Acceptance Terms of Agreement

Student Health Insurance 2017 - 2018 Plan Year

University Mandate

Georgetown University (GU) requires most students who are charged GU tuition and registered in resident thesis research or registered for nine or more credit hours in a GU degree program (eight or more credit hours if a Law or Graduate student) to have the Premier Plan, underwritten by United HealthCare Insurance Company and designed specifically for GU students unless they decline the coverage during their applicable Open Enrollment Period and show that they have coverage under another policy that remains in effect throughout the academic year.

Eligible students are mandated coverage only once per academic year, at the beginning of the first academic term in which they are first eligible.  Once an eligible student is enrolled, the coverage remains in effect for the remainder of the Plan Year, through 8/14/2018.  The Premium Rate - including an administrative fee up to $60, Terms of Coverage dates, and applicable Open Enrollment Period dates are below.

Fall 2017-2018 Plan Year:

Term of Coverage: 8/15/2017 - 8/14/2018
Applicable Open Enrollment Period: Late June - September 15, 2017

  • $2,680 per student
  • $5,361 per student and spouse or student and one child
  • $8,042 per student and two or more children
  • $8,042 per student, spouse, and one child
  • $10,723 per student, spouse, and two or more children

Spring 2017-2018 Plan Year:

Term of Coverage: 1/1/2018 - 8/14/2018
Applicable Open Enrollment Period: 2nd week in December 2017 - January 31, 2018

  • $1,680 per student
  • $3,361 per student and spouse or student and one child
  • $5,042 per student and two or more children
  • $5,042 per student, spouse, and one child
  • $6,723 per student, spouse, and two or more children

Late Enrollments

Students who are enrolled for less than 9 credit hours are not eligible to purchase the Premier Plan except Law and Graduate students who are enrolled for at least 8 credit hours and resident thesis research students.

After the applicable Open Enrollment Period, eligible students and dependents that have become involuntarily ineligible by their group health plan due to age, job status,, or plan year termination during an employer Open Enrollment Period may enroll in the Premier Plan within 31 days of having been notified of their ineligibility.  Insured students may also enroll dependents within 31 calender days of a "qualifying event", e.g., marriage or birth of a child.  Refer to the Late Enrollment web page and the Description of Benefits for the definition of "qualifying event."

E-mail the GU Student Health Insurance Office, shi@georgetown.edu, to obtain the proper forms, pro-rated premium, and instructions for such mid-year enrollments.  Include your GUID# that begins with an "8" in your e-mail.

Acceptance Instructions

Prompt submission of an acceptance election will help to ensure that your name is sent to the insurance carrier early in the term, which enables your medical and prescription benefits to be activated early.  If an acceptance election is not received, submission of your name to the insurance carrier will be delayed, but your applicable effective date will remain unchanged.

Please be sure to keep your address(es) on file in the Registrar's Office current.  The local address you have on file when your Open Enrollment Period ends will be the final address given to the insurance company and will be the address to which claim information is sent.  If you do not have a local address on file, then your permanent address will be used.  If you change your address after your Open Enrollment, contact the Arthur J. Gallagher & Co., Student Health & Special Risk insurance agency at gallagherstudent.com with the change of address.

Student Agreement When Accepting the Premier Plan Coverage (SUBJECT TO APPLICABLE STUDENT CODE OF CONDUCT PROVISIONS)

I accept the Premier Plan for GU students.  I understand that the premium for coverage is or will be included on my student account.  I understand this coverage is with United HealthCare Insurance Company.  I also understand that the term of coverage is in effect as of 12:01 A.M. of the applicable effective date of coverage indicated above through 11:59 P.M. on August 14, 2018.  I understand that I must actively attend classes as an eligible student for at least 31 days after the effect date of coverage; otherwise, I will become ineligible and my premium will be refunded.

I also understand and agree that partial refunds are not granted, even if I purchase other insurance for myself and/or for my dependents after Open Enrollment.

I understand that the submission of an acceptance to Student Health Insurance indicates agreement to the Terms and Conditions for Accepting the 2017-2018 Premier Plan. In addition, a Fall 2017 acceptance also indicates acceptance to the 2016-2017 Early Arrival Premier Plan, if mandated and charged, and is subject to applicable Student Code of Conduct Provisions.