Frequently Asked Questions
You can make your open enrollment elections by going to Employee Access + and following the instructions below:
- Log on to Employee Access+ website at limited.georgetown.edu/access with your GU NetID and password
- Enter your GU NetID and Password and click Verify
- Click on Faculty & Staff Services
- Click on Employee Services
- Select Open Enrollment on the employee menu screen
- Follow the instructions to make your elections
- Your current medical, dental, vision, supplemental life, dependent life and voluntary AD&D elections will remain the same.
- You will not be enrolled in the flexible spending accounts in 2011.
- Your contributions will be automatically adjusted to reflect the 2011 insurance premiums.
What documentation is required to enroll a qualified adult for coverage under the Medical, Dental or Vision plan?
Georgetown reserves the right to require documentation of a dependent’s eligibility status at any time.
A Legally Domiciled Adult is an individual over 18 who has for at least 6 months lived in the same principal residence as the employee and remains a member of the employee's household throughout the coverage period; and who either
No. You can elect coverage for a maximum of two adults, in addition to any eligible dependent children. So, if you're legally married, you can elect adult coverage for you plus either your spouse or an LDA.
Health, dental and vision care coverage is available to two adults - the employee and either a spouse or LDA. If the employee is the only adult now using the family coverage and the other adult meets the eligibility requirements for LDA status, the second adult can be added, provided you have not covered another LDA within the past six (6) months. If, however, you cover your legal spouse under family coverage, you cannot also cover an LDA.
A child's eligibility depends on the child's relationship to the employee. A child related to the employee by blood or adoption would, for example, qualify as a dependent.
No. To qualify as an LDA an individual must meet all eligibility requirements which include - for both Category A and Category B LDAs - that the adult has lived with you in your principal residence for at least six months before enrollment and continues to live with you during the coverage period.
You can enroll an LDA in medical, dental or vision plans on or prior to the last day of the month following the date of hire, during open enrollment, or within 90 days of a qualified change in status. After the termination of coverage for an LDA, there is a six month waiting period before a new LDA may be enrolled.
Yes. You can enroll an LDA in any of the available medical plans. The LDA must participate in the same plan in which you, the employee, are enrolled.
No. If an LDA is age 65 or older, claims will be processed under UHC, Aetna, CareFirst or Kaiser as secondary.
Employees who elect LDA coverage will pay the same amount for coverage as employees do for employee + spouse or family coverage. However, there may be other cost implications depending on whether or not the LDA is the employee's tax dependent.
There could be. For example, federal law requires that the value of employer-provided coverage for LDAs who are not tax dependents be imputed and reported as taxable income to the employee. We recommend that you consult with an attorney about the tax and other legal implications of electing LDA coverage.
The amount reported as taxable income for LDA coverage under the medical, dental and vision plans are determined each year. Federal tax laws require employers to report as taxable income the fair value of coverage but the IRS has never issued guidance on how "fair value" should be determined. While Georgetown follows a formula used by many employers, this is not guarantee that the IRS will agree with the amount of taxable income. We recommend that you consult with your attorney or tax professional if you have any questions.
To qualify for Category B LDA coverage, an individual must meet the definition of "dependent" set forth in Section 152 of the Internal Revenue Code. That section specifies the conditions of financial support, relationship and citizenship necessary to "dependent" status under federal tax law.
No. There are no evidence of insurability rules requirements for any individual under these plans.
- the end of the month following an employee's date of termination, or
- the end of the month in which the individual no longer satisfies the eligibility criteria for LDA status.
No. COBRA coverage applies only to the legal spouse and dependent children of an employee. An LDA who has lost eligibility may not elect continuing coverage under COBRA in his or her own right. If the employee remains an active Georgetown employee and the LDA relationship terminates, the LDA is not eligible for COBRA. Georgetown will extend, however, certain COBRA-like benefits to LDAs. An employee on COBRA may add an LDA in the same manner as is permitted for active employees with spouses. If an employee with an LDA terminates employment and chooses COBRA coverage for 18 months, the employee may continue coverage for his or her LDA for that same 18 month period. If the employee does not elect COBRA coverage, the LDA may not make a separate election to continue his or her coverage. In addition, an employee on COBRA may add an LDA in the same manner as is permitted for active employees with spouses. However, should the employee die or become Medicare entitled or should the LDA relationship end, the LDA may not make an election under COBRA as a second qualifying event.
You can enroll yourself, one other qualified adult member of your household, and your dependent children under Georgetown' s medical plans. The qualified adult member of your household can be either your legal spouse or a legally domiciled adult (LDA).
There is no waiting period. You are eligible to participate in the dental plan as of your date of hire, but must enroll in the plan by the last day of the calendar month following the calendar month of your date of hire. Georgetown University does not choose any "default plan" for newly hired employees. If you do not enroll by the deadline required of newly hired employees, you must wait until the next "Open Enrollment" period to enroll, and will not have medical coverage until the following January 1st.
None of the plans offered provide adult orthodontia benefits. Orthodontia for covered dependent children is offered through the Aetna DMO and the Delta Dental Enhanced plan.
Yes, with your Delta Dental program, you have complete freedom of choice in selecting a dentist. You can select any dentist at any time for any covered service. Your choice of dentist can determine your savings. You likely will save most when you visit a dentist who participates in the Delta Dental PPOSM network. When you must visit a non-PPO dentist, your next best option is a dentist who participates in the Delta Dental Premier network, the largest dentist network in the U.S. Delta Dental Premier dentists usually will save you more money than non-participating dentists will. While Premier dentists’ contracted fees are often slightly higher than PPO dentists’ fees, Premier dentists agree not to balance bill you.
How do I know if my dentist participates with the Delta Dental PPO or Premier networks?
Delta Dental’s web site at www.deltadentalins.com features an online dentist directory. You can search for dentists by name, address and specialty. You can get directions and maps to dentists’ offices online. You can also call Delta Dental’s toll-free number – 800-932-0783 – and a customer service representative can tell you if your dentist participates with Delta Dental – or your dentist’s office can tell you if your dentist participates with Delta Dental.
When enrolled in Delta Dental Standard or Enhanced plans, will I have to submit my own claim form?
Delta Dental participating dentists take care of all paperwork for you, including submitting your claims. If you visit a dentist who does not participate with Delta Dental, you may need to submit a claim form. Claim forms are available for downloading from Delta Dental’s web site at www.deltadental.com or you can contact Delta Dental at 800-932-0783 to request a form be sent to you.
One Delta Drive
Mechanicsburg, PA 17055
How long will it take to process my claim?
Delta Dental typically processes claims in 10 calendar days or less from the date Delta Dental receives the claim, provided it is complete and eligibility can be verified. If your dental office participates with Delta Dental, you will receive notification that payment was made to your dentist. This notice will advise you of the amount of the bill for which you are responsible. If you have not already paid your dentist your portion of the bill, this is something you should do once you know how much you owe. If your dental office does not participate with Delta Dental, then Delta Dental sends its payment to you.
How can I find out what my benefits are or whether my claims have been approved?
Delta Dental’s web site has a number of services that make it quick and easy to get information about your dental benefits. You can get information about your account online via a secure log-in system. Information includes program benefits, your and your dependents’ eligibility, status of deductibles, maximum usage and claim status. You can also print out an ID card. Just log on to www.deltadentalins.com and follow the links to Online Services. Delta Dental’s web site also has helpful information about how to get the most from your dental coverage, and dental health tips on such topics as caring for children’s teeth, the dangers of mouth piercing, and coping with teeth grinding. You can also download a claim form for those occasions when you may use a non-participating dentist.
Delta Dental can accept customer service inquiries of any nature over the Internet. Our customer service representatives promptly respond to questions and comments on such matters as claim status, enrollee
eligibility, and group benefits. You can also call Delta Dental’s toll-free number and a customer service representative will be happy to answer your questions about your benefits and any of your claims.
When is a dentist required to accept Delta Dental’s allowances? When can a dentist balance bill?
Balance billing occurs when a dentist bills you for the difference between the dentist’s actual charge and the amount benefited by Delta Dental for the service. Delta Dental’s participating dentists are prohibited from balance billing. They agree to accept Delta Dental’s allowances or their fees – whichever is less (the Allowed Amount) – as payment in full. The Allowed Amount is the maximum amount that a participating dentist can charge for a covered service. Delta Dental pays a portion of the Allowed Amount. You are responsible for paying the difference between Delta Dental’s payment and the Allowed Amount. Participating dentists are paid directly by Delta Dental, and by agreement cannot bill you more than the applicable copayment or deductible for covered services. You also may be responsible for charges that exceed your annual benefit maximum or for services that are not covered benefits.
You are eligible to participate in the Flexible Spending Accounts if you are
- A staff employee (including members of the Allied International Union and SEIU) hired to work at least 30 hours per week;
- A faculty member or AAP hired to work at least 75% time; or
- A fellow.
Absolutely. There is no requirement that you must participate in our medical insurance plan to enroll in our health care reimbursement plan. For example, you may choose to enroll yourself, your spouse, and your dependent children in the health care reimbursement plan even if your family is enrolled in the medical insurance plan offered through your spouse's employer. Likewise, you can enroll in the health care reimbursement plan to cover out-of-pocket dental expenses for yourself or any of your dependents (including your spouse) if you choose not to participate in any dental plan, choose to participate in the dental plan offered by your spouse's employer, or choose to purchase dental insurance on your own behalf.
No. The IRS specifically disallows medical insurance premiums as an allowable expense for purposes of the health care reimbursement plan. If you are enrolled in one of our health care plans, this is basically a moot point as Georgetown allows for you to pay these premiums with pre-tax dollars. However, if you are paying COBRA premiums for your dependent, or purchase medical insurance elsewhere with post-tax dollars, you cannot use the health care reimbursement plan for those premium payments.
The payroll system will calculate your deduction, based on your annual election and your pay frequency. If you are paid biweekly, then your deduction will be 1/24 of your annual election. (Remember, when a given month has three biweekly pay dates, benefits deductions are only applicable to the first two pay dates in the month.) If you are paid monthly, 12 months of the year, then your deduction will be 1/12 of your annual election. If you are paid monthly, 10 months of the year, then your deduction will be 1/10 of your annual election. Of course, all deductions for these plans are made on a pre-tax basis.
No. Participants cannot change the timing of their deductions. For example, participants cannot ask to have their deductions taken out only in the first six months of the plan year, even if they anticipate that they will be terminating employment before the end of the plan year. Likewise, participants cannot request that the deductions be taken out only in the second six months of the plan year either.
Yes. You may have your reimbursements directly deposited into your checking or savings account. In order to take advantage of this feature, you simply have to complete a short form authorizing Colonial HealthCare to directly deposit your reimbursement. Simply download the form, complete it, and return it to Colonial HealthCare. You can also contact them (877-819-9413) to request that they mail or fax a blank form for you to complete. You must return the completed form directly to Colonial HealthCare (do not send the form, or even a copy of the form, to the Benefits Office). Please note that you may elect this direct deposit option at any time; you need not wait until the beginning of a new plan year.
If you terminate employment during the year, special rules apply. Eligible expenses must be incurred on or before your date of termination, and the claim must be filed no later than 90 days from your date of termination, in order for it to be reimbursed by the Plan. You will be reimbursed for the amount of your eligible expenses up to your annual election for the health care reimbursement account (please note for terminated employees this amount can exceed the amount you contributed to the plan). The rule is different for the dependent care reimbursement plan --you will be reimbursed only for the amount you contributed to that plan, which is often less than the annual election for employees terminating during the middle of a plan year.
No. If you receive a reimbursement for more than you contributed to the health care reimbursement account, you will get to keep the amount you received in excess of the amount you funded. Georgetown will not, and cannot by law, ask for you to pay us back for the excess you receive from the plan. Please note this is not applicable for the Dependent Care Reimbursement Plan because you can never receive a reimbursement in excess of the amount you have funded.
FSA Debit Card - The Benefits Card
What is the The Benefits Card?
All FSA participants receive a debit-style MasterCard that allows direct access to FSA funds for eligible health care and dependent care expenses. This means no waiting period for reimbursements. When you use your card, available funds are deducted from your FSA account to pay for services or supplies. You must submit receipts for these purchases to Colonial HeathCare within 10 days in order to comply with IRS rules.
To receive reimbursement from your account, you complete a claim form and submit it to Colonial HealthCare. You may download the form and instructions on the link provided. Follow the instructions on the form. Please read above (the section entitled Use It or Lose It!) to for information regarding claim filing deadlines.
How do I initiate a STD claim?
First, contact your supervisor and/or the Office of Faculty and Staff Benefits to inform of your absence due to illness, accident or injury.
- You may also file a claim by Contacting Matrix at 1.866.533.3438
- You may also file a claim through Matrix’s secure website, www.matrixefiling.com.
What Information Do I Need To Give Matrix?
- Phone Number
- Social Security Number
- Type of absence
- Manager’s/Supervisor’s name, phone number, and e-mail address
- Benefits representative’s name, phone number, and e-mail address:
Amanda Harris, 202-687-1319, email@example.com
- Starting date of absence
- Information about your health care provider/physician (name, address, phone number, fax number)
What Do I Need To Do After I Call Matrix?
- Review the “Intake” form, and mark any necessary changes. If corrections or changes are made on the form, fax or mail a copy to Matrix as soon as possible.
- Complete the “Medical Disability Certification Application for Disability Benefits” form. Fax or mail form to Matrix as soon as possible.
- Complete and sign the “Authorization To Obtain Medical Information” (you can use either the form included in the packet from Matrix or a copy of the Authorization from the back of your Matrix wallet card). Take, fax or send the signed form to your health care provider/physician as soon as possible.
- Notify your Manager/Supervisor/Benefits representative of your absence (and maintain contact with him/her during your disability leave).
What Is Matrix’s Next Step?
Matrix’s absence management experts will review the information provided by you and your health care provider/physician to determine if your disability claim is approved and to determine the approved duration. Matrix will notify you by mail if your disability claim/absence is approved and specify the approved duration. If your disability claim is not approved, Matrix will notify you by mail and state the reasons for denial. Matrix will also advise Georgetown University of the approval/duration or denial.
Matrix is committed to review requests for disability absences and make decisions as soon as they have all the necessary information. It is critical that you and your health care provider/physician supply all the information necessary for Matrix to reach a decision. If a required health statement is not received, your Georgetown University pay will be suspended until the required health statement is received. (Please note that it is ultimately your responsibility to make sure your health care provider/physician provides Matrix with complete information on a timely basis.)
How Will I Be Paid While I Am Out On An Approved Short-Term Disability?
Short-term disability benefits are paid through the Georgetown University payroll system according to the company’s standard payroll schedule. For additional information on STD benefits you can contact your Supervisor or the Office of Faculty and Staff Benefits.
How Does Short-Term Disability Coordinate with Long-Term Disability (LTD)?
If you are on STD for a period that is likely to extend beyond 90 calendar days and you are eligible for LTD coverage, Matrix will coordinate your transition from STD to LTD.
• Defined Contribution Retirement Plan (403(b) Plan)
• GURP (Georgetown University Retirement Plan)
Georgetown University will automatically contribute 5% of each paycheck into a retirement savings account for eligible faculty, staff and AAPs. In addition to Georgetown University’s automatic contribution, participants who contribute 3% of their pre-tax pay will receive an additional 5% contribution from Georgetown University, for a total contribution of 13% of pay. Participants who contribute less than 3% will receive a proportionate share of the additional 5% contribution by Georgetown University. As well, participants are immediately vested in the contributions toward their retirement.
You direct how Georgetown University’s contributions and your personal contributions are invested. You decide which investment company(ies) to use. After you have selected your investment company(ies), you will be contacted directly by the company and asked to choose from a variety of fund(s) offered by the company. If you do not make an investment decision, these contributions will be invested in the Plan’s default investment option, until such time as you do make an investment decision. Note that your contribution will be invested in the same manner as Georgetown University contributions.
When will Georgetown University’s contributions be deposited into my account?
Each pay period, Georgetown University remits your contributions, along with Georgetown University contributions, to whichever investment company(ies) you have elected. You may choose from three investment companies:
• Fidelity Investments
• The Vanguard Group
If I leave Georgetown University, what can I do with my Defined Contribution Retirement Plan balance?
You have several options on what to do with your accrued benefit. You can take your balance with you when you retire or leave employment as a lump sum or monthly annuity. You can also:
• Roll over to a new employer’s plan, if allowed by the new plan
• Roll over the balance to an Individual Retirement Account (IRA)
• Leave the account with Georgetown University and start receiving benefits when you reach retirement age. You must begin taking a minimum distribution in the year after you reach age 70 ½.
If you cash out your account before retirement age, you may be subject to taxes and other financial penalties.
Those individuals who are currently enrolled in the Defined Contribution Retirement Plan and were hired prior to 1/1/96, will receive (or be eligible to receive) a maximum contribution of 12% of pay to their retirement account from Georgetown University.
Not immediately. You must satisfy the eligibility requirements as if you were a new employee if your employment gap exceeds 12 months.
No, you must be currently benefits-eligible to receive this benefit.
You will be eligible once you have completed 9 months of benefits-eligible service. If you become benefits-ineligible (for any reason) for less than one year, your waiting period for TAP benefits equals the time of your gap.
Not immediately. You must satisfy the eligibility requirements as if you were a new employee if you become benefits-ineligible for more than 12 months. Note that this answer is the same for employees who terminate employment or switch to a benefits-ineligible status for more than 12 months. (Refer to question #1.)
Yes, but with several important caveats. We always pay the schools directly, and always require an invoice, even for retroactive payments. We do not abolish the documentation requirements, and you may not always be able to supply the documentation retroactively (in that case, no benefits can or will be paid).
This type of employment status change triggers the 8-semester TAP limit (a change from the Staff maximum of 120 credit hours) and your record will be reviewed to determine your remaining TAP balance.
As with all of our benefits, you may only receive one Dependent TAP benefit per child, availing of a maximum of eight undergraduate semesters by age 30. If both parents are TAP-eligible, either parent may submit tuition assistance applications.
The school to which I am applying requires a deposit prior to my registering for classes. Can I submit this deposit to the TAP program for payment?
Not usually. Please send an email to firstname.lastname@example.org to alert our office of changes to your student account record so we may adjust your TAP disbursement accordingly.
If you add courses, you may submit another tuition invoice and TAP application for the additional charges, as long as they do not exceed your maximum TAP benefit. If you drop courses, most institutions will return the excess TAP payment to our office. For dependents, if any portion of the TAP disbursement is retained by the school, that partial disbursement still counts against the 8 semester maximum. In any event, it is strongly encouraged that you contact the Office of Faculty and Staff Benefits when dropping courses at an outside institution.
Generally, TAP benefits are not taxable with several important exceptions. TAP benefits are taxable:
- if you received this benefit as a MedStar employee in, or prior to, summer semester of 2008;
- if you are receiving benefits for your child's graduate school education; or
- to the extent that these benefits exceed $5,250 for your graduate school education, with very limited exceptions.
To learn more about these exceptions, go to TAPTAXFACTS.
- Trade schools, including public schools that offer night programs;
- GED programs, certification exams, or prep classes
- Private high schools, elementary schools, and pre-schools;
- Non-college credit certificate programs, other than Georgetown University's Center for Continuing and Professional Education (CCPE); and
- Courses that are not part of a degree-granting program and are not job related, except for courses offered through the GU School for Continuing Studies (SCS).
- International colleges and universities, with some exceptions. Please contact the Office of Faculty and Staff Benefits for details.
Students studying abroad as part of their school's study abroad program are covered under TAP as long as the program is approved through a domestic institution and the tuition for the study abroad program is billed by, and paid to, that domestic institution and not the school/program located abroad. An original tuition invoice from the student’s institution reflecting the study abroad tuition must be submitted with the TAP online application.
All non-tuition fees are not covered, such as:
- Mandatory fees
- Lab fees
- Application fees
- Room & board, and meal fees
- Late fees
- Student health fees
- Gym/recreation/activity fees
- Library fees
- Damage fees
- Fines of any type
No, to protect the integrity of the program, we do not waive the eligibility requirements, even for participants who miss the service requirements by a short period of time. You must meet the service requirements for eligibility by the first day of classes. If you miss the deadline, even by a small period of time, you can apply for TAP benefits for the next semester of study.
No, for IRS-compliance purposes we always pay the school directly, even if you have already paid the tuition bill. If you have already paid the school, you should ask them to reimburse you after we have made payment to them. Please note that we have no control over any other institution's policies with respect to refunds. Therefore, you should verify with the school that they will reimburse you if you choose to pay them directly prior to our processing your TAP benefit.
No, you cannot use TAP if you are on a leave of absence of more than 30 days.
No. You are not required to remain employed at Georgetown after receiving TAP benefits. Of course, if you terminate employment, you will no longer be eligible to receive the benefit, but you will not be required to reimburse the University for the benefits you have already used. If you resign during a semester during which you or your dependents are using TAP benefits, you will not be required to reimburse Georgetown for that semester, but you will not be eligible for TAP benefits for any subsequent semester.