2017 - amazon s3 · 2016. 11. 2. · l in your gms inbox, select the option to enroll in benefits....

2017InternationalBenefits Guide

Choice Access Service

Benefits at-a-Glance for International Faculty, Staff and AAPsMedical and Prescription Drug Coverage

Dental CoverageFlexible Spending Accounts

Salary ContinuanceLong Term Disability

Basic Life Insurance – $20,000Basic AD&D Insurance – $20,000Business Travel Accident Insurance

Supplemental Life InsuranceDependent Spouse Life InsuranceDependent Child Life Insurance

Voluntary AD&D InsuranceInternational Employee Assistance Program

International SOSTuition Assistance for Employees and Eligible Children

Retirement Plans:Defined Contribution Retirement Plan

Voluntary Contribution Retirement PlanGeorgetown University Retirement Plan B (GURP B)

Introduction 3Eligibility and New Hire Enrollment 4Open Enrollment 5Making Changes During the Year 6Medical and Prescription Drug Coverage 8Dental 10Flexible Spending Accounts 12Disability 14Survivor Benefits 15Additional Life/AD&D Insurance Options 16International Employee Assistance Program 19International SOS 20Tuition Assistance Program 21Retirement Benefits 22Appendix A: Georgetown University at Qatar 24 Medical Coverage 24 End of Service Benefit 25 Important Contacts and Resources 25Appendix B: Insurance Premiums 26Appendix C: Legal Notices 28

Qatar Only:End of Service Benefit

Defined Contribution Retirement PlanVoluntary Contribution Retirement Plan

TABLE OF CONTENTS

2

INTRODUCTION

Welcome to Georgetown University!

It is a pleasure and an honor to have you join our community. The work you do here will further Georgetown University’s mission of creating and communicating knowledge, educating men and women to be reflective lifelong learners, and to be in service to others. That is important work!

The concept of Cura Personalis, or Care for the Whole Person, is central to who we are as an institution of higher learning and as an employer. Whether you are maintaining good health, managing a chronic illness, planning for retirement, pursuing education, caring for young children or aging parents, the Office of Faculty and Staff Benefits is here to offer you resources and assistance in your endeavors. It’s the privilege of the Office of Faculty and Staff Benefits to support your well-being through the benefits, programs, resources and services we provide.

This is your 2017 guide to the benefits offered to those faculty and staff working internationally for Georgetown University. We are excited to announce that in 2017, there will be no changes to your insurance premiums. Our partners at Cigna Global Health Benefits will continue to provide two health plan options. Depending on your citizenship, the following is available:

l International employees (excluding U.S. expatriates): You can choose from one of the following options: Worldwide coverage (includes U.S. coverage) or International only coverage (excludes coverage in the U.S. except in emergency situations)

l U.S. expatriates: Worldwide coverage (includes U.S. coverage)

By offering a plan option that excludes U.S. coverage for those who don’t need or use it, we’re able to create savings for both the University and for those individuals paying medical premiums (non-Qatar). We encourage all international employees (excluding U.S. expatriates) to only select the coverage they need. Of course, for those who travel to the U.S., emergency coverage is included in all of our health plans.

Open Enrollment for international benefits is held in the Fall and follows the same process and time-frame that your U.S.-based colleagues experience. During Open Enrollment (October 14 – November 15, 2016) you’ll have the opportunity to make any changes to your benefits for January 1, 2017.

It’s an honor to serve all faculty and staff who bring the mission, vision and traditions of Georgetown University to students and communities around the globe. Thank you for all you do in service to Georgetown University. The Office of Faculty and Staff Benefits stands ready to provide you with outstanding choice, access and service in relation to your international benefits.

Be well,

Charles DeSantisAssociate Vice President for Benefits, Payroll and WellnessChief Benefits Officer

http://benefits.georgetown.edu

Our website provides you with detailed information about your benefits including:

l Plan summaries

l Important forms and contact information

l Provider directories for Qatar and the U.K.

8

3


Benefits EligibilityBenefits are available to faculty and academic and administrative professionals (AAPs) working at least 75% time and staff working at least 30 hours per week. Eligible dependents include your:

l Legal Spouse.

l 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.

If you would like information regarding international benefits available for Legally Domiciled Adults (LDAs), please contact the Office of Faculty and Staff Benefits at 1-202-687-2500 or email [email protected].

Coverage for your dependent children is described below.

Plan Age LimitationMedical* - Until age 26

- Until age 30 if a full-time studentDental - Until age 19

- Until age 30 if a full-time student* Patient Protection and Affordable Care Act mandates coverage for married

and unmarried dependents to age 26.

New Hire Enrollment and Effective Date RulesYou have 60 days from your date of hire to enroll in your benefits through the Georgetown Management System (GMS).

l You are automatically enrolled in the following plans and they are effective on your date of hire: salary continuance, long term disability, basic life, basic AD&D, business travel accident, and retirement.

l Your medical (includes prescription drug), dental, flexible spending account plans (health care and dependent care), and international employee assistance program (IEAP) will take effect on either: a) the first of the month following your date of hire; or b) on your date of hire (if your date of hire is the first of the month). If you want to participate in the dental or flexible spending account plans, these plans require an active election.

l Employees working in Qatar: If you do not take action during your new hire enrollment period, you will be defaulted to the Cigna International medical plan. Non-sponsored employees receiving medical insurance coverage through another family member will not be eligible for medical coverage through Cigna.

l Non-U.S. citizen employees working in an international location other than Qatar: If you do not take action during your new hire enrollment period, you will be defaulted to the Cigna International medical plan.

l U.S. expatriate employees working in an international location other than Qatar: If you do not take action during your new hire enrollment period, you will be defaulted to the Cigna Worldwide medical plan.

l Supplemental life (for you), spouse life, child life, voluntary AD&D, and IEAP coverage will take effect on either: a) the first of the month following your date of hire; or b) on your date of hire (if your date of hire is the first of the month). If you want to participate, all plans require an active election. If your election requires you and/or your spouse to submit an evidence of insurability form, insurance will take effect on the date MetLife approves insurability.

If you do not enroll for coverage when you are first eligible, you may not do so until a future Open Enrollment except as summarized in the Making Changes During the Year and the HIPAA Special Enrollment Rights sections of this guide.

If you need assistance enrolling in your benefits, contact the Office of Faculty and Staff Benefits.

Georgetown reserves the right to require documentation of a dependent’s eligibility at

any time (e.g., marriage or birth certificate).

Continuing CoverageIf you have insurance coverage that is continuing beyond the effective date of your Georgetown coverage, you may waive the Georgetown-sponsored plans and, when your medical and dental coverage terminates, you may enroll as a qualifying event. This allows you to maintain continuous coverage without paying premiums on overlapping coverage. To enroll as a result of a qualifying event, you will need to provide supporting documentation that verifies the loss of other coverage. Supporting documentation should be uploaded into GMS. You will also have the opportunity to enroll in or change plans during Open Enrollment.

ELIGIBILITY AND NEW HIRE ENROLLMENT

4

mailto:[email protected]

Open EnrollmentOpen Enrollment offers you the opportunity to review and make changes to your benefit elections for the upcoming year. Open Enrollment is held in the fall (typically mid-October through mid-November). The Open Enrollment period for January 1, 2017 benefits is October 14 – November 15, 2016. During this time you may enroll and make changes to your benefits using GMS.

Open Enrollment Action ItemsYou will need to take action during Open Enrollment if:

l You want to make changes to your medical, dental, supplemental life (for you), dependent life (for your legal spouse/child) and/or voluntary AD&D insurance plans;

l You want to add or remove coverage for your dependents; or

l You want to enroll (or re-enroll) in a flexible spending account (health care or dependent care).

Enrolling in your retirement plans: You can enroll in and make changes to your retirement plans at any time during the year. See the Retirement Benefits section of this guide for more details.

Making Benefit Elections in Georgetown Management System (GMS)Log in to the GMS website at http://gms.georgetown.edu using your NetID and password. As an alternative, you can download Georgetown’s mobile app (from the App Store or Google Play) and make your elections directly from the app.

l In your GMS inbox, select the option to enroll in benefits. Open the “Benefit Change Event” in your GMS inbox.

l Elect or waive coverage for each option and select “Continue” when you are sure your selections are accurate.

l You will need the date of birth, Social Security number (or equivalent identifier) and address for each dependent and/or beneficiary you wish to include. You will also need to submit documentation via GMS that verifies the eligibility of your dependent (such as a birth or marriage certificate).

l Submit your elections after reviewing and completing each page.

You can also make your retirement plan elections through GMS. After you enroll, you will receive account information from the vendor and can change your allocations any time through the vendor’s website.

Helpful Tip

For purposes of this guide, the message “Open Enrollment action is required” refers to action you must take during the Open Enrollment period.

Look for the – it identifies areas where you need to take action. This year, Open Enrollment for benefits effective January 1, 2017 will take place from October 14 – November 15, 2016.

Georgetown Management System (GMS)GMS is your one-stop shop for managing, accessing and viewing personal, job, pay, benefits, and financial information. GMS is also where you will make your Open Enrollment benefit elections. For more information, visit http://gms.georgetown.edu. 8

OPEN ENROLLMENT

If You Do Not Take Any Action During Open Enrollmentl Your medical, dental, supplemental life, dependent

life, and voluntary AD&D elections will remain the same.

l Any contributions you had elected for the current calendar year’s flexible spending account plans (health care and/or dependent care) will change to $0 effective January 1 of the following calendar year (note: these plans require you to re-enroll if you want to continue your contributions).

l If enrolled, your medical, dental, long term disability, supplemental life, dependent life, and voluntary AD&D contributions will be automatically adjusted to reflect any applicable change in insurance premiums. See Appendix B for more information.

5

http://gms.georgetown.edu


Making Changes During the YearGenerally, after you make your medical, dental and flexible spending account elections (i.e., plans that you pay for on a pre-tax basis), Internal Revenue Service (IRS) regulations permit changing those elections only during the next Open Enrollment. However, if you experience a qualifying event during the year and you notify the Office of Faculty and Staff Benefits within 60 calendar days of the event, you may change certain benefit plan elections before the next Open Enrollment.

Qualifying events recognized under the plans and IRS regulations are:

l Birth or adoption

l Marriage, divorce, annulment or legal separation

l Death of your spouse or child/ren

l Gain or loss of other coverage for spouse or child/ren

l Change in your employment classification from part-time to full-time

l Change in spouse or child/ren eligibility

l Loss of health plan coverage for your spouse and/or child/ren

l Loss of eligibility under your parent’s benefit plan(s)

l Unpaid leave of absence for you or your spouse

The IRS requires that any benefit election change you make must be consistent with (and on account of) the qualifying event. For example, marriage would be a qualifying event for adding a spouse to your medical coverage. To validate your qualifying event, you will be required to provide supporting documentation (e.g., marriage certificate).

For more information on making changes during the year, refer to the Qualifying Events Matrix at https://benefits.georgetown.edu/enrolling/benefitschanges or contact the Office of Faculty and Staff Benefits.

Special Enrollment Opportunities for Medical and Dental CoverageThe Health Insurance Portability and Accountability Act (HIPAA) is a federal law that provides you with the opportunity to select or change coverage after certain qualifying events. You may be eligible to enroll for coverage before an Open Enrollment period if you notify the Office of Faculty and Staff Benefits within 60 calendar days of one of the following events:

l Termination of Other Coverage. If you declined medical and/or dental coverage for you or your dependents because you had other coverage, you may enroll yourself and your eligible dependents if the other coverage is now terminated for one of the following reasons:

- The other coverage was COBRA and your COBRA period is now exhausted.

- The other coverage was not COBRA and either the coverage terminated due to loss of eligibility or employer contributions toward the coverage terminated. Loss of eligibility may include legal separation, divorce, death, termination of employment, reduction in the number of hours of employment or meeting/exceeding a lifetime limit on all benefits.

This special enrollment provision does not apply if the other coverage was terminated for cause (including failure to timely pay required premiums).

MAkING CHANGES DURING THE YEAR

6

https://benefits.georgetown.edu/enrolling/benefitschanges


l New Dependent. If you acquire a new dependent due to marriage, birth, adoption or placement for adoption, you may enroll yourself and certain dependents as follows:

- If the new dependent is a spouse who is newly eligible due to marriage, you may enroll yourself and your spouse.

- If the new dependent is a child who is newly eligible due to birth, adoption or placement for adoption, you may enroll yourself and your spouse (with or without the new child). For example: If you and your spouse previously declined coverage, you may enroll yourself, your spouse and your newborn child immediately following the birth of the child. You may not enroll other children at this time unless another qualifying event makes them eligible for coverage, such as gaining legal custody of another eligible child.

l Termination of Medicaid or Children’s Health Insurance Program (CHIP). If you declined medical or dental coverage for you or your dependents because you had Medicaid or CHIP, you may enroll yourself and your eligible dependents if:

- Medicaid or CHIP coverage is terminated as a result of loss of eligibility for you or your dependents.

- You or your dependents become eligible for a subsidy under Medicaid or CHIP.

You must request coverage within 60 calendar days after you or your dependent are terminated from, or determined to be eligible for, such assistance.

Helpful Tip

Report family status changes promptly to ensure new dependents are covered and dependents who become ineligible (e.g., children exceeding the plan’s age limitation) are removed from coverage.

MAkING CHANGES DURING THE YEARMAkING CHANGES DURING THE YEAR

7

8

Enrollment in medical coverage is required for faculty and staff working internationally. Georgetown University provides you with international medical and prescription drug coverage through the Cigna Global Health Benefits medical plan.

Open Enrollment ElectionsDuring Open Enrollment, you may:

l Choose between the Cigna Worldwide medical plan and the Cigna International medical plan (excludes coverage in the U.S. except in emergency situations) if you are an international employee

l Add or remove dependents/change coverage level

If You Do Not Take Any Action During Open EnrollmentYour current medical coverage will continue and contributions will be automatically adjusted to reflect any applicable change in insurance premiums. See Appendix B for more information.

CostInformation regarding medical insurance premiums can be found in Appendix B.

Helpful Tip

If seeking care within the United States, emphasize that you are covered by Cigna Global Health Benefits, not Cigna Health Care, to ensure prompt claims processing.

Your Guide to Cigna Global Health Benefitswww.cignaenvoy.com

Register for a PIN/Password online: 1. Go to www.cignaenvoy.com2. Select “I have not registered yet” from the “I am a customer” box3. Enter the first nine digits of your ID number and click “Register”4. Complete the required fields; refer to your ID card for the account number5. Click on “Register”6. You will immediately receive a temporary PIN/Password. When

you use this for the first time, you will be prompted to create a new PIN/Password of your choice.

Once registered, you will be provided with online access to: your benefits, a provider directory, claims submission and tracking details, health and well-being advice, a health information library, a health assessment, a targeted risk assessment, and Cigna contact information.

Cigna Global Health BenefitsCigna Global Health Benefits ensures that all Georgetown University employees have access to quality health care while they are employed abroad. The Cigna Global Health Benefits medical plan is an indemnity plan that allows participants to seek care from any licensed health care provider.

Depending on your citizenship, the following is available:

l International employees (excluding U.S. expatriates*): You can choose from one of the following options: Worldwide coverage (includes U.S. coverage) or International only coverage (excludes coverage in the U.S. except in emergency situations)


* Due to requirements of the Patient Protection and Affordable Care Act, U.S. citizens must have access to full health care coverage in the United States.

MEDICAL AND PRESCRIPTION DRUG COvERAGE

Important reminder for GU-Qatar: Non-sponsored employees receiving medical insurance coverage through another family member will not be eligible for medical coverage through Cigna.

Open Enrollment action is required if you want to make changes to your

current coverage

8

www.cignaenvoy.com

www.cignaenvoy.com

Cigna Global Health Benefits Summary of Medical and Prescription Drug Benefits

Plan Features Cigna Global Health Benefits

Plan PaysLifetime Maximum Unlimited

You PayCalendar Year Deductible N/ACalendar Year Out-of-Pocket Maximum - Individual- Family

$2,000$4,000

Preventive Care- Well Baby Exam- Adult Physical Exam- Routine OB/GYN Exam- Mammogram- Cancer Screening (pap, prostate

and colorectal)- Prescription Drugs (up to a

90-day supply)

$0

Office Visit, Lab and Testing- Doctor Office Visit- Diagnostic X-ray and Lab Testing- Specialty Diagnostic- Physical/Speech Therapy- Chiropractic Care (max 20 days/

calendar year)- Pre/Postnatal Office Visit

20%

Intpatient Services- Hospital Room and Board- Physician/Surgeon

20%

Emergency or Urgent Care 20%Outpatient Services- Outpatient Facility- Outpatient Physician

20%

Prescription Drugs- Generic- Brand-Name- Retail (up to a 30-day supply)- Home Delivery (up to a

90-day supply)

20%

Mental Illness and Substance Abuse- Inpatient- Outpatient

20%

This summary is provided for general information only. Since exclusions, dollar, frequency, age limitations and medical necessity guidelines apply, you should refer to the specific plan documents for detailed information.

Medical and Prescription Drug Plan Frequently Asked Questions What is an out-of-pocket maximum?The out-of-pocket maximum is the most you will pay each calendar year for covered medical and prescription drug expenses. Once you reach the out-of-pocket maximum, the plan pays 100% of any additional covered medical and prescription drug expenses for the remainder of the year. You will still be responsible for paying any applicable charges related to non-compliance penalties as well as provider charges in excess of the maximum reimbursable charge after you have reached your out-of-pocket maximum.

What is coinsurance?Coinsurance is the percentage of the total eligible medical expenses you must pay (for example, 20%) up to your out-of-pocket maximum.

What is an Explanation of Benefits (EOB)?An EOB is the insurance company’s written explanation of how an insurance claim was calculated. It shows the amount paid by the health plan and the amount the participant must pay as well as any discounted fees associated with that claim.

What is the difference between preventive care and diagnostic care?Preventive care helps protect you from getting sick. Diagnostic care is used to find the cause of an existing illness. For example, say your doctor suggests you have a colonoscopy because of your age. That’s preventive care. On the other hand, say your doctor suggests a colonoscopy to see what’s causing your symptoms. That’s diagnostic care and you may need to pay for part of the cost.

What does it mean if a service requires prior authorization?The term prior authorization means the approval that a participating provider must receive from Cigna’s review organization, prior to services being rendered, in order for certain services and benefits to be covered under your plan. Services that require prior authorization include, but are not limited to:– Inpatient hospital services;– Inpatient services at any participating other health care

facility;– Residential treatment;– Outpatient facility services;– Intensive outpatient programs;– Advanced radiological imaging;– Nonemergency ambulance; or– Transplant services.

MEDICAL AND PRESCRIPTION DRUG COvERAGEMEDICAL AND PRESCRIPTION DRUG COvERAGE

9

Georgetown University provides you with access to dental coverage through Cigna Global Health Benefits while you are employed abroad.

Why is Dental Insurance Important?Oral health is important, not only for looks, but for your general health as well. A routine dental exam can detect symptoms of various diseases and conditions, including cardiovascular disease, diabetes, osteoporosis and other conditions. Regular check-ups and cleanings can save you the pain and expense of future problems. Dental insurance will keep these visits affordable and is a cost effective way to minimize health care costs for you and your family.

The American Dental Association recommends regular dental check-ups because they can improve your health by helping you:

l Prevent oral cancer: An oral cancer screening is a routine part of a dental exam. Regular check-ups, including an examination of the entire mouth, are essential in the early detection of cancerous and precancerous conditions.

l Prevent gum disease: If diagnosed early, gum disease can be treated and reversed. Regular dental cleanings and check-ups, flossing daily, brushing twice a day, and eating a balanced diet are key factors in preventing gum disease.

l Help maintain good physical health: Recent studies indicate there may be an association between oral health and serious health conditions such as cardiovascular disease and diabetes, underscoring the importance of good oral hygiene habits. Visiting your dentist regularly can help keep you and your smile healthy.

l Prevent the need for advanced treatment: Your dentist and hygienist will be able to detect any early signs of problems with your teeth or gums that can be easily treatable. If these problems go untreated, root canals, gum surgery and removal of teeth could become the only treatment options available.

l Protect your children’s health: Regular check-ups can help prevent tooth decay in your children, which if untreated, can cause decay so severe that the teeth cannot be repaired. Children need strong, healthy teeth to talk and to chew their food. Schedule your child’s first dental visit when their first tooth appears. Treat your first dental visit as you would a well-baby checkup with your child’s physician.


l Enroll in the dental plan if you have previously declined coverage

l Waive coverage

l Add or remove dependents/change coverage level

If You Do Not Make Changes During Open EnrollmentIf enrolled, your current dental coverage will continue and contributions will be automatically adjusted to reflect any applicable change in insurance premiums. See Appendix B for more information.

If you are not currently covered under the dental plan and you do not enroll during Open Enrollment, or if you cancel your coverage, you may not enroll until a future Open Enrollment, except as summarized in the Making Changes During the Year and the HIPAA Special Enrollment Rights sections of this guide.

CostInformation regarding dental insurance premiums can be found in Appendix B.

DENTAL


current coverage

10

Plan Feature Plan PaysPlan Maximums- Calendar Year- Orthodontia Lifetime Maximum (limited to dependent children under age 19)

$1,000 per individual$1,000 per individual

You PayCalendar Year Deductible- Individual- Family

$50$100

Diagnostic and Preventive Services- Oral Exams (2 per person per calendar year), X-rays, and Cleanings (2 per

person per calendar year)No deductible, $0

Basic Services- Endodontics, Periodontics, Maintenance of Removable and Fixed Bridge

Prosthodontics, and Oral Surgery25% after deductible

Major Services- Restorative and Installation of Removable and Fixed Bridge Prosthodontics 25% after deductible

Orthodontic Services (dependent children under age 19) No deductible, 25%


Summary of Dental Benefits

Questions?The Cigna Global Health Benefits customer service center is available 24/7 to answer your questions:

l 1-302-797-3100 (Reverse charges accepted)

l 1-800-441-2668 (Within the U.S.)

Dental Provider DefinitionsEndodontist: Treats diseases of the tooth root, dental pulp and surrounding tissue

Oral Surgeon: Specializes in the surgical treatment of the jaw, face and teeth

Orthodontist: Prevents and corrects irregularities of the teeth using braces

Pedodontist (or Pediatric Dentist): Treats children

Periodontist: Studies and treats gum disease

Prothodontist: Treats and corrects missing teeth using dental implants, dentures, crowns and some cosmetic procedures.

DENTAL

11


l Enroll or re-enroll in the Health Care FSA and/or Dependent Care Account (note: these plans require you to re-enroll if you want to continue your contributions)

l Waive coverage

If You Do Not Make Changes During Open Enrollment You may not enroll until a future Open Enrollment, except as summarized in the Making Changes During the Year and the HIPAA Special Enrollment Rights sections of this guide.

FLEXIBLE SPENDING ACCOUNTS

Flexible Spending AccountsFlexible spending accounts (FSAs) are unique employer-sponsored tax-advantaged accounts authorized by the federal government that allow you to use pre-tax dollars to pay for out-of-pocket qualified health and dependent care expenses. The FSA plan is administered by ConnectYourCare. You may elect to participate in the Health Care FSA, which reimburses you for qualified health-related expenses that are not covered by medical, dental or vision plans, and/or a Dependent Care Account, which reimburses you for qualified dependent care expenses that allow you (and your spouse) to work. The Health Care FSA and Dependent Care Account are two distinct accounts and money cannot be transferred between them. Refer to the chart below for details regarding eligible expenses permitted by each account.

Use It or Lose It At the end of the plan year, excess funds are forfeited. However, the IRS allows a grace period during which you may continue to incur expenses and get reimbursed from your previous year’s FSA balance. So, if you have money remaining in your FSA on December 31, 2017, you can use that 2017 balance on eligible expenses that you incur through March 15, 2018. You have until April 30, 2018 to submit those claims for reimbursement.

Health Care FSA Dependent Care AccountAdvantages l Pay for eligible, out-of-pocket expenses with pre-tax dollars

l Reduce your taxable income l Increase your take home pay

What’s Covered In general, health-related expenses that are not covered by a health (medical, dental or vision) plan

In general, dependent care expenses that allow you (and your legal spouse if you are married) to work

Eligible Expenses

Examples include:l Out-of-pocket costs (including deductibles,

copays and coinsurance)l Health care expenses not covered by your

plan and approved by the IRSl Over-the-counter medications that are

prescribed by a physician

Examples include:l Care you must pay for − Child day care for children under age 13 − Adult dependent day care − Dependent day care centers − Preschool expenses − Housekeeping services in your home for your child or

other qualifying individualRestrictions l Medical expenses that are not deductible

under IRS Section 213 may not be reimbursed

l Over-the-counter drugs not prescribed by a physician

l Expenses reimbursed under this plan may not be claimed as a federal tax credit on your tax return

l Important note: Do NOT enroll in this account thinking you can submit your child’s (or other dependent’s) health care expenses for reimbursement – it won’t work and you won’t be able to disenroll!

Maximum Annual Election $2,600 $5,000 (maximum per household)

Access to Funds Immediate access to annual election You may access these funds only as they are accrued

Did You Know?There are items that may not be covered under a medical, dental or vision plan, but if they are eligible expenses under the Health Care FSA, you can use your funds to pay for those items (which will save you, on average, 30% since you are contributing on a pre-tax basis).

Eligible ExpensesVisit www.connectyourcare.com/tools/eligible-expenses to view examples of eligible expenses.

Open Enrollment action is required if you want to enroll or re-enroll

12

www.connectyourcare.com/tools/eligible

FLEXIBLE SPENDING ACCOUNTS

www.connectyourcare.comAs an FSA participant, you may track your account balances, pending and completed reimbursements, view account statements and much more.

Mobile FeaturesConnectYourCare offers a secure, interactive mobile application for Android, iOS, and Windows devices.

Features include:l View account balance, account alerts

and transaction history l View all claims, claims requiring

action and claims details l Submit a new claim and upload claim

documentationl Online bill pay

You can also register for mobile alerts so that you can be notified immediately if your health care payment card purchase requires additional documentation. Learn more about the mobile features by visiting www.connectyourcare.com/mobilevideo.

Learn more about FSAs at www.connectyourcare.com/fsavideo.

Health Care FSA: How to Pay at the Doctor, Dentist, Eye Doctor, or HospitalWhen you pay for health care at the doctor, dentist, eye doctor, or hospital, be sure to always present your health insurance ID card first to ensure proper processing of your charges.

l Copays: If you are asked to pay a copay, you may pay with your health care payment card, or you may pay out of pocket and request reimbursement from your account. Save your itemized receipt to submit as documentation.

l Additional charges: If you’re asked to pay additional charges, if possible, do not pay your provider until the claim is processed by your health plan and you receive your Explanation of Benefits (EOB) in the mail. This helps avoid overpayment. Compare your EOB with the provider bill to verify the amount being charged by your provider is the same as the patient balance on the EOB. Then, pay with your health care payment card, or pay out of pocket and request reimbursement from your account. You may send in your EOB or itemized provider bill as documentation.

Dependent Care Account: How to Pay Your Dependent Care ProviderIf you have a Dependent Care Account, you should pay for your qualified dependent care expenses out of pocket and request reimbursement from your account. You will need to submit your itemized receipt as documentation. Remember, receipts for these expenses must include the name of the dependent and the tax identification number of the dependent care provider.

Using Your AccountConnectYourCare makes it easy to access and use your account funds. There are two ways to pay for health care:

1. Use your health care payment card: This is the simplest way to purchase health care! Pay using your health care payment card and keep your itemized receipt as documentation, as you may be required to substantiate the expense. Then, log on to your online account to see if documentation is needed. If so, you may upload your supporting documentation directly, or download the manual claim form.

2. Pay out of pocket and request reimbursement: Pay using your own personal credit card, cash, or check and keep your itemized receipt as documentation. Then, log on to your online account to file for reimbursement. You may upload your supporting documentation directly, or download the manual claim form. You can receive reimbursement funds via check or direct deposit.

Set up direct deposit online to receive quicker reimbursements.

TIP

13

www.connectyourcare.com

www.connectyourcare.com/mobilevideo

www.connectyourcare.com/fsavideo

Salary ContinuanceSalary continuance is short term disability leave that is fully paid for, and administered, by your department. There is a 15 day waiting period for staff and AAPs and coverage begins on the sixteenth (16th) working day of absence.

You will be expected to return to work after your disability period ends. Should you exhaust the disability leave period and your physician determines that you are unable to return to work due to disability, you may elect to file for long term disability (LTD) benefits. Contact the Office of Faculty and Staff Benefits for more information.

Long Term DisabilityCigna long term disability insurance provides income protection if you are disabled due to injury or illness and you have satisfied the 90 day elimination period.

LTD Plan

Monthly Benefit 60% of base monthly salary up to $15,000

Elimination Period 90 days

Pre-existing Exclusion

Any condition diagnosed or treated in the 12 months prior to your effective date will not be covered unless you have been without treatment for six consecutive months after that date. In this case, the remainder of the pre-existing condition period, defined as 24 months, will be waived.

CostEnrollment is automatic and you pay the full cost of LTD coverage on an after-tax basis. Refer to the cost table below for more details.

How Your LTD Cost is Calculated

Your cost is equal to $0.69 per $1,000 of covered monthly salary. The example below assumes an annual salary of $55,000 or monthly salary of $4,583.33.

A. Covered Monthly Salary $4,583.33

B. Per $100 of Covered Monthly Salary

Line A ÷ 100 = $45.83

C. Premium Rate $0.69D. Your Monthly

Cost Line B x Line C = $31.62

DISABILITY

14

Georgetown recognizes the importance of financial protection for your survivors in the event of your death. The University provides basic life insurance, basic accidental death and dismemberment (AD&D) insurance, and business travel accident insurance at no cost to you.Additional life and AD&D insurance may be purchased through the University at group rates, as described on the following pages.

Basic Life/AD&D Insurance$20,000 / $20,000 As an active Georgetown University employee, you are enrolled in MetLife’s Basic Term Life insurance in the amount of $20,000 and up to $20,000 of MetLife Basic Accidental Death & Dismemberment (AD&D) coverage – at no cost to you and with no medical questions asked. Basic AD&D insurance is a benefit payable in the event of your death or if you suffer a significant loss as a result of an accident.

CostGeorgetown pays the entire costs of these benefits and enrollment in these plans is automatic. Your coverage begins automatically and is subject to any active at work requirements.

Business Travel Accident (BTA)Georgetown understands you may be required to travel for University business purposes from time to time. It is for this reason that the University offers eligible employees access to employer-paid BTA coverage insured through Hartford that can help protect you when you are traveling for eligible business-related purposes. The maximum benefit payable is $750,000, subject to a $3.75 million maximum aggregate amount payable for any single accident. BTA benefits are in addition to your MetLife Basic Life and AD&D coverage, as well as any MetLife Supplemental Life and Voluntary AD&D coverage you may have. For more details, please contact the Office of Faculty and Staff Benefits.

CostGeorgetown pays the entire cost of this benefit and enrollment in this plan is automatic. Your coverage begins automatically and is subject to any active at work requirements.

Beneficiary DesignationYour life insurance beneficiary serves a very important purpose – making sure your benefits are distributed as you intended. Without a valid beneficiary, the life insurance proceeds payable as a result of your death will be distributed according to the terms of the insurance contract. Please keep in mind that changes in your family situation (such as marriage, divorce, birth or adoption) do not automatically alter or revoke your beneficiary designation. You can change your beneficiary designation at any time throughout the year in the Georgetown Management System (GMS). Visit http://benefits.georgetown.edu for step-by-step instructions.

Important: Since GMS classifies this as a “Benefit Change”, it will take 1 – 2 days before it is reflected on your benefits screen in GMS. You will not need to submit your request multiple times.

SURvIvOR BENEFITS

15



Supplemental Life and Voluntary AD&D InsuranceMetLife’s Supplemental Life insurance and Voluntary AD&D coverages are employee-paid benefits that allow you to purchase additional financial protection for your loved ones. You can enroll for coverage within the first 60 days of your employment at Georgetown University and you can update your election(s) during the annual Open Enrollment period. Please refer to the Supplemental Life and Voluntary AD&D Insurance Options chart on the next page for more details.

Will Preparation and Estate ResolutionServices (ERS) for U.S. Expatriates* If you are enrolled in MetLife’s Supplemental Life plan, you and your legal spouse have face-to-face and telephone access to the Hyatt Legal Plan network of over 14,000 participating plan attorneys – at no cost to you. You and your legal spouse will also have unlimited access to prepare or update a will, living will or power of attorney and your beneficiaries have the same access to probate an estate. You have the option to choose from a participating Hyatt Legal Plan attorney (in which all attorney fees will be fully covered with no claim forms to file) or you may select a non-network attorney and receive reimbursement for covered services according to a set fee schedule. After you are enrolled in MetLife’s Supplemental Life plan, you can contact Hyatt Legal Plan by calling 1-800-821-6400 (mention Georgetown University’s group number: 123529).

* Included with MetLife Supplemental Life Insurance. Will Preparation and MetLife Estate Resolution Services are offered by Hyatt Legal Plans, Inc., a MetLife company, Cleveland, Ohio. In certain states, legal services benefits are provided through insurance coverage underwritten by Metropolitan Property and Casualty Insurance Company and affiliates, Warwick, Rhode Island. For New York sitused cases, the Will Preparation service is an expanded offering that includes office consultations and telephone advice for certain other legal matters beyond Will Preparation. Tax Planning and preparation of Living Trusts are not covered by the Will Preparation Service. Certain services are not covered by Estate Resolution Services, including matters in which there is a conflict of interest between the executor and any beneficiary or heir and the estate; any disputes with the group policyholder, MetLife and/ or any of its affiliates; any disputes involving statutory benefits; will contests or litigation outside probate court; appeals; court costs, filing fees, recording fees, transcripts, witness fees, expenses to a third party, judgments or fines; and frivolous or unethical matters.

Like most group insurance policies, insurance policies offered by MetLife contain certain exclusions, exceptions, waiting periods, reductions, limitations and terms for keeping them in force. Please contact the Office of Faculty and Staff Benefits or your MetLife Group Representative for costs and complete details.


Plan Enroll Change Amount of Coverage

Supplemental Life

Spouse Life

Child Life

Voluntary AD&D

Under certain circumstances, you will need to provide evidence of insurability (EOI) that is satisfactory to the insurance company before coverage can take effect.

When Enrolling or Increasing CoverageWhen you choose to enroll in or request increased coverage under your supplemental and spouse life plans:

1. Make your election on http://gms.georgetown.edu by the enrollment deadline.

2. Download and complete the EOI form from MetLife.

3. Return form directly to MetLife.

4. MetLife will inform you when your request has been reviewed; until then your coverage change will be “pending.” Any current coverage levels will continue to be in place until the request has been approved.

If You Do Not Make Changes During Open EnrollmentIf enrolled, your current survivor benefits coverage will continue and contributions will be automatically adjusted to reflect any applicable change in insurance premiums. This includes supplemental life, voluntary AD&D, spouse life and child life elections. See pages 17-18 for more information.

If you are not currently covered under these plans and you do not enroll during Open Enrollment, or if you cancel your coverage, you may not enroll until a future Open Enrollment.

ADDITIONAL LIFE/AD&D INSURANCE OP TIONS


current coverage

Tools and ResourcesTo help determine how much coverage you need, use the online insurance calculator at www.metlifeiseasier.net.

8

16


www.metlifeiseasier.net


Supplemental Life and Voluntary AD&D Insurance OptionsThe following table summarizes the key features of the benefits available under voluntary life and accident insurance.

Plan Description Coverage Amount* Evidence of Insurability (EOI) Required?

Monthly Cost(per $1,000 of coverage

except for child life)Supplemental Life l For you

Complements your basic life insurance by providing additional coverage in the event of your death.Enhanced features include free Will Preparation service.

l 1, 2, 3, 4 or 5 times your salary

If the coverage amount is not a multiple of $1,000, then it is rounded to the next higher multiple of $1,000.

Maximum: $1 million.

If you are age 65 or above in the year 2017, see the automatic benefit reduction clause* below for important information.

During Open Enrollment- Yes, if you are increasing

coverage or enrolling for the first time.

When You Are First Hired- No, if your total election

does not exceed $500,000.- Yes, if your total election

exceeds $500,000.

Your age as of 1/1/2017 Under 25

25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70+

Rate

$0.05$0.06$0.08$0.09$0.10$0.15$0.23$0.29$0.43$0.84$1.36

Voluntary AD&D l For you

Complements your supplemental life coverage in the event of death due to accident or covered disabling injury.

This coverage can help replace lost income and lessen the impact of costs associated with serious injuries.

l $10,000 – $1 million (in increments of $10,000)

l EOI is not required. $0.015

l For you & your family

The amount of insurance for your family is based on a percentage of your insurance coverage amount:Legal Spouse- 50% of your coverage amount

if children are not covered.- 40% of your coverage amount

if children are covered.Children- 15% of your coverage amount

if legal spouse is not covered.- 10% of your coverage amount

if legal spouse is covered.

$0.025

Spouse Life Life insurance for your legal spouse.You must be enrolled in supplemental life if you wish to enroll in spouse life.

l $10,000l $30,000l $50,000l $100,000l $150,000l $200,000l $250,000Maximum: You may choose from the options above, up to a maximum of 50% of your supplemental life amount (rounded down to closest coverage option) or $250,000, whichever is less.

During Open Enrollment- Yes, if you are increasing

coverage or enrolling for the first time.

When You Are First Hired- No, if your total election

does not exceed $30,000.- Yes, if your election

exceeds $30,000.

Legal spouse’s age as of 1/1/2017Under 25

25-2930-3435-3940-4445-4950-5455-5960-6465-6970+

Rate

$0.05$0.06$0.08$0.10$0.12$0.17$0.31$0.49$0.87$1.50$2.37

Child Life Life insurance for your dependent child/ren from age 15 days to 23 years, or 25 years if a full-time student.

l $5,000 l $10,000

l EOI is not required. $0.75 per month$1.50 per month

(Regardless of the number of children covered)

This summary is provided for general information only since exclusions and limitations apply. Evidence of insurability may be required. *Life coverage is reduced according to an age reduction schedule beginning at age 65 (reduced by 35%) and at age 70 (reduced to 50% of the original amount). Although the face value of your coverage will decrease according to the age reduction schedule, your cost for the coverage will increase according to the premium rate associated with your age bracket (refer to the Monthly Cost column in the table above).

17

CostYou pay the entire premium for these additional life and accident insurance options; your cost is deducted from your pay on an after-tax basis. Please note that rates are based on age attained as of January 1 and salary as of the following September 1. Benefits are paid based on salary at the time the loss is incurred.

How to Calculate Your Life/AD&D Insurance CostUse the table below to calculate your cost based on the amount of life insurance you will need.

Example Four times salary supplemental life insurance coverage for a 36 year old with a salary of $60,000:

1. Determine the amount of supplemental life insurance you are electing for yourself

Four times salary ($60,000 x 4) =

$240,000

2. Divide the coverage amount from line 1 by 1,000

$240,000 ÷ 1,000 = $240

3. Multiply line 2 by the rate for the employee’s age from the table on the previous page to get the monthly premium

$240 x $0.09 = $21.60

Things to Consider About Life/AD&D InsuranceMost people don’t like to think about needing life/AD&D insurance. But when an unexpected death happens to a wage earner, we realize how important life insurance can be. You can minimize the impact of an unexpected death by selecting the right amount of life/AD&D insurance.

What’s the Right Amount of Life/AD&D Insurance?How much is enough life/AD&D insurance? To help determine how much coverage you need, use the online insurance calculator at www.metlifeiseasier.net. You will need to consider both your family’s immediate and long-term financial needs, such as:

l Mortgage expenses

l Day care and everyday expenses

l Credit card debt

l College costs

l Charitable giving goals

l Financial goals

l Final expenses for a simple funeral, which can cost $10,000 or more


18

www.metlifeiseasier.net

The International Employee Assistance Program (IEAP) provides:

l Unlimited telephonic counseling available 24/7

l Five face-to-face visits with a professional counselor

Counseling services are provided by Workplace Options, the world’s largest provider of work-life services. Additional work/life support benefits can be accessed through your Cigna Global Health Benefits medical coverage.

If you’re a benefits-eligible employee working at an international location, you need not be enrolled in the Cigna Global Health Benefits medical coverage to access this IEAP benefit. Simply call the IEAP numbers listed on this page, share your name and identify yourself as a Georgetown University employee.

CostGeorgetown pays the entire cost of these benefits. There is no cost to you and enrollment is automatic.

The IEAP is available to help you during times of stress or crisis. The IEAP handles a wide range of problems. Cultural adjustment

Emotional well-being

Family

Marital

Stress

Financial

Substance abuse

Legal

Work place

Elder care

For more information and online resources, go to:

www.cignaenvoy.com or email [email protected]

IEAP Phone NumbersFor information and counseling services, contact the IEAP at:

l 44-2089-876550 (Reverse charges or return phone call may be requested)

l 1-800-870-5068 (When calling from U.S.)

(

8

INTERNATIONAL EMPLOYEE ASSISTANCE PROGRAM

19

www.cignaenvoy.com


24-Hour Worldwide Assistance and Emergency Evacuation ServicesManaged and administered by International SOS, the Georgetown University SOS Program provides 24-hour worldwide emergency medical and security evacuation assistance for Georgetown’s faculty, staff and students traveling abroad on University business.

Medical ServicesIf you are traveling abroad and need medical care, International SOS can provide care or transport you to a medical facility. Services include:l Emergency evacuationl Medically-supervised repatriationl Emergency and routine medical advicel Medical and dental referralsl Dispatch of prescription medicationl Pre-trip information on travel health issuesl Repatriation of mortal remainsl Return home of minor children

Security ServicesIf you are in a dangerous situation, International SOS can help get you out by providing you with:l Security evacuation assistancel Online travel security informationl Access to security crisis center

Travel ServicesIf you need other travel-related assistance, International SOS can help with:l Legal referralsl Translations and interpretersl Lost document advicel Emergency personal cash advances

Traveler’s ResourceFind information on University resources

and policies for all travelers:

http://travel.georgetown.edu

Cost Georgetown University covers the cost of this program. Additional services are available at an additional cost to you. For more information on covered and non-covered services, visit http://riskmanagement.georgetown.edu and click on “International Travel”.

INTERNATIONAL SOS

Frequently Asked QuestionsHow can International SOS help?International SOS provides you with peace of mind. One phone call connects you to the International SOS network of multilingual specialists for immediate help in an emergency. International SOS services are designed to help you with medical, personal, travel, security and legal problems when away from home.

How does it work?Carry the International SOS membership card with you at all times. It includes the telephone numbers of the three major worldwide International SOS Alarm Centers. In the event of an emergency, call one of the emergency phone numbers listed on the card. Contact [email protected] for a membership card.

What if I need a doctor? International SOS coordinator doctors can provide you advice by telephone or refer you to an English-speaking doctor for outpatient consultations.

What if local medical facilities are not adequate?If you are hospitalized in an area where adequate medical facilities are not available, International SOS will provide medical evacuation to the nearest facility capable of providing the required care. Evacuations are carried out under medical supervision and are attended by specialists when required.

What if my wallet is stolen and I need replacement documents?International SOS will assist with obtaining replacements if you lose important travel documents such as your passport or credit cards.

What if I’m unable to contact my family?International SOS will receive and transmit emergency messages between you and your family.

What if I don’t speak the language?Emergency telephone translation services are available through the 24-hour International SOS network, as well as referrals to interpreter services.

What if I’m traveling on vacation or personal business?International SOS benefits are not available when traveling on vacation or personal business. Georgetown’s faculty, staff and students are eligible for coverage only when traveling on official University business.

20


http://riskmanagement.georgetown.edu



TUITION ASSISTANCE PROGRAM

*International institutions are subject to review before TAP-eligibility is determined. Contact [email protected] for more information.

Georgetown University offers tuition benefits to employees and their children through the Tuition Assistance Program (TAP).

These benefits can be used for:

l Studies at Georgetown University

l Other U.S. accredited degree-granting institutions

l Other accredited international degree-granting institutions*

l Undergraduate studies

l Graduate studies

Dependent Child TAP Benefit****At Georgetown

Dependent Child TAP Benefit

l 33% of GU tuition paid in the semester following parent’s completion of three years continuous, active full-time service in benefits-eligible position

l 67% of GU tuition paid in the semester following the parent’s completion of five years continuous, active full-time service in benefits-eligible position

l 100% of tuition paid if employee hired prior to December 31, 1995

Maximum Benefit for Children of Faculty, Staff & AAPs

l 8 semesters

At Other Eligible Academic InstitutionsDependent Child TAP Benefit

l 16.5% of GU tuition paid in the semester following parent’s completion of three years continuous, active full-time service in benefits-eligible position

l 33% of GU tuition paid in the semester following parent’s completion of five years continuous, active full-time service in benefits-eligible position

Maximum Benefit for Children of Faculty, Staff & AAPs

l 8 semesters

****Must qualify for admission independently. Dependent must be enrolled in undergraduate study only and be under 30 years of age.

Employee TAP Benefit**At Georgetown

Employee TAP Benefit

l 100% of tuition paidl Eligible in the semester following

completion of one year continuous, active full-time service in benefits-eligible position

Maximum Benefit for Faculty*** & AAPs

l 8 semesters

Maximum Benefit for Staff l 120 credit hours

At Other Eligible Academic InstitutionsEmployee TAP Benefit

l Based on the 2016-2017 academic year, the maximum benefit is:

- $2,589.58 per semester - $1,726.38 per quarter - $5,179.15 per academic year - $20,716.62 per lifetimeThe benefit amount is calculated using a formula based on Georgetown University’s undergraduate tuition, and therefore is adjusted annually. Visit http://benefits.georgetown.edu for updates.

l Eligible in the semester following completion of three years continuous, active full-time service in benefits-eligible position

Maximum Benefit for Faculty** & AAPs

l 8 semesters

**Must qualify for admission independently.***Faculty may use this benefit for graduate study only.

21



RETIREMENT BENEFITS

Defined Contribution Retirement Plan 403(b)Who’s Eligible? l All faculty, staff and AAPs scheduled to work at least

20 hours per week or 50% time

l Staff who actively participate in GURP are not eligible to participate in this plan

l Adjunct faculty, fellows and temporary/on-call/student employees are not eligible to participate in this plan

If You Contribute:

Then GU Contributes: For a Total of:

0% 5.00% 5.00%1% 6.67% 7.67%2% 8.34% 10.34%3% 10.00%* 13.00%

*Eligible employees hired prior to 1996 and enrolled in the plan prior to 2009, may be eligible to receive a 12% contribution from the University.

For both the DCRP and the VCRP, you are immediately 100% vested in your account balance. Therefore, you are entitled to all the funds in your account when you leave the University, regardless of how long

you have been employed at Georgetown.

Georgetown University automatically contributes 5% of your pay to the plan every pay period. You may contribute up to 3% of your eligible pay on a before-tax basis. Georgetown University will also contribute up to an additional 5% of your pay when you contribute to the plan.

Georgetown University at Qatar faculty, staff and AAPs:

Turn to page 25 for information on the Defined Contribution Retirement Plan.

With this plan, you and Georgetown University work together to invest in your future. Your retirement account balance grows based on:

l Your contributions,

l Georgetown University’s contributions, and

l Investment income on your total account balance.

Contributions to the plan (yours and Georgetown University’s) are made to your account every pay period, giving your account the opportunity to grow throughout the year. You decide how to invest your contributions by choosing among a variety of funds offered by Fidelity Investments, TIAA-CREF and Vanguard. All investment earnings and/or losses are reflected in your account. In-service withdrawals, including loans, are strictly prohibited under this plan.

22

RETIREMENT BENEFITS

Voluntary Contribution Retirement Plan 403(b)Who’s Eligible?All employees of Georgetown University.

This plan is similar to the Defined Contribution Retirement Plan except you do not receive contributions to your account from Georgetown University. Contributions to this plan are only limited by the annual contribution maximums outlined by the IRS; this annual maximum includes your combined contributions to both the Voluntary and Defined Contribution Retirement Plans.

This plan provides an opportunity for you to add to your retirement savings while decreasing current income tax. When you participate in the plan, you contribute to your account on a before-tax basis. You decide how to invest your contributions by choosing among a variety of funds offered by Fidelity Investments, TIAA-CREF and Vanguard. All investment earnings and/or losses are reflected in your account.

457(b) Retirement PlanWho’s Eligible?Employees who are already contributing the maximum allowable amount to their Voluntary Contribution Retirement Plan and have a base salary of $200,000 or more.

Contact the Office of Faculty and Staff Benefits for more information.

Visit http://benefits.georgetown.edu or contact the Office of Faculty and Staff Benefits at

[email protected] or 1-202-687-2500 for additional information.

23



CignaLinks…Middle EastCigna Global Health Benefits has partnered with the Saudi Arabian Insurance Company (SAICO), a prominent local health care administrator, to enhance your standard Cigna Global Health Benefits coverage. CignaLinks…Middle East is designed to provide simplified claims processing and access to a larger network of hospitals and clinics within the six countries covered by the plan. When accessing care within the SAICO network, the plan pays 100% of covered services with the exception of services sought for mental health and substance abuse.

As a CignaLinks…Middle East member, you will have two ID cards – one from SAICO for use in Qatar, the United Arab Emirates, Oman, Bahrain and Kuwait, and one from Cigna Global Health Benefits, for use when you or your covered family members access care anywhere in the world outside these countries.

Plan Feature CignaLinks… Middle East

Plan Pays

Lifetime Maximum Unlimited

You Pay

Calendar Year Deductible N/ACalendar Year Out-of-Pocket Maximum (U.S. $)- Individual- Family

$2,000$4,000

Inpatient Facility $0

Inpatient Physician Services $0

Outpatient Facility $0

Outpatient Physician Services $0

Prescription Drugs $0Mental Illness and Substance Abuse- Inpatient- Outpatient

$0

Accessing in-network care1. Find a network provider in the CignaLinks…Middle

East Qatar Provider Directory (available through HR or at http://benefits.georgetown.edu).

2. Present your SAICO ID card and there will be no need to file a claim form.

Accessing out-of-network care in the Middle East (Qatar, Saudi Arabia, United Arab Emirates, Oman, Bahrain and Kuwait)1. Pay provider at time of service.2. File a Cigna claim form. You may do this through the

Cigna Envoy website at www.cignaenvoy.com.3. Reimbursement will be sent to you by check or wire

transfer.Accessing care outside of the Middle East1. Visit any provider.2. Contact Cigna Global Health Benefits to arrange to

pay provider directly, OR, pay for services and file a claim for reimbursement.

The following medical coverage options are available for faculty, staff and AAPs at Georgetown University at Qatar.

Cigna Global Health Benefits Medical CoverageCigna Global Health Benefits ensures that all Georgetown University international employees have access to quality health care while they are abroad. This indemnity plan allows participants to seek care from any licensed health care provider. However, by utilizing providers within the CignaLinks…Middle East network, participants may receive further discounted rates.

Depending on your citizenship, the following is available:

l International employees (excluding U.S. expatriates): You can choose from one of the following options: Worldwide coverage (includes U.S. coverage) or International only coverage (excludes coverage in the U.S. except in emergency situations)


As a general rule, enrolled plan participants pay 20% coinsurance and the plan pays the remaining 80% of covered services. Refer to pages 8-9 (Medical and Prescription Drug Coverage) for more information, or visit http://benefits.georgetown.edu for a Schedule of Benefits.


APPENDIX A: GEORGETOWN UNIvERSITY AT QATAR


24


www.cignaenvoy.com



Local ContactsGU-Q Human Resources Omar Al Swadi, Immigration and Government Relations Manager 4457-8295

Jolanta Jankowska, Employment Manager 4457-8289

Marilyn Williams, Compensation, Benefits and Wellness Manager 4457-4362

David Phongsavan, Associate Director for Rewards 4457-8226

Karen Rasch, Associate Director for Talent Management 4457-8487

Eunice Dickerson, Payroll and Tax Manager 4457-8325

SAICO 4432-2781 (Phone)4432-5420 (Fax)

Important Contacts and Resources

End of Service BenefitThe End of Service Benefit (EOSB) provides a lump sum payment at the time you terminate employment. The benefit is based on the length of your employment with GU-Qatar. Under this benefit, eligible participants earn one month’s final base (basic) salary for each completed year of service. The EOSB is prorated for partial years of service. Vesting in this option begins after one year of service.

EligibilityAll full-time employees (excludes tenured main campus faculty and active GURP B participants). Employees who are U.S. citizens or green card holders only may elect the Defined Contribution Retirement Plan in lieu of the EOSB.

Defined Contribution Retirement PlanIn this 403(b) retirement plan, available to U.S. citizens and green card holders, contributions are made by both the employee and employer. The fund’s value is based on the amount of contribution made and the return on investment.

Only employees who are U.S. citizens or green card holders may elect retirement plan benefits in lieu of the End of Service Benefit. If you elect this option, you are required to contribute 3% of your salary and the University will contribute an additional 10% of your salary, for a total of 13% being contributed to the Plan.

Georgetown University provides a one-time opportunity for eligible, newly hired faculty and staff of Georgetown University at Qatar to choose between two retirement savings options: the Defined Contribution Retirement Plan – 403(b) – or End of Service Benefits. Retirement plan elections are irrevocable.

Eligible GU-Q faculty and staff who do not make an election to participate in the Defined Contribution Retirement Plan by the end of the month following their date of hire are automatically enrolled in the End of Service Benefit. The enrollment is irrevocable.

APPENDIX A: GEORGETOWN UNIvERSITY AT QATAR

25

Insurance PremiumsYour cost for coverage depends on the benefit elections you make and how many eligible dependents you enroll. Medical, dental and FSA contributions are automatically deducted from your pay on a pre-tax basis. LTD contributions (page 14) and voluntary life/AD&D contributions (pages 17-18) are deducted from your pay on an after-tax basis.

Pre-tax contributions save you money. This is because pre-tax contributions are deducted from your pay before federal – and in most cases, state – income tax withholdings and FICA (Social Security and Medicare) tax withholdings are calculated. This lowers your taxable income, which in turn lowers the total amount you pay in taxes.

Post-tax contributions have certain advantages. Because you pay for LTD and voluntary life/AD&D insurance on an after-tax basis, any benefits paid under these plans will not be taxed again. This means that if you receive benefits from your disability plan or life/AD&D insurance plan, you will not be taxed on the benefit amount.

If you are paid monthly, your contributions will be deducted from each paycheck throughout the year. If you are paid biweekly, all premiums will be deducted from 24 of your 26 annual paychecks. In those months in which there are three pay dates, only retirement plan contributions will be deducted.

The following chart shows the amounts that will be deducted from your pay each month for medical and dental insurance.

APPENDIX B: INSURANCE PREMIUMS

GU-Q Medical PremiumsGeorgetown University provides you with international medical and prescription drug coverage while you are employed at the GU-Q campus in Doha. The Qatar Foundation covers the full monthly premium cost. No employee premium contribution is required.


26

APPENDIX B: INSURANCE PREMIUMS

You Pay Monthly Pre-Tax

University Pays Monthly Total

Employee Only

Medical

Employees Working in Qatar - Worldwide Plan (Includes U.S. Coverage) $0.00 $363.60 $363.60

Employees Working in Qatar - International Plan (Excludes U.S Coverage Except Emergencies) $0.00 $323.75 $323.75

Employees Working Outside Qatar - Worldwide Plan (Includes U.S. Coverage) $54.54 $309.06 $363.60

Employees Working Outside Qatar - International Plan (Excludes U.S Coverage Except Emergencies) $14.69 $309.06 $323.75

Dental Cigna Global Health Benefits $34.08 $5.19 $39.27

Employee & Legal Spouse

Medical






Employee & Child/ren

Medical






Family (Employee, Legal Spouse, Child/ren)

Medical

Employees Working in Qatar - Worldwide Plan (Includes U.S. Coverage) $0.00 $1,349.95 $1,349.95

Employees Working in Qatar - International Plan (Excludes U.S Coverage Except Emergencies) $0.00 $1,200.52 $1,200.52

Employees Working Outside Qatar - Worldwide Plan (Includes U.S. Coverage) $202.49 $1,147.46 $1,349.95

Employees Working Outside Qatar - International Plan (Excludes U.S Coverage Except Emergencies) $53.06 $1,147.46 $1,200.52


27

Notice of Privacy PracticesEffective September 23, 2013

This notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please review it carefully. If you have any questions about this notice, please contact the Georgetown University Privacy Official, Georgetown University, 202 Healy Hall, 37th & O Streets, N.W., Washington, D.C. 20057-1246, 1-202-687-6457, or by e-mail to [email protected].

Who Must Follow This NoticeThis notice describes the privacy practices of the self-insured health care plan(s) offered by Georgetown University to its employees and retirees (“Georgetown Plans”). The Georgetown Plans are managed for the University by our “business associates,” administrators who interact with the medical care providers and/or handle members’ claims. The Georgetown Plans include the UnitedHealthcare Choice Plus and Medicare Standard Plans and the CareFirst BlueChoice Advantage Plans. This notice does not apply to the health care plans offered by the University that are fully insured.

Our ObligationsWe are required by law to:

l Maintain the privacy of protected health information as required by applicable laws and as set forth in this notice;

l Give you this notice of our legal duties and privacy practices regarding health information about you; and

l Follow the terms of our notice that is currently in effect.

How We May Use and Disclose Health InformationThe following categories describe ways that we may use and disclose health information that identifies you (“Health Information”). Some of the categories include examples, but every type of use or disclosure of Health Information in a category is not listed.

Except for the purposes described below, we will use and disclose Health Information only with your written permission. If you give us permission to use or disclose Health Information for a purpose not discussed in this notice, you may revoke that permission, in writing, at any time by contacting the University Privacy Official.

For Treatment. We may use Health Information to facilitate your treatment or receipt of health care services. We may use or disclose Health Information to doctors, nurses, technicians, or other personnel who are involved in your medical care. For example, we may use or disclose your Health Information to determine your eligibility for services requested by a provider.

For Payment. We may use and disclose Health Information in the course of activities that involve reimbursement for health care, such as determination of eligibility for coverage, claims processing, billing, obtaining payment of premiums, utilization review, medical necessity determinations, health care data processing, and precertifications.

For Health Care Operations. We may use and disclose Health Information for health care operations purposes. These uses and disclosures are necessary to make sure that all of our enrollees receive quality care and for our operation and management purposes. For example, we may use and disclose Health Information to a business associate who on the Georgetown Plans’ behalf performs a function or activity involving the use or disclosure of your medical information, including claims processing or administration, planning, data analysis, utilization review, quality assurance benefits management, referrals to specialists, or provides legal, actuarial, accounting, consulting, data aggregation, management, administrative or financial services that involve individually identifiable Health Information.

Appointment Reminders, Treatment Alternatives, and Health-Related Benefits and Services. We may use and disclose Health Information to contact you as a reminder that you have an appointment. We also may use and disclose Health Information to tell you about treatment options or alternatives or health-related benefits and services that may be of interest to you.

Fundraising Activities. We may use Health Information to contact you in an effort to raise money. We may disclose Health Information to a related foundation or to our business associate so that they may contact you to raise money for us. However, you have the right to opt out of any such communications by contacting the University Privacy Official in writing.

APPENDIX C: LEGAL NOTICES

28


Individuals Involved in Your Care or Payment for Your Care. We may release Health Information to a person who is involved in your medical care or helps pay for your care, such as a family member or friend. We also may notify your family about your location or general condition or disclose such information to an entity assisting in a disaster relief effort.

Research. Under certain circumstances, we may use and disclose Health Information for research purposes. For example, a research project may involve comparing the health and recovery of all patients who received one medication or treatment to those who received another, for the same condition. Before we use or disclose Health Information for research, though, the project will go through a special approval process. This process evaluates a proposed research project and its use of Health Information to balance the benefits of research with the need for privacy of Health Information. Even without special approval, we may permit certain researchers to look at records to help them identify patients who may be included in their research project or for other similar purposes, so long as they do not remove or take a copy of any Health Information.

To Plan Sponsor. The Georgetown Plans may only disclose Health Information to the University, the Plan Sponsor, as is necessary for the use and administration of the Plans. The Plan Sponsor can only use the Health Information as permitted or required in the plan documents and applicable law, and the Plan Sponsor cannot use or disclose the Health Information for employment-related actions and decisions or in connection with any other benefit or employee benefit plan.

Special CircumstancesAs Required by Law. We will disclose Health Information when required to do so by international, federal, state or local law.

To Avert a Serious Threat to Health or Safety. We may use and disclose Health Information when necessary to prevent or lessen a serious threat to your health and safety or the health and safety of the public or another person. Any disclosure, however, will be to someone who may be able to help prevent the threat.

Business Associates. We may disclose Health Information to our business associates that perform functions on our behalf or provide us with services if the information is necessary for such functions or services. For example, we may use another company to perform billing services on our behalf. All of our business associates are obligated, under contract with us, to protect the privacy of your information and are not allowed to use or disclose any information other than as specified in our contract.

Organ and Tissue Donation. If you are an organ donor, we may release Health Information to organizations that handle organ procurement or organ, eye or tissue transplantation or to an organ donation bank, as necessary, to facilitate organ or tissue donation and transplantation.

Military and Veterans. If you are a member of the armed forces, we may release Health Information as required by military command authorities. We also may release Health Information to the appropriate foreign military authority if you are a member of a foreign military.

Workers’ Compensation. We may release Health Information for workers’ compensation or similar programs, to the extent authorized by the laws relating to these programs. These programs provide benefits for work-related injuries or illness.

Public Health Activities. We may disclose Health Information for public health activities. These activities generally include disclosures to prevent or control disease, injury or disability; report births and deaths; report child abuse or neglect; report reactions to medications or problems with products; notify people of recalls of products they may be using; track certain products and monitor their use and effectiveness; notify a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition; and conduct medical surveillance of the hospital in certain limited circumstances concerning workplace illness or injury. We also may release Health Information to an appropriate government authority if we believe a patient has been the victim of abuse, neglect or domestic violence; however, we will only release this information if you agree or when we are required or authorized by law.

Health Oversight Activities. We may disclose Health Information to a health oversight agency for oversight activities authorized by law. These oversight activities include, for example, audits, investigations, inspections, and licensure. These activities are necessary for the government to monitor the health care system, government programs, and compliance with civil rights laws.

Lawsuits and Disputes. If you are involved in a lawsuit or a dispute, we may disclose Health Information in response to a court or administrative order. We also may disclose Health Information in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute, but only if efforts have been made to tell you about the request or to obtain an order protecting the information requested.


29

Law Enforcement. We may release Health Information if asked by a law enforcement official for the following reasons: (1) in response to a court order, subpoena, warrant, summons or similar process; (2) limited information to identify or locate a suspect, fugitive, material witness, or missing person; (3) about the victim of a crime if, under certain limited circumstances, we are unable to obtain the person’s agreement; (4) about a death we believe may be the result of criminal conduct; (5) about criminal conduct on our premises; and (6) in emergency circumstances to report a crime, the location of the crime or victims, or the identity, description, or location of the person who committed the crime.

Coroners, Medical Examiners and Funeral Directors. We may release Health Information to a coroner or medical examiner for the purposes of identifying a deceased person, determining the cause of death, or performing other duties required by law. We also may release Health Information to funeral directors as necessary for their duties.

National Security and Intelligence Activities. We may release Health Information to authorized federal officials for intelligence, counter-intelligence, and other national security activities authorized by law.

Protective Services for the President and Others. We may disclose Health Information to authorized federal officials so they may provide protection to the President, other authorized persons or foreign heads of state or conduct special investigations.

Inmates or Individuals in Custody. If you are an inmate of a correctional institution or under the custody of a law enforcement official, we may release Health Information to the appropriate correctional institution or law enforcement official. This release would be made only if necessary (1) for the institution to provide you with health care; (2) to protect your health and safety or the health and safety of others; (3) for the administration, safety and security of the correctional institution; or (4) for the law enforcement of the correctional institution.

Your RightsExcept for uses and disclosures described and limited as set forth in this notice, we will use and disclose your health information only with a written authorization from you. This includes, except for limited circumstances allowed by federal privacy law, not using or disclosing psychotherapy notes about you, selling your health information to others, or using or disclosing your health information for certain promotional communications that are considered prohibited marketing communications under federal law, without your written authorization.

Once you give us authorization to release your health information, we cannot guarantee that the recipient to whom the information is provided will not disclose the information. You may take back or “revoke” your written authorization at any time by contacting the University Privacy Official in writing, except if we have already acted based on your authorization.

You have the following rights regarding Health Information we maintain about you:

Right to Inspect and Copy. You have the right to inspect and copy certain Health Information that we maintain about you and that may be used to make decisions about your care or payment for your care. If we maintain your health information electronically, you will have the right to request that we send a copy of your health information in an electronic format to you. You can also request that we provide a copy of your information to a third party that you identify. To inspect and copy your Health Information, you must make your request, in writing, to the University Privacy Official. In certain limited circumstances, we may deny your request to inspect and copy your health information. If we deny your request, you may have the right to have the denial reviewed. We may charge a reasonable fee for any copies.

Right to Get Notice of a Breach. We will comply with the requirements of applicable privacy laws related to notifying you in the event of a breach of your health information.

Right to Amend. If you feel that Health Information we have is incorrect or incomplete, you may ask us to amend the information. You have the right to request an amendment for as long as the information is kept by or for us. To request an amendment, you must make your request, in writing, to the University Privacy Official and you must provide the reasons for the requested amendment. Right to an Accounting of Disclosures. You have the right to request an accounting of certain disclosures of Health Information we made. To request an accounting of disclosures, you must make your request, in writing, to the University Privacy Official. This accounting will not include disclosures of information made (i) for treatment, payment, and health care operations purposes; (ii) to you or pursuant to your authorization; (iii) to correctional institutions or law enforcement officials; and (iv) other disclosures for which federal law does not require us to provide an accounting.


30

Right to Request Restrictions. You have the right to request a restriction or limitation on the Health Information we use or disclose for treatment, payment, or health care operations. In addition, you have the right to request a limit on the Health Information we disclose about you to someone who is involved in your care or the payment for your care, like a family member or friend. For example, you could ask that we not share information about your surgery with your legal spouse. To request a restriction, you must make your request, in writing, to the University Privacy Official. We are not required to agree to your request. If we agree, we will comply with your request unless we need to use the information in certain emergency treatment situations.

Right to Request Confidential Communications. You have the right to request that we communicate with you about medical matters in a certain way or at a certain location. For example, you can ask that we contact you only by mail or at work. To request confidential communications, you must make your request, in writing, to the University Privacy Official. Your request must specify how or where you wish to be contacted. We will accommodate reasonable requests.

Right to a Paper Copy of This Notice. You have the right to a paper copy of this notice. You may ask us to give you a copy of this notice at any time. Even if you have agreed to receive this notice electronically, you are still entitled to a paper copy of this notice. You may obtain a copy of this notice at our website, http://benefits.georgetown.edu.

To obtain a paper copy of this notice, contact:University Privacy OfficialGeorgetown University202 Healy Hall, 37th & O Streets, N.W.Washington, D.C. 20057

Changes to This NoticeWe reserve the right to change this notice. We reserve the right to make the revised or changed notice effective for Health Information we already have as well as any information we receive in the future. We will post a copy of the current notice at the Office of Faculty and Staff Benefits.

Important NoticesComplaints. If you believe your privacy rights have been violated, you may file a complaint with us or the Secretary of the Department of Health and Human Services. To file a complaint with us, contact the University Privacy Official. All complaints must be made in writing. You will not be penalized for filing a complaint.

Primary Care Physicians (PCPs) and OB/GYN CareTo the extent that any of the medical plan options allow for the designation of a primary care provider, you have the right to designate any primary care provider who is available to accept you or your family members and who participates in the applicable medical plan option’s network of providers. For children, you may designate a pediatrician as the primary care provider. Until you make this designation, the medical plan option may designate one for you.

Furthermore, you do not need prior authorization from your medical plan carrier or from any other person (including a primary care provider) in order to obtain access to obstetrical or gynecological care from a health care professional in the applicable medical plan’s network (as applicable) who specializes in obstetrics or gynecology. The health care professional, however, may be required to comply with certain procedures, including obtaining prior authorization for certain services, following a pre-approved treatment plan, or procedures for making referrals. For a list of participating health care professionals who specialize in obstetrics or gynecology, contact the applicable medical plan carrier.

For information on how to select a primary care provider, and for a list of the participating primary care providers, contact your medical plan carrier.

Notice Under the Women’s Health and Cancer Rights ActIf you have had or are going to have a mastectomy, you may be entitled to certain benefits under the Women’s Health and Cancer Rights Act of 1998 (WHCRA). For individuals receiving mastectomy-related benefits, coverage will be provided in a manner determined in consultation with the attending physician and the patient for:

l All stages of reconstruction of the breast on which the mastectomy was performed,

l Surgery and reconstruction of the other breast to produce a symmetrical appearance,

l Prostheses, and

l Treatment of physical complications of the mastectomy, including lymphedema.

Such coverage may be subject to annual deductibles and coinsurance provisions as may be deemed appropriate and are consistent with those established for other benefits under the plan or coverage.


31


Michelle’s LawPublic law 110-381, also known as “Michelle’s Law,” allows dependent college students insured under their parent’s policy to remain covered if they are required to take a medical leave of absence from school or make any other enrollment changes that might cause them to lose dependent student eligibility. In order to qualify for this continued coverage, the dependent must be suffering from a serious illness or injury and the leave of absence or other enrollment changes must be medically necessary, as determined by the treating physician. Such dependents may remain covered up to the earlier of: one year after the first day of the medically necessary leave of absence; or the date on which such coverage would otherwise terminate under the terms of the plan/coverage. Following the medical leave, student dependents will once again be required to provide student certification (as may be required under the applicable plan) in order to remain eligible for dependent coverage.

Premium Assistance Under Medicaid and the Children’s Health Insurance Program (CHIP) If you or your children are eligible for Medicaid or CHIP and you’re eligible for health coverage from your employer, your state may have a premium assistance program that can help pay for coverage, using funds from their Medicaid or CHIP programs. If you or your children aren’t eligible for Medicaid or CHIP, you won’t be eligible for these premium assistance programs but you may be able to buy individual insurance coverage through the Health Insurance Marketplace. For more information, visit www.healthcare.gov. If you or your dependents are already enrolled in Medicaid or CHIP and you live in a state listed below, contact your state Medicaid or CHIP office to find out if premium assistance is available.

If you or your dependents are NOT currently enrolled in Medicaid or CHIP, and you think you or any of your dependents might be eligible for either of these programs, contact your state Medicaid or CHIP office or dial 1-877-KIDS NOW or www.insurekidsnow.gov to find out how to apply. If you qualify, ask your state if it has a program that might help you pay the premiums for an employer-sponsored plan.

If you or your dependents are eligible for premium assistance under Medicaid or CHIP, as well as eligible under your employer plan, your employer must allow you to enroll in your employer plan if you aren’t already enrolled. This is called a “special enrollment” opportunity, and you must request coverage within 60 days of being determined eligible for premium assistance. If you have questions about enrolling in your employer plan, contact the Department of Labor at www.askebsa.dol.gov or call 1-866-444-EBSA (3272).

If you live in one of the following states, you may be eligible for assistance paying your employer health plan premiums. The following list of states is current as of July 31, 2016. Contact your state for more information on eligibility.

Alabama – MedicaidWebsite: http://myalhipp.com

Phone: 1-855-692-5447Alaska – Medicaid

The AK Health Insurance Premium Payment ProgramWebsite: http://myakhipp.com

Phone: 1-866-251-4861Email: [email protected]

Medicaid Eligibility: http://dhss.alaska.gov/dpa/Pages/medicaid/default.aspx

Arkansas – Medicaid Website: http://myarhipp.com

Phone: 1-855-MyARHIPP (1-855-692-7447)Colorado – Medicaid

Medicaid Website: www.colorado.gov/hcpfMedicaid Customer Contact Center: 1-800-221-3943

Florida – MedicaidWebsite: http://flmedicaidtplrecovery.com/hipp

Phone: 1-877-357-3268Georgia – Medicaid

Website: http://dch.georgia.gov/medicaidClick on Health Insurance Premium Payment (HIPP)

Phone: 1-404-656-4507Indiana – Medicaid

Healthy Indiana Plan for low-income adults 19-64Website: www.hip.in.govPhone: 1-877-438-4479

All other MedicaidWebsite: www.indianamedicaid.com

Phone: 1-800-403-0864Iowa – Medicaid

Website: www.dhs.state.ia.us/hippPhone: 1-888-346-9562

Kansas – MedicaidWebsite: www.kdheks.gov/hcf

Phone: 1-785-296-3512Kentucky – Medicaid

Website: http://chfs.ky.gov/dms/default.htmPhone: 1-800-635-2570

Louisiana – MedicaidWebsite: http://dhh.louisiana.gov/index.cfm/subhome/1/n/331

Phone: 1-888-695-2447


32

www.healthcare.gov

www.insurekidsnow.gov

www.askebsa.dol.gov

http://myalhipp.com

http://myakhipp.com


http://dhss.alaska.gov/dpa/Pages/medicaid/default.aspx

http://dhss.alaska.gov/dpa/Pages/medicaid/default.aspx

http://myarhipp.com

www.colorado.gov/hcpf

http://flmedicaidtplrecovery.com/hipp

http://dch.georgia.gov/medicaid

www.hip.in.gov

www.indianamedicaid.com

www.dhs.state.ia.us/hipp

www.kdheks.gov/hcf

http://chfs.ky.gov/dms/default.htm

http://dhh.louisiana.gov/index.cfm/subhome/1/n/331

Maine – MedicaidWebsite: www.maine.gov/dhhs/ofi/public-assistance/index.html

Phone: 1-800-442-6003TTY: Maine relay 711

Massachusetts – Medicaid and CHIPWebsite: www.mass.gov/MassHealth

Phone: 1-800-462-1120Minnesota – Medicaid

Website: http://mn.gov/dhs/maPhone: 1-800-657-3739

Missouri – MedicaidWebsite: www.dss.mo.gov/mhd/participants/pages/hipp.htm

Phone: 1-573-751-2005Montana – Medicaid

Website: http://dphhs.mt.gov/MontanaHealthcarePrograms/HIPPPhone: 1-800-694-3084

Nebraska – Medicaid Website: http://dhhs.ne.gov/Children_Family_Services/

AccessNebraska/Pages/accessnebraska_index.aspxPhone: 1-855-632-7633

Nevada – MedicaidMedicaid Website: http://dwss.nv.gov

Medicaid Phone: 1-800-992-0900New Hampshire – Medicaid

Website: www.dhhs.nh.gov/oii/documents/hippapp.pdfPhone: 1-603-271-5218

New Jersey – Medicaid and CHIPMedicaid Website: www.state.nj.us/humanservices/

dmahs/clients/medicaidMedicaid Phone: 1-609-631-2392

CHIP Website: www.njfamilycare.org/index.htmlCHIP Phone: 1-800-701-0710

New York – MedicaidWebsite: www.nyhealth.gov/health_care/medicaid

Phone: 1-800-541-2831North Carolina – Medicaid

Website: www.ncdhhs.gov/dmaPhone: 1-919-855-4100

North Dakota – MedicaidWebsite: www.nd.gov/dhs/services/medicalserv/medicaid

Phone: 1-844-854-4825Oklahoma – Medicaid and CHIP

Website: http://www.insureoklahoma.orgPhone: 1-888-365-3742

Oregon – Medicaid Website: http://healthcare.oregon.gov/Pages/index.aspx

www.oregonhealthcare.gov/index-es.htmlPhone: 1-800-699-9075

Pennsylvania – MedicaidWebsite: www.dhs.pa.gov/hipp

Phone: 1-800-692-7462Rhode Island – Medicaid

Website: www.eohhs.ri.govPhone: 1-401-462-5300

South Carolina – MedicaidWebsite: www.scdhhs.govPhone: 1-888-549-0820

South Dakota - MedicaidWebsite: http://dss.sd.govPhone: 1-888-828-0059

Texas – MedicaidWebsite: http://gethipptexas.com

Phone: 1-800-440-0493Utah – Medicaid and CHIP

Medicaid Website: http://health.utah.gov/medicaidCHIP Website: http://health.utah.gov/chip

Phone: 1-877-543-7669Vermont– Medicaid

Website: www.greenmountaincare.orgPhone: 1-800-250-8427

Virginia – Medicaid and CHIPMedicaid Website: www.coverva.org/programs_premium_

assistance.cfmMedicaid Phone: 1-800-432-5924

CHIP Website: www.coverva.org/programs_premium_assistance.cfm

CHIP Phone: 1-855-242-8282Washington – Medicaid

Website: www.hca.wa.gov/free-or-low-cost-health-care/program-administration/premium-payment-program

Phone: 1-800-562-3022 ext. 15473West Virginia – Medicaid

Website: www.dhhr.wv.gov/bms/Medicaid%20Expansion/Pages/default.aspx

Phone: 1-877-598-5820, HMS Third Party LiabilityWisconsin – Medicaid and CHIP

Website: www.dhs.wisconsin.gov/publications/p1/p10095.pdfPhone: 1-800-362-3002

Wyoming – MedicaidWebsite: https://wyequalitycare.acs-inc.com

Phone: 1-307-777-7531

To see if any other states have added a premium assistance program since July 31, 2016, or for more information on special enrollment rights, contact either:

U.S. Department of LaborEmployee Benefits Security Administrationwww.dol.gov/ebsa1-866-444-EBSA (3272)

U.S. Department of Health and Human ServicesCenters for Medicare & Medicaid Serviceswww.cms.hhs.gov1-877-267-2323, Menu Option 4, Ext. 61565

OMB Control Number 1210-0137 (expires 10/31/2016)


33

www.maine.gov/dhhs/ofi/public-assistance/index.html

www.mass.gov/MassHealth

http://mn.gov/dhs/ma

www.dss.mo.gov/mhd/participants/pages/hipp.htm

http://dphhs.mt.gov/MontanaHealthcarePrograms/HIPP

http://dhhs.ne.gov/Children_Family_Services/AccessNebraska/Pages/accessnebraska_index.aspx

http://dhhs.ne.gov/Children_Family_Services/AccessNebraska/Pages/accessnebraska_index.aspx

http://dwss.nv.gov

www.dhhs.nh.gov/oii/documents/hippapp.pdf

www.state.nj.us/humanservices

www.njfamilycare.org/index.html

www.nyhealth.gov/health_care/medicaid

www.ncdhhs.gov/dma

www.nd.gov/dhs/services/medicalserv/medicaid

http://www.insureoklahoma.org

http://healthcare.oregon.gov/Pages/index.aspx

www.oregonhealthcare.gov/index-es.html

www.dhs.pa.gov/hipp

www.eohhs.ri.gov

www.scdhhs.gov

http://dss.sd.gov

http://gethipptexas.com

http://health.utah.gov/medicaid

http://health.utah.gov/chip

www.greenmountaincare.org

www.coverva.org/programs_premium_assistance.cfm




www.hca.wa.gov/free-or-low-cost-health-care/program-administration/premium

www.hca.wa.gov/free-or-low-cost-health-care/program-administration/premium

www.dhhr.wv.gov/bms/Medicaid

default.aspx

www.dhs.wisconsin.gov/publications/p1/p10095.pdf

https://wyequalitycare.acs-inc.com

www.dol.gov/ebsa

www.cms.hhs.gov

HIPAA Special Enrollment RightsIf you are declining enrollment for yourself or your eligible dependents (including your legal spouse/LDA) because of other health insurance or group health plan coverage, you may be able to enroll yourself and your dependents in this plan if you or your dependents lose eligibility for that other coverage (or if the employer stops contributing toward your or your dependents’ other coverage). However, you must request enrollment within 60 days after your or your dependents’ other coverage ends (or after the employer stops contributing toward the other coverage).

In addition, if you have a new dependent as a result of marriage, birth, adoption, or placement for adoption, you may be able to enroll yourself and your dependents. However, you must request enrollment within 60 days after the marriage, birth, adoption, or placement for adoption.

For more information on making changes during the year, refer to the Qualifying Events Matrix at https://benefits.georgetown.edu/enrolling/benefitschanges or contact the Office of Faculty and Staff Benefits at 1-202-687-2500 or by email at [email protected].

Summary Annual Reports (SARs) Available OnlineThe SARs of Georgetown University are available online and include an explanation of plan expenses, employee and employer contribution information, and details on how you can obtain additional information about the plan. If you were enrolled in, or eligible for, one or more of the University’s benefits plans, it is your legal right as a participant to know this information about your benefits.

Effective each December 15, you may view copies of the prior plan year’s SARs on our website at http://benefits.georgetown.edu. You may not be enrolled in all of the plans that are referenced, so please disregard any reports that do not apply to you. If you require a paper copy of the SARs, you can order them from the Office of Faculty and Staff Benefits. Simply email [email protected] or call 1-202-687-2500.

Important Notice from Georgetown University About Your Prescription Drug Coverage and MedicarePlease read this notice carefully and keep it where you can find it. This notice has information about your current prescription drug coverage with Georgetown University and about your options under Medicare’s prescription drug coverage. This information can help you decide whether or not you want to join a Medicare drug plan. If you are considering joining, you should compare your current coverage, including which drugs are covered at what cost, with the coverage and costs of the plans offering Medicare prescription drug coverage in your area. Information about where you can get help to make decisions about your prescription drug coverage is at the end of this notice.

There are two important things you need to know about your current coverage and Medicare’s prescription drug coverage:

1. Medicare prescription drug coverage became available in 2006 to everyone with Medicare. You can get this coverage if you join a Medicare Prescription Drug Plan or join a Medicare Advantage Plan (like an HMO or PPO) that offers prescription drug coverage. All Medicare drug plans provide at least a standard level of coverage set by Medicare. Some plans may also offer more coverage for a higher monthly premium.

2. Georgetown University has determined that the prescription drug coverage offered by the Georgetown University Health and Welfare Plan is, on average for all plan participants, expected to pay out as much as standard Medicare prescription drug pays and is therefore considered Creditable Coverage. If your existing coverage is Creditable Coverage, you can keep this coverage and not pay a higher premium (a penalty) if you later decide to join a Medicare drug plan.

Read this notice carefully – it explains your options. When Can You Join a Medicare Drug Plan?You can join a Medicare drug plan when you first become eligible for Medicare and each year from October 15th to December 7th. However, if you lose your current creditable prescription drug coverage, through no fault of your own, you will also be eligible for a two (2) month Special Enrollment Period (SEP) to join a Medicare drug plan.


34







What Happens to Your Current Coverage If You Decide to Join a Medicare Drug Plan?If you are an active employee (or a covered legal spouse or dependent of an active employee), your current Georgetown University active employee medical plan pays for other medical expenses in addition to prescription drug benefits. If you decide to join a Medicare drug plan, your current Georgetown University coverage will not be affected. Specifically, you and your eligible dependents will still be eligible to receive all of your current medical and prescription drug benefits under Georgetown University’s active employee medical and prescription drug plan.

If you decide to join a Medicare drug plan and drop your current Georgetown University active employee medical and prescription drug plan, be aware that you and your dependents may be able to enroll back into Georgetown University’s active employee medical and prescription drug plan at a later time, such as during an Open Enrollment period.

When Will You Pay a Higher Premium (Penalty) to Join a Medicare Drug Plan?You should also know that if you drop or lose your current coverage with Georgetown University and don’t join a Medicare drug plan within 63 continuous days after your current coverage ends, you may end up paying a higher premium (a penalty) to join a Medicare drug plan later.

If you go 63 continuous days or longer without creditable prescription drug coverage, your monthly premium may go up by at least 1% of the Medicare base beneficiary premium per month for every month that you did not have that coverage. For example, if you go nineteen months without creditable coverage, your premium may consistently be at least 19% higher than the Medicare base beneficiary premium. You may have to pay this higher premium (a penalty) as long as you have Medicare prescription drug coverage. In addition, you may have to wait until the following October to join.

For More Information About This Notice or Your Current Prescription Drug Coverage:Contact the Office of Faculty and Staff Benefits at 1-202-687-2500 or by email at [email protected]. NOTE: You’ll get this notice each year. You will also get it before the next period you can join a Medicare drug plan, and if this coverage through Georgetown University changes. You also may request a copy of this notice at any time.

For More Information About Your Options Under Medicare Prescription Drug Coverage:More detailed information about Medicare plans that offer prescription drug coverage is in the “Medicare & You” handbook. You’ll get a copy of the handbook in the mail every year from Medicare. You may also be contacted directly by Medicare drug plans.

For More Information About Medicare Prescription Drug Coverage:

l Visit www.medicare.gov

l Call your State Health Insurance Assistance Program (see the inside back cover of your copy of the “Medicare & You” handbook for their telephone number) for personalized help

l Call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048.

If you have limited income and resources, extra help paying for Medicare prescription drug coverage is available. For information about this extra help, visit Social Security on the web at www.socialsecurity.gov, or call them at 1-800-772-1213 (TTY 1-800-325-0778).

Remember: Keep this Creditable Coverage notice. If you decide to join one of the Medicare drug plans, you may be required to provide a copy of this notice when you join to show whether or not you have maintained creditable coverage and whether or not you are required to pay a higher premium (a penalty).

Date: October 15, 2016Name of Entity/Sender:

Georgetown University

Contact-Position/Office:

Office of Faculty and Staff Benefits Associate Vice President for Benefits

Address: 37th & O Streets, N.W. Washington, D.C. 20057-1265

Phone Number: 1-202-687-2500Email: [email protected]


35


www.medicare.gov

www.socialsecurity.gov


Health Care Reform and Your Health Insurance Options Effective January 1, 2014, the Patient Protection and Affordable Care Act (PPACA) – also known as “Health Care Reform” – requires most Americans to have health insurance. Individuals who do not have coverage will be required to pay a penalty. The Health Insurance Marketplace (“health insurance exchange”) was created to ensure that everyone has access to affordable health insurance. The Marketplace is an option for someone who does not have employer-provided health coverage or for someone who chooses not to enroll in employer-provided health coverage. Because Georgetown offers a medical plan that meets the specified affordable and minimum value requirements under the PPACA, you are NOT eligible for a subsidy through the Marketplace, even if you choose not to enroll in a Georgetown medical plan.

If it is discovered that you are receiving a subsidy when eligible for a Georgetown medical plan, you will be responsible for refunding the full amount of the subsidy to the Centers for Medicare & Medicaid Services.

Why Am I Receiving This Notice? This notice provides you with information about the Health Insurance Marketplace and where you can access a website that contains more information about health plans offered to you by either your state or the U.S. Department of Health and Human Services.

Georgetown is required to send the enclosed notice to every U.S. employee to comply with rules under the federal PPACA.

What Do I Need To Do?You’re currently eligible to participate in a Georgetown-sponsored medical plan. If you participate in the medical plan, you and the University share in the cost of your coverage. Your share of the cost is paid with pre-tax dollars.


If you choose not to participate in a Georgetown plan and you buy insurance in the Marketplace, you will be responsible for paying the entire premium yourself with after-tax dollars.

What Is The Individual Mandate Tax?Under the PPACA, starting in 2014, most Americans are required to have health insurance or pay a penalty. If you elect coverage through Georgetown, you will satisfy this requirement. For more information about the individual mandate, please visit: http://www.irs.gov/uac/Questions-and-Answers-on-the-Individual-Shared-Responsibility-Provision.

What This Means For You• Georgetown has you and your family covered. As

a benefits-eligible employee, you and your eligible dependents have access to health care coverage through Georgetown.

• Our plans are affordable. You’ll hear about new coverage options available in the Health Insurance Marketplace, but in most cases, Georgetown’s coverage will continue to provide the greatest value. And because our plans exceed the federally required “minimum value standards,” you are NOT eligible for federal subsidies.

• We’ll keep you updated. As we get updates, we’ll provide resources and support to help you understand the impact of health care reform and to feel confident about your personal coverage decisions.

Questions?Call 1-800-318-2596(TTY: 1-855-889-4325) or visit www.healthcare.gov.

This is a Notice on Marketplace Health Insurance Coverage Options. Georgetown is required by law to send this to you, but know that no action is required by you.

36

http://www.irs.gov/uac/Questions

www.healthcare.gov


Notice to All Employees of Georgetown University: 2017 403(b) Universal Availability Notice

for Georgetown University Voluntary Contribution Retirement Plan This notice is to inform you that as an employee of Georgetown University you are eligible to participate in the Voluntary Contribution Retirement Plan. The Georgetown University Voluntary Contribution Retirement Plan (the “Voluntary Plan”) is a retirement workplace 403(b) savings plan. The Voluntary Plan, distinct from GURP and the Defined Contribution Retirement Plan, allows employees to make pre-tax contributions or additional pre-tax contributions to a 403(b) savings account to help save for retirement. The University does not contribute to the Voluntary Plan; all employee contributions are made through salary reduction. Employees are always 100% vested in the Voluntary Plan. Plan contributions as well as any investment earnings are tax-deferred – and are not taxable until distributed. Eligibility: If you are an employee of the University, you are eligible to enroll in the Voluntary Plan. Enrollment: You may enroll in the Voluntary Plan or discontinue or change your enrollment at any time. Visit http://benefits.georgetown.edu/saving/voluntary or call the Office of Faculty and Staff Benefits at 1-202-687-2500 for more information. Contribution and Investment Elections:To enroll, you must elect your contribution amount and designate the investment company to which you want your contributions deposited. To do so, log on to http://gms.georgetown.edu with your NetID and password. New Employees will be prompted to enroll as part of the New Hire benefit event in their GMS inbox. All other employees should follow the instructions at https://benefits.georgetown.edu/saving/voluntary. Annual contribution limits do apply. Once you’ve submitted your choices in GMS, you’ll be automatically enrolled in a target date retirement fund by the investment company(ies) you have selected. You can change your investment allocations at any time after your first contribution has been made by contacting your investment company. You will receive further information and instructions from your chosen investment company(ies) soon after you enroll.

Investment Companies: You may obtain further information about the Voluntary Plan by contacting the investment companies directly. You may do so by visiting their websites or by calling their toll-free numbers to talk to a representative.

Investment Company Website/E-mail Telephone Fidelity Investments http://netbenefits.com/georgetown 1-800-343-0860TIAA-CREF www.tiaa-cref.org/georgetown 1-800-842-2888Vanguard http://georgetown.vanguard-education.com/ekit 1-800-523-1188

We look forward to serving you in 2017 and beyond. Sincerely,

Vivek Kumar Retirement Benefits Analyst Office of Faculty and Staff Benefits

37

http://benefits.georgetown.edu/saving/voluntary

http://benefits.georgetown.edu/saving/voluntary


https://benefits.georgetown.edu/saving/voluntary

http://netbenefits.com/georgetown

www.tiaa-cref.org/georgetown

http://georgetown.vanguard-education.com/ekit

NOTES

38

NOTES

39

Georgetown Benefits Directory

Office of Faculty and Staff Benefits- Benefits help- GMS assistance

http://benefits.georgetown.eduemail: [email protected]

1-202-687-2500

Georgetown Management System (GMS)

http://gms.georgetown.eduemail: [email protected]

1-202-687-4949

Medical, Prescription Drug and Dental- Cigna Global Health Benefits- GU Policy # 02774A

www.cignaenvoy.com 1-302-797-3100 (Reverse charges accepted)1-800-441-2668 (Within the U.S.)

Flexible Spending Accounts- ConnectYourCare www.connectyourcare.com

email: [email protected]

Long Term Disability Contact the Office of Faculty and Staff BenefitsLife/AD&D Insurance- MetLife- Hyatt Legal Plans (Supp. Life Group Number: 123529

Will Prep)

1-800-638-64201-800-821-6400

Business Travel Accident- The Hartford Contact the Office of Faculty and Staff BenefitsInternational Employee Assistance Program- Cigna Envoy www.cignaenvoy.com 44-2089-876550 (Reverse charges accepted)

1-800-870-5068 (Within the U.S.)- Workplace Options [email protected] Assistance and Evacuation Services- International SOS http://riskmanagement.georgetown.edu

(Click on “International Travel Assistance”)1-215-942-8226 (Collect calls accepted)1-800-523-6586 (Within the U.S.)

- Traveler’s Resource http://travel.georgetown.eduTuition Assistance Program Contact the Office of Faculty and Staff BenefitsRetirement- Fidelity Investments- TIAA-CREF- Vanguard

http://netbenefits.com/georgetownhttp://enroll.tiaa-cref.org/georgetownhttp://georgetown.vanguard-education.com/ekit

1-800-343-08601-800-842-27761-800-523-1188 (Hit “*” then “0” to speakwith an associate)

GUAdvantage - Health, Wellness, Travel, Electronics, Restaurants, Movies, and much more www.beneplace.com/georgetownGUWellness http://wellness.georgetown.edu

email: [email protected]

Important Information About Medicare Prescription Drug Coverage

If you (and/or your dependents) have Medicare or will become eligible for Medicare in the next 12 months, a Federal law gives you more choices about your

prescription drug coverage. Please see pages 34-35 for more details.

Georgetown reserves the right to modify, terminate or amend its plans/provisions, or any part thereof, at its discretion at any time or for any reason. Details of the benefits or the limitations and exclusions of the plans are contained in the official plan documents and agreements between the insurance companies and Georgetown University. It is these documents that legally govern the operation of the plans and which will control in the event of any omission or other differences arising elsewhere. Copies of the summary plan description (SPD) for each plan can be found at http://benefits.georgetown.edu or can be obtained by contacting the Office of Faculty and Staff Benefits at 1-202-687-2500.

GU 2017 International Benefits Guide 10-31-2016





www.cignaenvoy.com

www.connectyourcare.com


www.cignaenvoy.com


http://riskmanagement.georgetown.edu


http://netbenefits.com/georgetown

http://enroll.tiaa-cref.org/georgetown

http://georgetown.vanguard-education.com/ekit

www.beneplace.com/georgetown

http://wellness.georgetown.edu



2017 - amazon s3 · 2016. 11. 2. · l in your gms inbox, select the option to enroll in benefits....

Documents