Benefit Form Library
Enrolling in, or making changes to, your medical, dental, vision or retirement plan?
Go to http://gms.georgetown.edu and log on to the Georgetown Management System using your NetID and password. Click on "Benefits" and enroll or make changes online.
The Benefits Office is pleased to provide you access to the forms listed below so you do not have to come to our office, or call us, merely to obtain a form. It is not intended for you to be able to complete any of these forms on-line.
You will need Adobe Acrobat Reader© to view these forms. If you do not have Adobe Acrobat Reader software on your computer, simply click >> here << to get the free software from Adobe and follow the installation instructions.
Carefirst BlueChoice Claim Form
CareFirst/Walgreens Prescription Drug Mail Order Form
CareFirst/Argus Prescription Direct Reimbursement Form
CareFirst BlueChoice Student Certification Form
CareFirst/CVS Caremark Mail Order Form (2014)
Aetna Open Choice Claim Form
Aetna Rx Home Delivery Order Form
United Healthcare Choice Plus Claim Form
United Healthcare/Medco Prescription Reimbursement Form
United Healthcare/Medco Prescription Mail Order Form
EyeMed Vision Care - Out-of-Network Claim Form
Legally Domiciled Adult
**Please Note: GURP final calculations submitted in November and December are typically delayed due to the annual change in interest rates. These calculations are typically not completed until late January.
Georgetown University Retirement Plan (GURP) Benefit Application & Calculation Request Form
Life Insurance Forms
MetLife Statement of Health Form
2013 Flexible Spending Account Forms
Flexible Spending Account Claim Form
Flexible Spending Account Direct Deposit Authorization
Tuition Assistance Program (TAP) Forms
For current faculty and staff, we strongly recommend that you apply for TAP benefits online. However, if you do not have a Net ID and password, you can contact the Office of Faculty and Staff Benefits at 202-687-2500 for a paper form. For retirees, you may download application forms below:
- Retirees: TAP Benefits at GU
- Retirees: TAP Benefits at Outside Institutions
- Retirees: Child TAP Benefits at GU
- Retirees: Child TAP Benefits at Outside Institutions