2020-2021 Plan Year
In order to better serve you, the answer to most questions for enrolling or waiving the Premier Plan can be found on this website. Below are the answers to the most frequently asked questions. For detailed enrollment & benefit questions refer to the Certificate of Coverage.
Q1: If I am charged for the Premier Plan, will I remain eligible for the Plan?
Answer: To remain eligible for the Premier Plan, you must be enrolled in the required number of credit hours and degree and actively attend classes for the first 31 days.
End of Employer Plan Year
Q2: My employer plan year coverage ends in December. May I enroll late into the Premier Plan for a prorated price, if my coverage is terminated during my employer’s Open Enrollment Period?
Answer: Yes, as long as you maintain the required credit hours for eligibility in the Spring semester. Email firstname.lastname@example.org to provide proof of termination during your employer’s Open Enrollment Period within 31 days of terminating. Your effective date will be the day after your employer plan’s termination date, so you will not have a gap in coverage.
Mid-Year Enrollment Limitations
Q3: If I waive the Premier Plan in the Fall, can I change my mind and enroll in the Plan later?
Answer: Generally, no. Late Enrollment is allowed if an eligible student is involuntarily dropped from other coverage due to age or job status or due to termination during the other plan year’s open enrollment period. In addition, the late enrollment application must be received within 31 days of being involuntarily dropped or terminated during the other plan year’s open enrollment period.
If you know you will be eligible for Late Enrollment during your applicable Open Enrollment period (Fall or Spring), include the termination date of your other coverage in the text box provided when completing the waiver section of the survey. SHI should then e-mail you a Temporary Waiver agreement, so the Premier Plan charge can be temporarily removed from your Student Account. If you do not receive the email within five business days of submitting your waiver, email email@example.com to request instructions for a Temporary Waiver.
No Prorated Refunds
Q4: I will be eligible to enroll in another plan in November, can I purchase the Premier Plan from August 15 through November?
Answer: No, the Premier Plan coverage ends August 14, of each Plan Year and prorated refunds are not granted. You may purchase other private “gap” coverage until the new insurance is in effect. To notify the Student Health Insurance Office of these special circumstances, indicate the termination date of your “gap” coverage when completing the waiver survey in the text box provided.
Q5: Can I extend/continue my insurance?
Answer: If your Premier Plan coverage terminates on August 14, and you will no longer be eligible to enroll in the new Plan Year, you may be eligible to enroll in the Calendar Year Continuation Plan. Review the Continuation Plan eligibility provisions to determine if you are eligible.
Q6: I submitted my waiver, was it approved?
Answer: Allow five business days before confirming if your waiver was approved. To confirm that your waiver has been approved, view your Student Account in MyAccess to see if a credit for the Premier Plan has been posted to your account. If the waiver is not approved, the Student Health Insurance Office will send a request for additional information or an explanation for the denial to your GU e-mail address.
Q7: If I waive the Premier Plan in the Fall, can I change my mind and enroll in the Plan during the Spring Open Enrollment Period?
Answer: No, each student has only one Open Enrollment opportunity per Plan Year. However, you may change your mind during your applicable Open Enrollment Period. And, you may enroll under the Late Enrollment provisions under specific termination of other coverage circumstances.
Credit Hours and Mid-Year Enrollment
Q8: My son is covered under my plan, but he will be involuntarily dropped from my coverage in the Spring semester because he is turning age 26. He is also reducing his credit hours to part-time in the Spring. Can he enroll in the Premier Plan in the Spring?
Answer: For Late Enrollment, students must have established eligibility during their applicable Open Enrollment Period (either Fall or Spring) and have remained eligible for the Academic Year. If he is taking less than 9 credit hours (Undergraduate) or less than 8 credit hours (Graduate) in the Spring term, he will not meet the eligibility requirements. However, you may opt to enroll your son in your employer COBRA Plan. Otherwise, he should enroll in the Premier Plan in the Fall.
Emergency Room Limitation
Q9 – Emergency Room Limitation: Why was coverage for my Emergency Room visit denied?
Answer: Charges for Medical Emergency Expenses are covered only when the condition is a true Medical Emergency as defined in the Certificate of Coverage. If you have a non-emergent condition that needs to be treated after regular business hours:
- Contact the on-call Student Health Center physician at 202-444-PAGE for advice; or,
- Go to the UHCSR Urgent Care center after hours. UHCSR Urgent Care centers can be found through the online provider search tool at www.uhcsr.com
Q10 – Worldwide Coverage: Does the Premier Plan provide coverage worldwide?
Answer: Yes, reimbursement for treatment outside the U.S. would be paid according to Schedule 3 in the Schedule of Benefits Summary in the Certificate of Coverage.
Dental and Vision Discount Network Is Not Insurance
Q11: Does the Premier Plan cover dental or vision care?
Answer: Generally no, except insureds up to age 19. The Premier Plan is a medical injury and sickness Plan. However, all members have access to the EyeMed Discount Network, which included on the Premier Plan Service web page. In addition, any student can enroll in a voluntary Delta Dental Plan offered by Georgetown and a voluntary vision plan offered by Gallagher Insurance Agency that complements the Premier Plan. Note: Georgetown University does not make vendor service/product recommendations.
Q12: Are pre-existing conditions covered?
Answer: Pre-existing conditions are covered if the condition or treatment is not specifically excluded or limited per the Exclusions and Limitations in the Certificate of Coverage.
Q13: Are medications or devices that prevent pregnancy covered?
Answer: Georgetown University has certified that this student health insurance plan qualifies for an accommodation with respect to the Federal requirement to cover all Food and Drug-administration approved contraceptive services for women, as prescribed by a health care provider, without cost sharing. This means that Georgetown will not contract, arrange, pay or refer for contraceptive coverage. The accommodation remains in place, thereby, UnitedHealthcare will continue to provide separate payments for contraceptive services that you use, without cost sharing and at no other cost, for so long as participants are enrolled in this plan. Georgetown University will not administer or fund these payments.
UPDATE 12/1/17: As it has for the past four years, Georgetown will continue to claim the accommodation related to contraceptive coverage under the Affordable Care Act. This means that UnitedHealthcare will provide separate payments for contraceptive services that plan participants use, without cost sharing and at no other cost to plan participants. Georgetown will not administer or fund these payments.
Student Health Center Contraceptive Treatment
Q14: Can the physicians and nurse practitioners at Georgetown Student Health Center prescribe contraceptives?
Answer: Yes, if you have a medical condition for which these medications may be indicated. See the Student Health Center website for more information.
Contacts for Insurance and Health Care
Q15: I have reviewed the materials on the website, but I still have questions, whom should I contact?
Answer: If you cannot find the answer to your question on this website, refer to the contact page on the back cover of the the summary booklet, Premier Plan At a Glance, for information on who to contact with specific concerns. Student Health Insurance is also available to direct you to the appropriate contact for your questions.