Medical Insurance

Georgetown University offers a variety of medical insurance plans designed to meet the diverse needs of our faculty, staff, and their families. Whether you prefer the flexibility of a nationwide network or the coordination of care offered through regional plans, you’ll find options that support your health, budget, and personal circumstances.

Who can enroll?

  • An administrative staff employee, including AAPs and members of the 1199SEIU United Healthcare Workers East union, hired to work 30 or more hours per week;
  • An academic employee hired to work at least 75% time; or
  • A Postdoctoral or Law Center Fellow.

If you are covered under a medical plan, you may also elect coverage for your spouse and your eligible dependent children. You will select from one of the following levels of coverage:

  • Employee only
  • Employee and Spouse/LDA
  • Employee and Child/ren
  • Family (Employee, Spouse/LDA and Children)

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. 

There may be tax and other legal implications for those who elect coverage for a LDA. You are encouraged to consult with an attorney before electing LDA coverage. 

All medical plans will cover dependent children until age 26, regardless of whether or not they are full-time college students. Only Carefirst BlueChoice Advantage and UnitedHealthcare Choice Plus will allow children to be covered until age 30 if they are full-time students.  

Coverage for a Legally Domiciled Adult (LDA)
For medical, dental, and vision coverage only, you may choose to cover either your spouse or another qualified adult member of your household, known as a Legally Domiciled Adult (LDA) — not both.

  • A Legally Domiciled Adult (LDA) is an individual who:
  • Is age 18 or older;
  • Has lived in your principal residence for at least the past six months;
  • Remains a member of your household for the duration of the coverage period; and
  • Meets one of the following criteria:


Option 1: Unrelated Adult Partner

The individual:

  • Has a close, personal relationship with you (not a casual roommate or tenant);
  • Shares basic living expenses and is financially interdependent with you;
  • Is not legally married to anyone else and not related to you by blood in a way that would prohibit marriage; and
  • Is not receiving or eligible for employer-sponsored group coverage.

Option 2: Dependent Relative

The individual:

  • Is your blood relative who meets the IRS Section 152 definition of a tax dependent; and
  • Is not receiving or eligible for employer-sponsored group coverage.

⚠️ You may not cover both a spouse and a Legally Domiciled Adult under Georgetown’s medical plan.

Important: You must be prepared to provide documentation that substantiates the LDA criteria above. Electing coverage for an LDA may have tax and legal implications. Before enrolling an LDA, you are encouraged to consult a qualified tax advisor or attorney.

The university offers Affordable Care Act-compliant medical insurance coverage to certain non-benefits-eligible populations. The following employees are eligible for this coverage:

  • An Employee who is enrolled in a Ph.D. program at the University and who works as either a teaching assistant or a research assistant at the University as part of their Ph.D. program.  
  • An Employee who is classified as a “Temporary Employee” or a “Hoya Temp,” is not a “seasonal employee” as defined by the Affordable Care Act (“ACA”), and:
    • is hired with the reasonable expectation that he or she will work 30 hours or more per week; or
    • does in fact work, on average, 30 hours or more per week as measured over the course of an ACA-compliant measurement period implemented by the University.
  • An Employee who is classified as a “Student Employee,” is not a “seasonal employee” as defined by the ACA, and:
    • is hired with the reasonable expectation that he or she will work 30 hours or more per week; or
    • does in fact work, on average, 30 hours or more per week as measured over the course of an ACA-compliant measurement period implemented by the University.

CareFirst BlueChoice Advantage CDHP (ACA Compliant Plan)
This plan is available to those who meet the eligibility requirements outlined above. It’s important to note that any employees who may be eligible for student health insurance this coverage would be supplemental.

What plans are available?

Need help choosing the right benefit plans for you? Use UPWISE to help you decide.

Under the Kaiser Health Maintenance Organization (HMO) plan, you choose a primary care physician (PCP) who coordinates all of your medical care within the Kaiser network. Kaiser Permanente many centers located throughout the Washington, DC metropolitan area.

Accessing Care
With the exception of life threatening emergency treatment, participants must receive care through Kaiser centers. Hospitalization coverage is included at area hospitals associated with Kaiser.

  • You must select a PCP in order to obtain care within the network
  • As needed, your PCP will refer you to specialists within the network
  • Except in emergency situations, coverage is not provided for care received outside the network. You can learn more about coverage while traveling at kp.org/travel.
  • You pay a copayment for each visit to a physician’s office

Prescription Drug Plan
Kaiser provides prescription drug coverage at a Kaiser center pharmacies and participating community pharmacies. No reimbursement is made for prescriptions purchased outside of a Kaiser center or participating community pharmacy.  Mail order pharmacy is also available for 90-day supply.

Under the Kaiser Health Maintenance Organization (HMO) plan, you choose a primary care physician (PCP) who coordinates all of your medical care within the Kaiser network. Kaiser Permanente many centers located throughout the Washington, DC metropolitan area.

Accessing Care
With the exception of life threatening emergency treatment, participants must receive care through Kaiser centers. Hospitalization coverage is included at area hospitals associated with Kaiser.

  • You must select a PCP in order to obtain care within the network
  • As needed, your PCP will refer you to specialists within the network
  • Except in emergency situations, coverage is not provided for care received outside the network. You can learn more about coverage while traveling at kp.org/travel.
  • You pay a copayment for each visit to a physician’s office

Prescription Drug Plan
Kaiser provides prescription drug coverage at a Kaiser center pharmacies and participating community pharmacies. No reimbursement is made for prescriptions purchased outside of a Kaiser center or participating community pharmacy.  Mail order pharmacy is also available for 90-day supply.

With the Kaiser Permanente High Deductible Health Plan (HDHP 3 Signature), you’ll enjoy the same network of doctors, facilities, and high-quality care you know from the Kaiser HMO—along with the flexibility and tax advantages of a high-deductible plan.

Under this plan, you’ll first pay a set annual deductible for most covered health care services before the plan begins sharing costs through copays or coinsurance. Once you’ve met your deductible, you’ll pay only the applicable copay or coinsurance for covered services for the remainder of the plan year.

Preventive care—including routine checkups, screenings, and immunizations—is always covered at no cost, even before you meet your deductible.

Accessing Care
With the exception of life threatening emergency treatment, participants must receive care through Kaiser centers. Hospitalization coverage is included at area hospitals associated with Kaiser.

  • You must select a PCP in order to obtain care within the network
  • As needed, your PCP will refer you to specialists within the network
  • Except in emergency situations, coverage is not provided for care received outside the network. You can learn more about coverage while traveling at kp.org/travel.
  • You will pay $0 for most preventive care services 
  • You will pay out of pocket until you reach your deductible ($1,700 for individual / $3,400 for all other tiers)
  • Once your deductible is met, you will pay a 10% coinsurance for most services

Prescription Drug Plan
Once you’ve met your deductible, Kaiser covers prescription drugs with a copayment for prescriptions purchased at a Kaiser center and at participating community pharmacies. No reimbursement is made for prescriptions purchased outside of a Kaiser center or participating community pharmacy.  Mail order pharmacy is also available for 90-day supply.

When you enroll in the Kaiser HDHP, you have the opportunity to open a Kaiser Health Savings Account (HSA). An HSA allows you to save pre-tax dollars to use to help offset your deductible or other eligible medical expenses now or in retirement.

If you enroll in a Kaiser HSA, Georgetown University will contribute to your HSA account each pay period. Even if you contribute $0, you must enroll in the Kaiser HSA each year–and be actively at work–in order to receive the GU contribution to your HSA. 

Employee Only Coverage

  • $62.50 (monthly)
  • $31.25 (biweekly)

Employee plus spouse and/or dependents

  • $125 (monthly)
  • $62.50 (biweekly)

The IRS limits the amount that you can contribute to an HSA each year. In 2026, the maximum contribution is $4,400 (individuals) and $8,750 (family) and an additional $1,000 catch-up contribution for those over age 55. These include limits are inclusive of the Georgetown University contribution to your account. 

The CareFirst BlueChoice Advantage Point-of-Service (POS) plan combines the cost savings of an HMO with the flexibility of a PPO. You have the freedom to see any provider you choose, but you’ll pay less when you use BlueChoice Advantage network providers. Prescription drug coverage for this plan is provided by CVS Caremark.

Finding a Doctor
As a CareFirst member, you have access to a national network of providers. To locate a medical provider, go to CareFirst’s online directory and search the “BlueChoice Advantage” network in your zip code.  

The CareFirst BlueChoice Advantage plan allows members the flexibility to choose a health care provider when and where treatment is needed. When care is received inside the CareFirst service area members will experience the lowest out of pocket costs when they visit a BlueChoice provider. Members still have the option to access a BlueCard PPO doctor, but will be subject to higher out of pocket expenses.

Members receiving care outside the CareFirst Service area will experience the lowest out of pocket costs by accessing a national BlueCard PPO provider. Members will still have the option to opt-out of this network at a higher out of pocket expense.

Prescription Drug Plan
Participants in the CareFirst POS plan are covered for prescription drugs through CVS Caremark. You’ll receive two ID cards—one from CareFirst for medical services and one from CVS Caremark for prescriptions.

For short-term prescriptions (up to 30 days), you can fill them at over 68,000 participating pharmacies, including CVS, Rite Aid, Walgreens, Safeway, Giant, and many others.

For long-term medications, use Maintenance Choice to save money. These prescriptions must be filled as a 90-day supply at CVS Caremark retail locations, Kroger, Costco, or through CVS Caremark Mail Service. 

The CareFirst BlueChoice Advantage Consumer Directed Health Plan (CDHP) is a high-deductible health plan that gives you greater control over your health care spending. A CDHP pairs your health insurance with a tax-advantaged Health Savings Account (HSA), allowing you to save and pay for eligible medical expenses—now and in the future.

With this plan, you’ll need to meet your annual deductible before the plan begins to share costs for most medical and prescription drug services. Once your deductible is met, you’ll pay only the applicable copays or coinsurance for covered services up to the plan maximum for the rest of the plan year.

The CDHP uses the same network of providers as the BlueChoice Advantage POS plan, giving you access to high-quality care while helping you manage costs more effectively. Prescription drug coverage for this plan is provided by CVS Caremark.

Finding a Doctor
As a CareFirst member, you have access to a national network of providers. To locate a medical provider, go to CareFirst’s online directory and search the “BlueChoice Advantage” network in your zip code.  

The CareFirst BlueChoice Advantage plan allows members the flexibility to choose a health care provider when and where treatment is needed. When care is received inside the CareFirst service area members will experience the lowest out of pocket costs when they visit a BlueChoice provider. Members still have the option to access a BlueCard PPO doctor, but will be subject to higher out of pocket expenses.

Members receiving care outside the CareFirst Service area will experience the lowest out of pocket costs by accessing a national BlueCard PPO provider. Members will still have the option to opt-out of this network at a higher out of pocket expense.

Prescription Drug Plan
Participants in the CareFirst POS plan are covered for prescription drugs through CVS Caremark. You’ll receive two ID cards—one from CareFirst for medical services and one from CVS Caremark for prescriptions.

For short-term prescriptions (up to 30 days), you can fill them at over 68,000 participating pharmacies, including CVS, Rite Aid, Walgreens, Safeway, Giant, and many others.

For long-term medications, use Maintenance Choice to save money. These prescriptions must be filled as a 90-day supply at CVS Caremark retail locations, Kroger, Costco, or through CVS Caremark Mail Service. 

When you enroll in the CareFirst BlueChoice Advantage CDHP, you must also enroll in the CareFirst HSA (or, BlueFund HSA). You decide whether you want to contribute to your HSA upon first enrolling and each year during open enrollment. Georgetown does not contribute to the CareFirst HSA.

What is an HSA?

An HSA allows you to save dollars to pay health care expenses, now or in the future. In 2026, the maximum contribution is $4,400 (individuals) and $8,750 (family) and an additional $1,000 catch-up contribution for those over age 55. Your HSA is 100% vested immediately, and the account balance rolls over from one year to the next. Once your HSA balance reaches $1000, you are able to invest the money.

Some restrictions do apply. You cannot contribute to a Health Savings Account if

  • You, or another member of your household, are participating in a Health Care Flexible Spending Account (FSA) for 2026
  • As of December 31, 2025, you have an unused balance in your 2025 Health Care FSA
  • You are enrolled, or plan to enroll, in Medicare Part A or B in 2026.

The UnitedHealthcare (UHC) Choice Plus plan is a Preferred Provider Organization (PPO) plan that gives you the freedom to see any doctor or specialist in the network—without a referral. UHC offers a national network of providers, but you also have the flexibility to receive care from any licensed provider you choose.

This plan includes two levels of coverage, determined each time you receive care:

  • In-network: You’ll pay lower out-of-pocket costs when you use UnitedHealthcare network providers.
  • Out-of-network: You can still see non-network providers, but you’ll pay more for services.

Your costs under either level of coverage may include office visit copays, deductibles, and coinsurance.

How do I enroll?

All newly benefits eligible employees have 30 days from their date of hire or change in eligibility to make their benefits elections online at gms.georgetown.edu. Learn more on webpage for new employees here.

After you first enroll in your benefits as a new hire, you generally cannot make changes to your medical, dental, vision, or voluntary insurance coverage until the next Open Enrollment period. However, there are certain situations—called qualifying life events—that allow you to make mid-year changes to your coverage.

Qualifying Life Events
If you experience a qualifying life event, such as a change in employment or family status, you may update certain benefit elections during the year. To make a change, you must:
Submit documentation of the event to the Office of Faculty and Staff Benefits, and
Update your elections in GMS within 30 days of the qualifying event.

Examples of qualifying events include:

  • Marriage or divorce
  • Birth or adoption of a child
  • Loss or gain of other coverage
  • A change in your or your dependent’s employment status that affects eligibility

Open Enrollment
Open Enrollment is the annual period when you can make changes to your benefit elections without a qualifying life event. During this time, you can:

  • Enroll in or waive benefit plans
  • Add or remove dependents
  • Change plan options or coverage levels

Georgetown’s Open Enrollment period typically runs mid-October through mid-November, with any changes taking effect on January 1 of the following year.

Additional Information

Georgetown University continues to claim the accommodation related to contraceptive coverage under the Affordable Care Act. This means that the insurers or third party administrators of Georgetown’s employee health plans will provide separate payments for contraceptive services that plan participants use, without cost sharing and at no other cost to plan participants. Georgetown does not administer or fund these payments.

These links lead to the machine-readable files that are made available in response to the federal Transparency in Coverage Rule and includes negotiated service rates and out-of-network allowed amounts between health plans and healthcare providers. The machine-readable files are formatted to allow researchers, regulators, and application developers to more easily access and analyze data.

  • CareFirst
  • Kaiser
  • UnitedHealthcare
    UnitedHealthcare creates and publishes the Machine-Readable Files on behalf of Georgetown University. To link to the Machine-Readable Files, please visit transparency-in-coverage.uhc.com and hit CTRL F on your keyboard to bring up the search bar and enter “georgetown-university”.

Have Questions? Contact the Office of Faculty and Staff Benefits at 202-687-2500, or email benefitshelp@georgetown.edu.