Colonial HealthCare, I N C O R P O R A T E D - Georgetown University

Colonial HealthCare, I N C O R P O R A T E D
9901 Business Parkway, Lanham, MD 20706-1840 P. O. Box 827, Lanham, MD 20703-0827
301-306-2500 Fax: 301-306-2509
Georgetown University’s Flexible Spending Account benefit option is a great way to save money
on your taxes by choosing to pay for your dependent care expenses and qualifying health care
expenses using money which has been set aside from your pay without any taxes taken out. Your
elected amount is taken out of your pay each pay day, and is available to reimburse you for
expenses when you submit a claim to Colonial HealthCare.
We have always turned claims around quickly. All claims we receive by Friday are processed so
that we are able to mail checks the following Tuesday. Checks are mailed locally, so most people
receive their checks the following day.
NEW!
You can now elect direct deposit for your reimbursements, instead of waiting for a check. We
deposit your reimbursement into your account the same day we issue checks. We still send you a
paper notification of your reimbursement for your records.
When you enroll on-line for a Flexible Spending Account, please complete the attached direct
deposit form and mail it back to us if you want to have your money deposited directly into
your account. Attach a voided check, so we can make sure we have your account information
correct.
The material enclosed in the envelope should answer most of your questions about flexible
spending accounts. Should you have any question, please call us, or ask your Faculty & Staff
Benefits Department personnel.

Mail to:
Colonial HealthCare Incorporated
GU FSA Direct Deposit Accounts
P.O. Box 827 Lanham, MD 20703-0827
AUTHORIZATION AGREEMENT FOR DIRECT DEPOSITS
for FLEXIBLE SPENDING ACCOUNTS
DIRECT DEPOSIT I want my Flexible Spending Account reimbursements to be deposited directly to my bank account.
(To activate this option, identify your election by selecting “Yes” below and by completing and returning this Form with a voided
check.)
YES
NO
I hereby authorize Georgetown University to initiate deposit to the bank account indicated below. I authorize
credit entries and, if necessary, debit entries and adjustment for any credit entries made in error to my
account.
This account is: (Please check one of the following options)
New Change Cancel
Transit ABA Routing #
Account Number
Account Type (check one)
---------------------------------
------------------------------
Checking
Savings
Name of Bank:
Bank Address:
Please include a copy of a voided check (for checking accounts) or a deposit slip (for
savings accounts)
Bank Phone Number:
PLEASE PRINT YOUR NAME
SOCIAL SECURITY NUMBER
--------------------------------------------------------------
SIGNATURE
---------------------------------------------------------------
--------------------------------------------------
DATE
----------------------------------------