If we deny your request, you may have the right to have the denial reviewed. We may charge a reasonable fee for any copies.
Right to Get Notice of a Breach. We will comply with the requirements of applicable privacy laws related to notifying you in the event of a breach of your health information.
Right to Amend. If you feel that Health Information we have is incorrect or incomplete, you may ask us to amend the information. You have the right to request an amendment for as long as the information is kept by or for us. To request an amendment, you must make your request, in writing, to the University Privacy Official and you must provide the reasons for the requested amendment. Right to an Accounting of Disclosures. You have the right to request an accounting of certain disclosures of Health Information we made. To request an accounting of disclosures, you must make your request, in writing, to the University Privacy Official. This accounting will not include disclosures of information made (i) for treatment, payment, and health care operations purposes; (ii) to you or pursuant to your authorization; (iii) to correctional institutions or law enforcement officials; and (iv) other disclosures for which federal law does not require us to provide an accounting.
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Right to Request Restrictions. You have the right to request a restriction or limitation on the Health Information we use or disclose for treatment, payment, or health care operations. In addition, you have the right to request a limit on the Health Information we disclose about you to someone who is involved in your care or the payment for your care, like a family member or friend. For example, you could ask that we not share information about your surgery with your legal spouse. To request a restriction, you must make your request, in writing, to the University Privacy Official. We are not required to agree to your request. If we agree, we will comply with your request unless we need to use the information in certain emergency treatment situations.
Right to Request Confidential Communications. You have the right to request that we communicate with you about medical matters in a certain way or at a certain location. For example, you can ask that we contact you only by mail or at work. To request confidential communications, you must make your request, in writing, to the University Privacy Official. Your request must specify how or where you wish to be contacted. We will accommodate reasonable requests.
Right to a Paper Copy of This Notice. You have the right to a paper copy of this notice. You may ask us to give you a copy of this notice at any time. Even if you have agreed to receive this notice electronically, you are still entitled to a paper copy of this notice. You may obtain a copy of this notice at our website, http://benefits.georgetown.edu.
To obtain a paper copy of this notice, contact:University Privacy OfficialGeorgetown University202 Healy Hall, 37th & O Streets, N.W.Washington, D.C. 20057
Changes to This NoticeWe reserve the right to change this notice. We reserve the right to make the revised or changed notice effective for Health Information we already have as well as any information we receive in the future. We will post a copy of the current notice at the Office of Faculty and Staff Benefits.
Important NoticesComplaints. If you believe your privacy rights have been violated, you may file a complaint with us or the Secretary of the Department of Health and Human Services. To file a complaint with us, contact the University Privacy Official. All complaints must be made in writing. You will not be penalized for filing a complaint.
Primary Care Physicians (PCPs) and OB/GYN CareTo the extent that any of the medical plan options allow for the designation of a primary care provider, you have the right to designate any primary care provider who is available to accept you or your family members and who participates in the applicable medical plan option’s network of providers. For children, you may designate a pediatrician as the primary care provider. Until you make this designation, the medical plan option may designate one for you.
Furthermore, you do not need prior authorization from your medical plan carrier or from any other person (including a primary care provider) in order to obtain access to obstetrical or gynecological care from a health care professional in the applicable medical plan’s network (as applicable) who specializes in obstetrics or gynecology. The health care professional, however, may be required to comply with certain procedures, including obtaining prior authorization for certain services, following a pre-approved treatment plan, or procedures for making referrals. For a list of participating health care professionals who specialize in obstetrics or gynecology, contact the applicable medical plan carrier.
For information on how to select a primary care provider, and for a list of the participating primary care providers, contact your medical plan carrier.
Notice Under the Women’s Health and Cancer Rights ActIf you have had or are going to have a mastectomy, you may be entitled to certain benefits under the Women’s Health and Cancer Rights Act of 1998 (WHCRA). For individuals receiving mastectomy-related benefits, coverage will be provided in a manner determined in consultation with the attending physician and the patient for:
l All stages of reconstruction of the breast on which the mastectomy was performed,
l Surgery and reconstruction of the other breast to produce a symmetrical appearance,
l Prostheses, and
l Treatment of physical complications of the mastectomy, including lymphedema.
Such coverage may be subject to annual deductibles and coinsurance provisions as may be deemed appropriate and are consistent with those established for other benefits under the plan or coverage.
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Michelle’s LawPublic law 110-381, also known as “Michelle’s Law,” allows dependent college students insured under their parent’s policy to remain covered if they are required to take a medical leave of absence from school or make any other enrollment changes that might cause them to lose dependent student eligibility. In order to qualify for this continued coverage, the dependent must be suffering from a serious illness or injury and the leave of absence or other enrollment changes must be medically necessary, as determined by the treating physician. Such dependents may remain covered up to the earlier of: one year after the first day of the medically necessary leave of absence; or the date on which such coverage would otherwise terminate under the terms of the plan/coverage. Following the medical leave, student dependents will once again be required to provide student certification (as may be required under the applicable plan) in order to remain eligible for dependent coverage.
Premium Assistance Under Medicaid and the Children’s Health Insurance Program (CHIP) If you or your children are eligible for Medicaid or CHIP and you’re eligible for health coverage from your employer, your state may have a premium assistance program that can help pay for coverage, using funds from their Medicaid or CHIP programs. If you or your children aren’t eligible for Medicaid or CHIP, you won’t be eligible for these premium assistance programs but you may be able to buy individual insurance coverage through the Health Insurance Marketplace. For more information, visit www.healthcare.gov. If you or your dependents are already enrolled in Medicaid or CHIP and you live in a state listed below, contact your state Medicaid or CHIP office to find out if premium assistance is available.
If you or your dependents are NOT currently enrolled in Medicaid or CHIP, and you think you or any of your dependents might be eligible for either of these programs, contact your state Medicaid or CHIP office or dial 1-877-KIDS NOW or www.insurekidsnow.gov to find out how to apply. If you qualify, ask your state if it has a program that might help you pay the premiums for an employer-sponsored plan.
If you or your dependents are eligible for premium assistance under Medicaid or CHIP, as well as eligible under your employer plan, your employer must allow you to enroll in your employer plan if you aren’t already enrolled. This is called a “special enrollment” opportunity, and you must request coverage within 60 days of being determined eligible for premium assistance. If you have questions about enrolling in your employer plan, contact the Department of Labor at www.askebsa.dol.gov or call 1-866-444-EBSA (3272).
If you live in one of the following states, you may be eligible for assistance paying your employer health plan premiums. The following list of states is current as of July 31, 2016. Contact your state for more information on eligibility.
Alabama – MedicaidWebsite: http://myalhipp.com
Phone: 1-855-692-5447Alaska – Medicaid
The AK Health Insurance Premium Payment ProgramWebsite: http://myakhipp.com
Phone: 1-866-251-4861Email: [email protected]
Medicaid Eligibility: http://dhss.alaska.gov/dpa/Pages/medicaid/default.aspx
Arkansas – Medicaid Website: http://myarhipp.com
Phone: 1-855-MyARHIPP (1-855-692-7447)Colorado – Medicaid
Medicaid Website: www.colorado.gov/hcpfMedicaid Customer Contact Center: 1-800-221-3943
Florida – MedicaidWebsite: http://flmedicaidtplrecovery.com/hipp
Phone: 1-877-357-3268Georgia – Medicaid
Website: http://dch.georgia.gov/medicaidClick on Health Insurance Premium Payment (HIPP)
Phone: 1-404-656-4507Indiana – Medicaid
Healthy Indiana Plan for low-income adults 19-64Website: www.hip.in.govPhone: 1-877-438-4479
All other MedicaidWebsite: www.indianamedicaid.com
Phone: 1-800-403-0864Iowa – Medicaid
Website: www.dhs.state.ia.us/hippPhone: 1-888-346-9562
Kansas – MedicaidWebsite: www.kdheks.gov/hcf
Phone: 1-785-296-3512Kentucky – Medicaid
Website: http://chfs.ky.gov/dms/default.htmPhone: 1-800-635-2570
Louisiana – MedicaidWebsite: http://dhh.louisiana.gov/index.cfm/subhome/1/n/331
Phone: 1-888-695-2447
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Maine – MedicaidWebsite: www.maine.gov/dhhs/ofi/public-assistance/index.html
Phone: 1-800-442-6003TTY: Maine relay 711
Massachusetts – Medicaid and CHIPWebsite: www.mass.gov/MassHealth
Phone: 1-800-462-1120Minnesota – Medicaid
Website: http://mn.gov/dhs/maPhone: 1-800-657-3739
Missouri – MedicaidWebsite: www.dss.mo.gov/mhd/participants/pages/hipp.htm
Phone: 1-573-751-2005Montana – Medicaid
Website: http://dphhs.mt.gov/MontanaHealthcarePrograms/HIPPPhone: 1-800-694-3084
Nebraska – Medicaid Website: http://dhhs.ne.gov/Children_Family_Services/
AccessNebraska/Pages/accessnebraska_index.aspxPhone: 1-855-632-7633
Nevada – MedicaidMedicaid Website: http://dwss.nv.gov
Medicaid Phone: 1-800-992-0900New Hampshire – Medicaid
Website: www.dhhs.nh.gov/oii/documents/hippapp.pdfPhone: 1-603-271-5218
New Jersey – Medicaid and CHIPMedicaid Website: www.state.nj.us/humanservices/
dmahs/clients/medicaidMedicaid Phone: 1-609-631-2392
CHIP Website: www.njfamilycare.org/index.htmlCHIP Phone: 1-800-701-0710
New York – MedicaidWebsite: www.nyhealth.gov/health_care/medicaid
Phone: 1-800-541-2831North Carolina – Medicaid
Website: www.ncdhhs.gov/dmaPhone: 1-919-855-4100
North Dakota – MedicaidWebsite: www.nd.gov/dhs/services/medicalserv/medicaid
Phone: 1-844-854-4825Oklahoma – Medicaid and CHIP
Website: http://www.insureoklahoma.orgPhone: 1-888-365-3742
Oregon – Medicaid Website: http://healthcare.oregon.gov/Pages/index.aspx
www.oregonhealthcare.gov/index-es.htmlPhone: 1-800-699-9075
Pennsylvania – MedicaidWebsite: www.dhs.pa.gov/hipp
Phone: 1-800-692-7462Rhode Island – Medicaid
Website: www.eohhs.ri.govPhone: 1-401-462-5300
South Carolina – MedicaidWebsite: www.scdhhs.govPhone: 1-888-549-0820
South Dakota - MedicaidWebsite: http://dss.sd.govPhone: 1-888-828-0059
Texas – MedicaidWebsite: http://gethipptexas.com
Phone: 1-800-440-0493Utah – Medicaid and CHIP
Medicaid Website: http://health.utah.gov/medicaidCHIP Website: http://health.utah.gov/chip
Phone: 1-877-543-7669Vermont– Medicaid
Website: www.greenmountaincare.orgPhone: 1-800-250-8427
Virginia – Medicaid and CHIPMedicaid Website: www.coverva.org/programs_premium_
assistance.cfmMedicaid Phone: 1-800-432-5924
CHIP Website: www.coverva.org/programs_premium_assistance.cfm
CHIP Phone: 1-855-242-8282Washington – Medicaid
Website: www.hca.wa.gov/free-or-low-cost-health-care/program-administration/premium-payment-program
Phone: 1-800-562-3022 ext. 15473West Virginia – Medicaid
Website: www.dhhr.wv.gov/bms/Medicaid%20Expansion/Pages/default.aspx
Phone: 1-877-598-5820, HMS Third Party LiabilityWisconsin – Medicaid and CHIP
Website: www.dhs.wisconsin.gov/publications/p1/p10095.pdfPhone: 1-800-362-3002
Wyoming – MedicaidWebsite: https://wyequalitycare.acs-inc.com
Phone: 1-307-777-7531
To see if any other states have added a premium assistance program since July 31, 2016, or for more information on special enrollment rights, contact either:
U.S. Department of LaborEmployee Benefits Security Administrationwww.dol.gov/ebsa1-866-444-EBSA (3272)
U.S. Department of Health and Human ServicesCenters for Medicare & Medicaid Serviceswww.cms.hhs.gov1-877-267-2323, Menu Option 4, Ext. 61565
OMB Control Number 1210-0137 (expires 10/31/2016)
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HIPAA Special Enrollment RightsIf you are declining enrollment for yourself or your eligible dependents (including your legal spouse/LDA) because of other health insurance or group health plan coverage, you may be able to enroll yourself and your dependents in this plan if you or your dependents lose eligibility for that other coverage (or if the employer stops contributing toward your or your dependents’ other coverage). However, you must request enrollment within 60 days after your or your dependents’ other coverage ends (or after the employer stops contributing toward the other coverage).
In addition, if you have a new dependent as a result of marriage, birth, adoption, or placement for adoption, you may be able to enroll yourself and your dependents. However, you must request enrollment within 60 days after the marriage, birth, adoption, or placement for adoption.
For more information on making changes during the year, refer to the Qualifying Events Matrix at https://benefits.georgetown.edu/enrolling/benefitschanges or contact the Office of Faculty and Staff Benefits at 1-202-687-2500 or by email at [email protected].
Summary Annual Reports (SARs) Available OnlineThe SARs of Georgetown University are available online and include an explanation of plan expenses, employee and employer contribution information, and details on how you can obtain additional information about the plan. If you were enrolled in, or eligible for, one or more of the University’s benefits plans, it is your legal right as a participant to know this information about your benefits.
Effective each December 15, you may view copies of the prior plan year’s SARs on our website at http://benefits.georgetown.edu. You may not be enrolled in all of the plans that are referenced, so please disregard any reports that do not apply to you. If you require a paper copy of the SARs, you can order them from the Office of Faculty and Staff Benefits. Simply email [email protected] or call 1-202-687-2500.
Important Notice from Georgetown University About Your Prescription Drug Coverage and Medicare Please read this notice carefully and keep it where you can find it. This notice has information about your current prescription drug coverage with Georgetown University and about your options under Medicare’s prescription drug coverage. This information can help you decide whether or not you want to join a Medicare drug plan. If you are considering joining, you should compare your current coverage, including which drugs are covered at what cost, with the coverage and costs of the plans offering Medicare prescription drug coverage in your area. Information about where you can get help to make decisions about your prescription drug coverage is at the end of this notice.
There are four important things you need to know about your current coverage and Medicare’s prescription drug coverage:
1. Medicare prescription drug coverage became available in 2006 to everyone with Medicare. You can get this coverage if you join a Medicare Prescription Drug Plan or join a Medicare Advantage Plan (like an HMO or PPO) that offers prescription drug coverage. All Medicare drug plans provide at least a standard level of coverage set by Medicare. Some plans may also offer more coverage for a higher monthly premium.
2. Georgetown University has determined that, with the exception of the CareFirst BlueChoice Advantage CDHP with HSA, the prescription drug coverage offered by the Georgetown University Health and Welfare Plan is, on average for all plan participants, expected to pay out as much as standard Medicare prescription drug coverage pays and is therefore considered Creditable Coverage. If your existing coverage is Creditable Coverage, you can keep this coverage and not pay a higher premium (a penalty) if you later decide to join a Medicare drug plan.
3. Georgetown University has determined that the prescription drug coverage offered by the CareFirst BlueChoice Advantage CDHP with HSA is, on average for all plan participants, NOT expected to pay out as much as standard Medicare prescription drug coverage pays.
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Therefore, your coverage is considered Non-Creditable Coverage. This is important because, most likely, you will get more help with your drug costs if you join a Medicare drug plan, than if you only have prescription drug coverage from the CareFirst BlueChoice Advantage CDHP with HSA. This also is important because it may mean that you may pay a higher premium (a penalty) if you do not join a Medicare drug plan when you first become eligible.
4. You can keep your current CareFirst BlueChoice Advantage CDHP with HSA coverage. However, because your coverage is non-creditable, you have decisions to make about Medicare prescription drug coverage that may affect how much you pay for that coverage, depending on if and when you join a drug plan. When you make your decision, you should compare your current coverage, including what drugs are covered, with the coverage and cost of the plans offering Medicare prescription drug coverage in your area.
Read this notice carefully – it explains your options.
When Can You Join a Medicare Drug Plan? You can join a Medicare drug plan when you first become eligible for Medicare and each year from October 15th to December 7th. However, if you lose your current creditable prescription drug coverage, through no fault of your own, you will also be eligible for a two (2) month Special Enrollment Period (SEP) to join a Medicare drug plan. This applies to all Georgetown University Health and Welfare Plans, with the exception of the CareFirst BlueChoice Advantage CDHP with HSA.
However, if you decide to drop your current coverage with CareFirst BlueChoice Advantage CDHP with HSA, since it is employer/union sponsored group coverage, you will be eligible for a two (2) month Special Enrollment Period (SEP) to join a Medicare drug plan; however you also may pay a higher premium (a penalty) because you did not have creditable coverage under the CareFirst BlueChoice Advantage CDHP with HSA.
What Happens to Your Current Coverage If You Decide to Join a Medicare Drug Plan? If you are an active employee (or a covered legal spouse or dependent of an active employee), your current Georgetown University active employee medical plan pays for other medical expenses in addition to prescription drug benefits. If you decide to join a Medicare drug plan, your current Georgetown University coverage will not be affected. Specifically, you and your eligible dependents will still be eligible to receive all of your current medical and prescription drug benefits under Georgetown University’s active employee medical and prescription drug plan.
If you do decide to join a Medicare drug plan and drop your current Georgetown University active employee medical and prescription drug plan, be aware that you and your dependents may be able to enroll back into Georgetown University’s active employee medical and prescription drug plan at a later time, such as during an Open Enrollment period.
When Will You Pay a Higher Premium (Penalty) to Join a Medicare Drug Plan? For plans with creditable coverage (all plans except for the CareFirst BlueChoice Advantage CDHP with HSA), you should also know that if you drop or lose your current coverage with Georgetown University and don’t join a Medicare drug plan within 63 continuous days after your current coverage ends, you may pay a higher premium (a penalty) to join a Medicare drug plan later.
If you go 63 continuous days or longer without creditable prescription drug coverage, your monthly premium may go up by at least 1% of the Medicare base beneficiary premium per month for every month that you did not have that coverage. For example, if you go nineteen months without creditable coverage, your premium may consistently be at least 19% higher than the Medicare base beneficiary premium. You may have to pay this higher premium (a penalty) as long as you have Medicare prescription drug coverage. In addition, you may have to wait until the following October to join.
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Since the coverage under the CareFirst BlueChoice Advantage CDHP with HSA is not creditable, depending on how long you go without creditable prescription drug coverage you may pay a penalty to join a Medicare drug plan. Starting with the end of the last month that you were first eligible to join a Medicare drug plan but didn’t join, if you go 63 continuous days or longer without prescription drug coverage that’s creditable, your monthly premium may go up by at least 1% of the Medicare base beneficiary premium per month for every month that you did not have that coverage. For example, if you go nineteen months without creditable coverage, your premium may consistently be at least 19% higher than the Medicare base beneficiary premium. You may have to pay this higher premium (penalty) as long as you have Medicare prescription drug coverage. In addition, you may have to wait until the following October to join.
For More Information About This Notice or Your Current Prescription Drug Coverage: Contact the Office of Faculty and Staff Benefits at 1-202-687-2500 or by email at [email protected]. NOTE: You’ll get this notice each year. You will also get it before the next period you can join a Medicare drug plan, and if this coverage through Georgetown University changes. You also may request a copy of this notice at any time.
For More Information About Your Options Under Medicare Prescription Drug Coverage:More detailed information about Medicare plans that offer prescription drug coverage is in the “Medicare & You” handbook. You’ll get a copy of the handbook in the mail every year from Medicare. You may also be contacted directly by Medicare drug plans.
For More Information About Medicare Prescription Drug Coverage: l Visit www.medicare.gov.
l Call your State Health Insurance Assistance Program (see the inside back cover of your copy of the “Medicare & You” handbook for their telephone number) for personalized help.
l Call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048.
If you have limited income and resources, extra help paying for Medicare prescription drug coverage is available. For information about this extra help, visit Social Security on the web at www.socialsecurity.gov, or call them at 1-800-772-1213 (TTY 1-800-325-0778).
Remember: Keep this Creditable Coverage notice. If you decide to join one of the Medicare drug plans, you may be required to provide a copy of this notice when you join to show whether or not you have maintained creditable coverage and whether or not you are required to pay a higher premium (a penalty).
Date: October 15, 2016Name of Entity/Sender:
Georgetown University
Contact-Position/Office:
Office of Faculty and Staff Benefits Associate Vice President for Benefits
Address: 37th & O Streets, N.W. Washington, D.C. 20057-1265
Phone Number: 1-202-687-2500Email: [email protected]
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LEGAL NOTICES
Health Care Reform and Your Health Insurance Options Effective January 1, 2014, the Patient Protection and Affordable Care Act (PPACA) – also known as “Health Care Reform” – requires most Americans to have health insurance. Individuals who do not have coverage will be required to pay a penalty. The Health Insurance Marketplace (“health insurance exchange”) was created to ensure that everyone has access to affordable health insurance. The Marketplace is an option for someone who does not have employer-provided health coverage or for someone who chooses not to enroll in employer-provided health coverage. Because Georgetown offers a medical plan that meets the specified affordable and minimum value requirements under the PPACA, you are NOT eligible for a subsidy through the Marketplace, even if you choose not to enroll in a Georgetown medical plan.
If it is discovered that you are receiving a subsidy when eligible for a Georgetown medical plan, you will be responsible for refunding the full amount of the subsidy to the Centers for Medicare & Medicaid Services.
Why Am I Receiving This Notice? This notice provides you with information about the Health Insurance Marketplace and where you can access a website that contains more information about health plans offered to you by either your state or the U.S. Department of Health and Human Services.
Georgetown is required to send the enclosed notice to every U.S. employee to comply with rules under the federal PPACA.
What Do I Need To Do?You’re currently eligible to participate in a Georgetown-sponsored medical plan. If you participate in the medical plan, you and the University share in the cost of your coverage. Your share of the cost is paid with pre-tax dollars.
If you choose not to participate in a Georgetown plan and you buy insurance in the Marketplace, you will be responsible for paying the entire premium yourself with after-tax dollars.
What Is The Individual Mandate Tax?Under the PPACA, starting in 2014, most Americans are required to have health insurance or pay a penalty. If you elect coverage through Georgetown, you will satisfy this requirement. For more information about the individual mandate, please visit: http://www.irs.gov/uac/Questions-and-Answers-on-the-Individual-Shared-Responsibility-Provision.
What This Means For You• Georgetown has you and your family covered. As
a benefits-eligible employee, you and your eligible dependents have access to health care coverage through Georgetown.
•Our plans are affordable. You’ll hear about new coverage options available in the Health Insurance Marketplace, but in most cases, Georgetown’s coverage will continue to provide the greatest value. And because our plans exceed the federally required “minimum value standards,” you are NOT eligible for federal subsidies.
•We’ll keep you updated. As we get updates, we’ll provide resources and support to help you understand the impact of health care reform and to feel confident about your personal coverage decisions.
Questions?Call 1-800-318-2596(TTY: 1-855-889-4325) or visit www.healthcare.gov.
This is a Notice on Marketplace Health Insurance Coverage Options. Georgetown is required by law to send this to you, but know that no action is required by you.
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LEGAL NOTICES
Notice to All Employees of Georgetown University: 2017 403(b) Universal Availability Notice
for Georgetown University Voluntary Contribution Retirement Plan This notice is to inform you that as an employee of Georgetown University you are eligible to participate in the Voluntary Contribution Retirement Plan. The Georgetown University Voluntary Contribution Retirement Plan (the “Voluntary Plan”) is a retirement workplace 403(b) savings plan. The Voluntary Plan, distinct from GURP and the Defined Contribution Retirement Plan, allows employees to make pre-tax contributions or additional pre-tax contributions to a 403(b) savings account to help save for retirement. The University does not contribute to the Voluntary Plan; all employee contributions are made through salary reduction. Employees are always 100% vested in the Voluntary Plan. Plan contributions as well as any investment earnings are tax-deferred – and are not taxable until distributed. Eligibility: If you are an employee of the University, you are eligible to enroll in the Voluntary Plan. Enrollment: You may enroll in the Voluntary Plan or discontinue or change your enrollment at any time. Visit http://benefits.georgetown.edu/saving/voluntary or call the Office of Faculty and Staff Benefits at 1-202-687-2500 for more information. Contribution and Investment Elections:To enroll, you must elect your contribution amount and designate the investment company to which you want your contributions deposited. To do so, log on to http://gms.georgetown.edu with your NetID and password. New Employees will be prompted to enroll as part of the New Hire benefit event in their GMS inbox. All other employees should follow the instructions at https://benefits.georgetown.edu/saving/voluntary. Annual contribution limits do apply. Once you’ve submitted your choices in GMS, you’ll be automatically enrolled in a target date retirement fund by the investment company(ies) you have selected. You can change your investment allocations at any time after your first contribution has been made by contacting your investment company. You will receive further information and instructions from your chosen investment company(ies) soon after you enroll.
Investment Companies: You may obtain further information about the Voluntary Plan by contacting the investment companies directly. You may do so by visiting their websites or by calling their toll-free numbers to talk to a representative.
Investment Company Website/E-mail Telephone Fidelity Investments http://netbenefits.com/georgetown 1-800-343-0860TIAA-CREF www.tiaa-cref.org/georgetown 1-800-842-2888Vanguard http://georgetown.vanguard-education.com/ekit 1-800-523-1188
We look forward to serving you in 2017 and beyond. Sincerely,
Vivek Kumar Retirement Benefits Analyst Office of Faculty and Staff Benefits
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OTHER BENEFITS
The following benefits are available to all Georgetown faculty and staff:l Capital Bikeshare: Discounts are available for new
annual memberships. Contact the Office of Faculty and Staff Benefits for more details.
l Car Sharing: Discounts available through two nationally recognized car-sharing companies, car2go and Zipcar.
l Chaplain to the Staff: In 1995, Georgetown University established the position of Chaplain to the Staff to meet the personal, professional, and spiritual development needs of its employees.
l Child Care: Hoya Kids Learning Center is an on-site facility for children from 18 months old to 5 years old. Fees vary according to income level; separate facility and policy at GU Law Center.
l Credit Union: Hoya Federal Credit Union offers financial products and services to GU faculty, staff, and their families.
l Faculty and Staff Assistance Program: Assists faculty and staff (and their families) with professional and personal concerns, provided at no cost to the employee, as well as short term and crisis counseling and coordination of wellness programs, while remaining completely confidential.
l Holidays: Georgetown faculty and staff are provided with 13 paid holidays.
l Lactation Room: Georgetown University provides a clean, comfortable space on Main Campus designated for nursing mothers to pump while they have to be away from their babies due to work or school. The room accommodates up to 5 women at one time and is available for any GU staff, faculty, or student with a valid GUID. On the Medical Center campus, nursing mothers with a valid GUID should go to the Medical Center Human Resources Office located in the Med-Dent Building, Suite SE113 to obtain the door code for entering the Mother’s Room located in the Pre-Clinical Science Building. A similar facility is available on the Georgetown University Law Center campus.
l Training and Development: Provides individual classes as well as a Professional Management Certificate Program, available to all employees, paid for by the employees’ departments.
l Parking/Transportation: On-campus and satellite options available, can be paid by pre-tax paycheck deductions, price varies according to income level and site, free shuttle service to Wisconsin Avenue, Dupont Circle, Arlington, and Law Center, free motorist assistance, pre-tax SmartBenefits.
l PNC Bank: Offers on-campus ebranch, ATMs, workplace banking, as well as financial literacy programs for faculty and staff at the University.
2016-2017 Academic Year Holiday CalendarDate EventOctober 201610 Monday Columbus DayNovember 201624 Thursday Thanksgiving Day25 Friday Day After ThanksgivingDecember 201623 Friday Christmas Eve*26 Monday Christmas Day**27 Tuesday Holiday28 Wednesday Holiday29 Thursday Holiday30 Friday New Year’s Eve***January 20172** Monday New Year’s Day****16 Monday Dr. Martin Luther King, Jr. Day20 Friday Inauguration DayFebruary 201720 Monday President’s DayApril 201714 Friday Good FridayMay 201729 Monday Memorial Day
*Christmas Eve falls on a Saturday and will be observed on the Friday before.
**The legal holiday for Christmas Day falls on a Sunday in 2016 and we will observe this holiday on Monday, December 26, 2016 in accordance with the Federal Holiday Calendar.
***New Year’s Eve falls on a Saturday and will be observed on the Friday before.
****The legal holiday for New Year’s Day falls on a Sunday in 2017 and we will observe this holiday on Monday, January 2, 2017 in accordance with the Federal Holiday Calendar.
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Your cost for coverage depends on the benefit elections you make and how many eligible dependents you enroll. Medical, dental, vision and FSA contributions are automatically deducted from your pay on a pre-tax basis. Voluntary life/AD&D and LTD contributions are deducted from your pay on an after-tax basis.
If you are paid monthly, your contributions will be deducted from each paycheck throughout the year. If you are paid biweekly, all premiums will be deducted from 24 of your 26 annual paychecks. In those months in which there are three pay dates, only retirement plan contributions will be deducted.
The charts on the following pages show the amounts that will be deducted from your pay each pay period for medical, dental and vision insurance.
Monthly Imputed Income Liability*Plan LiabilityMedical- Kaiser Signature HMO- CareFirst BlueChoice Advantage POS- CareFirst BlueChoice Advantage
CDHP with HSA- UnitedHealthcare Choice Plus PPO
$568.06 $648.14
$510.58 $855.62
Dental- Delta Dental Standard PPO- Delta Dental Enhanced PPO- Aetna DMO
$39.96$71.88$42.22
Vision- EyeMed Vision Care Select $5.82
* Monthly imputed income calculation = Employee/Legal Spouse Total minus the Employee Only Total.
Pre-tax contributions save you money. This is because pre-tax contributions are deducted from your pay before federal – and in most cases, state – income tax withholdings and FICA (Social Security and Medicare) tax withholdings are calculated. This lowers your taxable income, which in turn lowers the total amount you pay in taxes.
Post-tax contributions have certain advantages. Because you pay for LTD and voluntary life/AD&D insurance on an after-tax basis, any benefits paid under these plans will not be taxed again. This means that if you receive benefits from your disability plan or life/AD&D insurance plan, you will not be taxed on the benefit amount.
2017 INSURANCE PREMIUMS
Employees with Legally Domiciled Adults (LDAs)
Federal law requires that an employee with a non-tax-dependent LDA must pay taxes on part of the benefit. The IRS considers the employer-provided value of the health care benefit for an LDA who is not the employee’s tax dependent (as defined by the IRS) to be income to the employee. The IRS calls this ‘imputed income’ – and it is subject to taxation. Be sure to designate your LDA as a non-tax dependent in GMS, if applicable.
University Contribution Strategy for Health CareIn 2007, Georgetown established a contribution strategy in which the University contributes 80% of the total premium of the lowest cost Georgetown-sponsored medical plan. To date, the lowest cost medical plan has been the Kaiser Signature HMO. This means Georgetown will contribute 80% of the Kaiser Signature HMO premium toward whichever medical plan you elect. With the addition of the CareFirst BlueChoice Advantage CDHP with HSA in 2014, Kaiser is no longer the lowest cost plan. Therefore, in 2014, the University amended its strategy so as to not negatively impact its faculty and staff. The University will continue to share in the cost of your health care by contributing 80% of the Kaiser Signature HMO premium.
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2017 INSURANCE PREMIUMS
For Faculty, Staff, Academic & Administrative Professionals (AAPs) and Fellows*
Family (Employee, Legal Spouse/LDA, Child/ren)
Medical
Kaiser Signature HMO $154.93 $309.86 $1,239.40 $1,549.26
CareFirst BlueChoice Advantage POS $264.11 $528.22 $1,239.40 $1,767.62
CareFirst BlueChoice Advantage CDHP with HSA $76.58 $153.16 $1,239.40 $1,392.56
UnitedHealthcare Choice Plus PPO $531.72 $1,063.44 $1,239.40 $2,302.84
DentalDelta Dental Standard PPO $40.38 $80.76 $5.19 $85.95
Delta Dental Enhanced PPO $74.82 $149.64 $5.19 $154.83
Aetna DMO $60.94 $121.88 $5.19 $127.07
Vision EyeMed Vision Care Select $9.54 $19.08 $0.00 $19.08
Employee & Child/ren
Medical
Kaiser Signature HMO $98.12 $196.24 $784.96 $981.20
CareFirst BlueChoice Advantage POS $167.27 $334.54 $784.96 $1,119.50
CareFirst BlueChoice Advantage CDHP with HSA $48.50 $97.00 $784.96 $881.96
UnitedHealthcare Choice Plus PPO $365.91 $731.82 $784.96 $1,516.78
DentalDelta Dental Standard PPO $26.57 $53.14 $5.19 $58.33
Delta Dental Enhanced PPO $49.94 $99.88 $5.19 $105.07
Aetna DMO $40.77 $81.54 $5.19 $86.73
Vision EyeMed Vision Care Select $6.50 $13.00 $0.00 $13.00
Employee & Legal Spouse/LDA
Medical
Kaiser Signature HMO $108.45 $216.90 $867.58 $1,084.48
CareFirst BlueChoice Advantage POS $184.89 $369.78 $867.58 $1,237.36
CareFirst BlueChoice Advantage CDHP with HSA $53.60 $107.20 $867.58 $974.78
UnitedHealthcare Choice Plus PPO $382.94 $765.88 $867.58 $1,633.46
DentalDelta Dental Standard PPO $32.73 $65.46 $5.19 $70.65
Delta Dental Enhanced PPO $60.99 $121.98 $5.19 $127.17
Aetna DMO $36.15 $72.30 $5.19 $77.49
Vision EyeMed Vision Care Select $6.18 $12.36 $0.00 $12.36
*The only Fellows eligible for dental benefits are Law Center Fellows.
You Pay Biweekly Pre-Tax
You Pay Monthly Pre-Tax
University Pays Monthly
2017 Monthly Total
Employee Only
Medical
Kaiser Signature HMO $51.64 $103.28 $413.14 $516.42
CareFirst BlueChoice Advantage POS $88.04 $176.08 $413.14 $589.22
CareFirst BlueChoice Advantage CDHP with HSA $25.53 $51.06 $413.14 $464.20
UnitedHealthcare Choice Plus PPO $182.35 $364.70 $413.14 $777.84
DentalDelta Dental Standard PPO $12.75 $25.50 $5.19 $30.69
Delta Dental Enhanced PPO $25.05 $50.10 $5.19 $55.29
Aetna DMO $15.04 $30.08 $5.19 $35.27
Vision EyeMed Vision Care Select $3.27 $6.54 $0.00 $6.54
45
NOTES
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NOTES
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GU 2017 Active Benefits Guide 10-31-2016
Georgetown reserves the right to modify, terminate or amend its plans/provisions, or any part thereof, at its discretion at any time or for any reason. Details of the benefits or the limitations and exclusions of the plans are contained in the official plan documents and agreements between the insurance companies and Georgetown University. It is these documents that legally govern the operation of the plans and which will control in the event of any omission or other differences arising elsewhere. Copies of the summary plan description (SPD) for each plan can be found at http://benefits.georgetown.edu or can be obtained by contacting the Office of Faculty and Staff Benefits at 1-202-687-2500.
Important Information About Medicare Prescription Drug Coverage If you (and/or your dependents) have Medicare or will become eligible for Medicare in the next 12 months, a Federal
law gives you more choices about your prescription drug coverage. Please see pages 38 – 40 for more information.
Georgetown Benefits DirectoryOffice of Faculty and Staff Benefits- Benefits help- GMS assistance
1-202-687-2500http://benefits.georgetown.eduemail: [email protected]: 1-202-687-2389
Georgetown Management System (GMS) 1-202-687-4949 http://gms.georgetown.eduemail: [email protected]
Medical- Kaiser Permanente 1-800-777-7902 www.kp.org- CareFirst BlueChoice Advantage 1-877-691-5856 www.carefirst.com- UnitedHealthcare 1-888-332-8885 www.myuhc.com
Health Advocate 1-866-695-8622 www.HealthAdvocate.com/georgetownemail: [email protected]
Dental- Delta Dental 1-800-932-0783 www.deltadentalins.com- Aetna Dental DMO 1-800-843-3661 www.aetna.comVision- EyeMed Vision Care Select- Amplifon Hearing Discounts for
EyeMed Members
1-866-723-05141-844-526-5432
www.eyemed.com
Health Savings and Flexible Spending Accounts- ConnectYourCare 1-877-292-4040 www.connectyourcare.com
email: [email protected] Term Disability Insurance- Matrix Absence Management, Inc. 1-866-533-3438 www.matrixabsence.comLong Term Disability Insurance Contact the Office of Faculty and Staff BenefitsLife/AD&D Insurance- MetLife - Hyatt Legal Plans (Supp. Life Will Prep)
1-800-638-64201-800-821-6400 Group Number: 123529
Business Travel Accident Insurance- The Hartford Contact the Office of Faculty and Staff BenefitsLong-Term Care- The Todd Benefits Group 1-888-310-8633 www.toddltc.com/hoyasRetirement- Fidelity Investments 1-800-343-0860 http://netbenefits.com/georgetown- TIAA-CREF 1-800-842-2776 www.tiaa-cref.org/georgetown- Vanguard 1-800-523-1188
Hit “*” then “0” to speak with an associate
http://georgetown.vanguard-education.com/ekit
GUAdvantage- Insurance (Personal, Home, Auto, Pet)- Health, Wellness, Travel, Electronics, and much more
www.beneplace.com/georgetown
Hyatt Legal Plan (MetLaw) 1-800-821-6400 https://info.legalplans.com (Access Code: "GetLaw")
MetLife Auto & Home Insurance 1-800-GET-MET-8 (1-800-438-6388)
Bright Horizons Care Advantage- Sittercity, Years Ahead- Preferred Enrollment, Tuition Discounts
www.careadvantage.com/georgetown
GUWellness http://wellness.georgetown.eduemail: [email protected]
