Retiree Medical Benefit
Overview
As a retiring employee, you can elect to continue your medical insurance. In order to be eligible for this benefit as a retiree, you must have been working at least 75% time or 30 hours per week at the time of your retirement and be enrolled in a Georgetown sponsored medical plan. If you do not enroll at the time of your retirement, you may choose to defer coverage until a later date. If you choose not to continue, or to defer, your coverage at the time of your retirement, you will not be able to re-enroll at a later date.
Your cost for medical coverage depends on age, the plan you elect, how many dependents you enroll, and your years of service with Georgetown.
Like active employees, you can switch from one plan to another, but only during our "Open Enrollment" period each year. Open Enrollment generally happens in the fall. Changes made during Open Enrollment take effect on January 1 of the following year. The Office of Faculty and Staff Benefits has created an Open Enrollment Newsletter and an Open Enrollment Guide specifically for our retired faculty and staff. You may access the online versions by clicking below:
Once enrolled in the retiree medical insurance program, you can opt out of it at any time you wish. If you drop coverage for yourself, all of your dependents will be dropped at the same time. However, you may drop coverage for your spouse or dependent (irrevocably) and retain coverage for yourself.
If you wish to discontinue participation, you must notify us in writing (sending an e-mail to benefitshelp@georgetown.edu will satisfy this requirement). It is critical that you understand that your decision to discontinue participation is irrevocable -- once you elect to discontinue your participation, you will not be allowed to re-join at a later date.
- United Healthcare Choice Plus – available to retirees nationwide
- CareFirst BlueChoice Opt-Out Plus Open Access (POS) – available to retirees living in DC, Maryland, Northern Virginia and Delaware
- Kaiser HMO – available to retirees living in the DC Metropolitan area
- Kaiser Medicare Advantage – available to retirees, 65 or older, enrolled in Medicare, living in the DC Metropolitan area
To compare these plans side by side, click here.
You cannot "split" plans between yourself and your dependents. For example, if you elect United Healthcare for yourself, your dependents cannot choose to participate in the Kaiser plan.
Although many of our retirees live in the metropolitan DC area, some of them relocate to other parts of the country during retirement. All retirees should send written notice of the address change to the Office of Faculty and Staff Benefits so our staff can ensure that you are enrolled in the appropriate plan given your new place of residence. Even if you move outside of the DC metropolitan area, you may find that there are in-network providers available in your region, as the United Healthcare plan operates on a national network. The new CareFirst BlueChoice plan has in-network benefits for residents of DC, Maryland, Virginia and Delaware.
Please note that if you do not live in the metropolitan DC area, you will not have access to the Kaiser Centers (although Kaiser has centers across the country, as a participant in our plan you only have access to the Kaiser Mid-Atlantic Centers).
Summary of Medicare Complementary Benefits for Retirees Over 65 (2009)
- United Healthcare Choice Plus
- CareFirst BlueChoice Opt-Out Plus Open Access
- Kaiser Permanente Medicare Plus
Dependent Eligibility
At the time of your retirement, you can elect to include your spouse and/or dependent children in the plan that you choose, provided your spouse and/or dependent children were covered at the time of retirement. You must make this election at the time of your retirement (i.e., you cannot add your spouse or existing dependent child at a later date). You also cannot add new spouses (due to marriage or remarriage) or newly acquired dependents (due to birth or adoption) after your initial election. The premium associated with spousal or dependent coverage is unsubsidized.
If you die before your spouse and/or dependent child(ren), and these family members are covered under the medical plan at the time of your death, then these family members will receive two years of free medical coverage. At the end of this "premium holiday," your family members are entitled to coverage for the remainder of their lifetimes at the unsubsidized rate.
At the time of your retirement, you can elect to include your spouse and/or dependent children in the plan that you choose, provided your spouse and/or dependent children were covered at the time of retirement. You must make this election at the time of your retirement (i.e., you cannot add your spouse or existing dependent child at a later date). You also cannot add new spouses (due to marriage or remarriage) or newly acquired dependents (due to birth or adoption) after your initial election. The premium associated with spousal or dependent coverage is unsubsidized.
If you die before your spouse and/or dependent child(ren), and these family members are covered under the medical plan at the time of your death, then these family members will receive two years of free medical coverage. At the end of this "premium holiday," your family members are entitled to coverage for the remainder of their lifetimes at the unsubsidized rate.
Forms
2009 Medical Plan Premiums & Your Cost
Generally, the University will subsidize the lesser of either:
- 50% (for those who have attained 10 to 14 years of service prior to retirement), 70% (15 to 24 years of service) or 90% (25 or more years of service) of your total medical premium;
OR - 50%, 70% or 90% (depending on your years of service) of $583 per month for retirees under the age of 65, or of $250 per month for retirees over the age of 65.
Your contribution, therefore, will consist of the remaining individual premium amount plus the total premium for any dependents covered under your medical plan. This formula does not apply to certain grandfathered populations, or to Georgetown Hospital employees who retired between August 1, 1998 – June 30, 2000.
Please note that there are exceptions to the rate for the "Over 65" group. The vast majority of retirees over 65 are eligible for Medicare as their primary medical insurance, and the lower rates reflect this. However, some retired participants who are over 65 are not eligible for Medicare (such as some non-US citizens). Also, please note that all dependent children covered under the Retiree Medical Insurance Plan will be charged as though they are not Medicare Primary, even if they are.
Medical premiums are recalculated annually.
Deferring Your Coverage
Upon retiring from Georgetown University you may defer your retiree medical coverage until a future date. You may only take advantage of this one-time deferment if you are enrolled in a medical plan at the time of your retirement.
Things to Consider
If you decide to defer your retiree medical coverage, keep in mind that:
- You won't be eligible for retiree dental.
- Only dependents who were covered under your medical plan at the time of your retirement will be eligible for coverage upon re-enrollment. Dependent children must also satisfy the plan's age requirements.
- If you defer coverage, you may be suject to any pre-existing condition exclusions or limitations - unless you're able to provide proof of continuous coverage (e.g., Certificate of Creditable Coverage).
Retiring faculty and staff who wish to participate in a Georgetown University-sponsored retiree medical plan, will be required to pay monthly premium contributions using one of the following options:
- Reduction from monthly Georgetown University Retirement Plan (GURP) annuity.
- Reduction from monthly TIAA-CREF annuity.
- If retiree does not receive an annuity from the sources listed above then they will be required to pay by personal check.
If you elect method #3, Georgetown University will bill you monthly for your medical insurance premiums. We endeavor to provide all of our retirees with accurate and timely invoices. In the event we make an error on your invoice, simply contact us and we will review our records with you. If we are in error, we will credit or debit your account accordingly. Likewise, we retain the right to review the invoices we have sent to you for accuracy. If we detect that we have billed you in error, or failed to invoice you for a previous period in which you were insured, and that error resulted in your being under-billed, we will bill you for the difference. We will expect that you will bring your account current, and will work out a reasonable payment plan if the amount of the under-billing was significant.
It is important that you understand that the benefit Georgetown University offers its retirees consists of subsidies to retirees on the medical insurance program offered to active employees. The benefit does not take the form of distinct retiree medical insurance plans. Therefore, if Georgetown University makes changes to its medical insurance plans for active employees, these changes will be applicable to retirees as well. Examples of changes to the medical plans for active employees include:
- Changes in provisions to an existing plan such as changes to co-payments, deductibles, etc.
- Deleting a plan as an option
- Adding a plan as an option
Although it has no intention to do so at the present time, Georgetown specifically reserves the right to amend, change, or discontinue the retiree subsidy for medical insurance premiums at any time, and for any reason.
