Medical Insurance

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

If you are covered under a medical plan, you may also elect coverage for your spouse/LDA 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)

Spouse/Legally Domiciled Adult (LDA)

For medical, dental and vision coverage only, instead of covering a spouse, you may cover another qualified adult member of your household. A qualified adult member of your household is a LDA if he/she is an individual over age 18 who has for at least 6 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 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 coverage for both a spouse and a LDA. 

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. 

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. 

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 United Health Care Choice Plus will allow children to be covered until age 30 if they are full-time students.  

The university offers medical insurance coverage to certain non-benefits-eligible populations. The following employees are eligible to participate in the Affordable Care Act-compliant CareFirst BlueChoice Advantage CDH 2015 Plan:

• An Employee who is classified as a Resident Assistant by the University.
• 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 his or her 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.

Plan Documents

• Summary of Benefits & Coverage (SBC)
• Plan Summary

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.

• CareFirst
• Kaiser
• United Healthcare

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”.