The August 7, 2012, chat with GEHA President Richard Miles has concluded. The transcript is available below.

Hartwell, Georgia (GEHA High Option): I have just gotten married and would like to add my wife to my GEHA policy. How do I do that?

Richard Miles: Congratulations! You can add a spouse to your health plan and change from a Self Only plan to a Self + Family plan any time from 31 days before your wedding day to 60 days after the event. You would contact your employing or retirement office to have your spouse added to your health plan.

Zephyrhills, Florida (GEHA Standard Option): Will GEHA pay for shingles shots for senior citizens?

Richard Miles: Yes, the shingles vaccination is covered for members ages 60 and older. When provided by an in-network provider, these vaccinations are covered at 100% of the plan allowable.

Sarasota, Florida (GEHA High Option): Any future plan to include hearing aids?

Richard Miles: GEHA does currently provide benefits for hearing aids. Under High Option, the plan will cover up to $500 per ear once every five years. Under Standard Option, the plan will cover up to $250 per ear once every five years.

Also, all GEHA members are entitled to discounts on hearing aids through HearPO. Visit hearpo.com/geha or call (866) 211-6048 for locations and additional information.

Orlando, Florida (GEHA High Option): Will you cover my expenses while traveling in cases of emergency? For example, what if I’m on vacation in the Bahamas and need to go to an emergency room?

Richard Miles: GEHA does provide benefits for its members outside of the United States for medically necessary covered services. Covered services would be payable at the PPO rate of benefits. We do ask that foreign claims for reimbursement be translated to English and American dollars if needed.

Mexia, Texas (GEHA High Option, Connection Dental Plus): When I signed up for insurance, I only had two options -- Self Only or Self and Family. Will there ever be an option for Self and Spouse?

Richard Miles: FEHB law does not currently allow for a Self plus One option under the FEHB health plans.

Hewitt, Texas (Connection Dental Federal (FEDVIP) High): I don’t have a question, but I wanted you to know that your service reps provide outstanding service. I’ve had several issues with my dental provider, and those issues have been resolved only because your employees "went the extra mile." Noted and appreciated.

Richard Miles: Thank you so much. We appreciate your nice comments. At GEHA, we pride ourselves on providing great customer service.

Fresno, California (GEHA Standard Option): I would like to know about eye/vision care.

Richard Miles: All GEHA health plan and dental plan members get vision coverage for no additional premium.

Through Connection Vision powered by EyeMed, you and your covered family members each pay a $5 copay for an annual eye exam when you use a qualified EyeMed participating provider. Or, if you use a provider that does not participate, EyeMed will reimburse you up to $45 for an annual routine eye exam.

To locate a participating EyeMed provider in your area, go to eyemedvisioncare.com and select the Insight network from the list in the "Locate a Provider" box. Or call (866) 804-0982.

Bloomington, Minnesota (GEHA Standard Option): I understand there is a hearing-aid benefit available through HearPO. But how can I find a HearPO provider near me?

Richard Miles: There are 2,700 HearPO providers across the country, but you must be pre-authorized by HearPO to receive your hearing benefit. Call HearPO at (866) 211-6048 to activate your benefit. HearPO will also help you find a provider close to you.

Davie, Florida (GEHA High Option): Are there any costs to activate my HearPO benefit?

Richard Miles: There are no costs associated with activating your HearPO benefit. Your HearPO benefit includes discounted prices on hearing aids and a free, one-year supply of batteries shipped to your home.

Douglass, Texas (GEHA Standard Option, Connection Dental Plus): The law requires insurers to give out annual rebates by August 1, starting this year, if less than 80 percent of the premium dollars they collect go toward medical care. For insurers covering large employers, the threshold is 85 percent. Will GEHA be issuing rebates to its clients?

Richard Miles: No, GEHA will not be issuing rebates. As a Voluntary Employee Beneficiary Association (VEBA), we are not subject to this rule. You’ll be happy to know we do exceed the goal set by the Affordable Care Act. GEHA administrative expenses are approximately 5 percent of the premium dollar. Historically on average we spend 95 percent of subscriber premiums on direct care to our members.

Lompoc, California (GEHA Standard Option): Will I be able to keep my GEHA health insurance if the Obamacare health care reform law stands as it is now?

Richard Miles: We do fully expect the FEHB program and GEHA to remain intact. We also expect that the FEDVIP program, which includes our Connection Dental Federal plan, to remain available to federal employees/retirees.

Marlton, New Jersey (GEHA High Option): Sir: It would be most helpful if you can describe GEHA works with Medicare. Do I present my Medicare card at the time of service? Do I need to sign up for Part D for prescriptions? Can your provider list identify the providers (doctor offices, hospitals, dentists, specialists, etc) who DO accept Medicare patients, especially, as in my case, not a new patient but one who is soon signing-up for Medicare? Will I have to change my doctor? Thank you.

Richard Miles: If you have Medicare Parts A and B primary, GEHA pays 100% of covered hospital and doctor expenses after Medicare. You pay no deductible or copays for surgical and medical benefits with GEHA Standard Option or High Option. You would present both your Medicare card and GEHA card to the provider at the time of service. The provider will bill Medicare and in most cases Medicare will forward the claim on to GEHA once they have processed the claim.

Regarding Medicare Part D, this additional prescription coverage is optional for you. OPM has determined that GEHA’s prescription coverage is considered Creditable Coverage, which means it is expected to pay out as much as the standard Medicare prescription drug coverage will pay for all plan participants. If you decide to enroll in Medicare Part D later, you will not have to pay a penalty for late enrollment as long as you keep your FEHB coverage.

Unfortunately, the list of providers that take Medicare changes regularly. Please check with your current physicians to ensure they are participating in Medicare.

Galena Park, Texas (Connection Dental Federal (FEDVIP) High): Does your company pay out-of-network doctors?

Richard Miles: Yes! Connection Dental Federal provides the same benefit to both in- and out-of-network providers. However, for many services, your out-of-pocket costs may be lower when you visit any of the more than 83,000 provider locations in the Connection Dental Network. Network providers will not bill you more than the plan’s maximum allowable charge for covered services.

Jacksonville, Florida (GEHA Standard Option): Why not consolidate GEHA’s health and dental plans?

Richard Miles: The FEHB and FEDVIP programs are intentionally separate, so that only federal employees who want additional dental coverage will pay additional dental premiums. FEHB does not allow current health plans in the program to add or increase dental benefits.

Creedmoor, North Carolina (GEHA Standard Option, Connection Dental Federal (FEDVIP) Standard): Does a dependent need to be a full-time student to be covered under a family plan until age 26?

Richard Miles: Dependent children under the age of 26 are eligible under your family health plan regardless of student status, residency or marriage. Coverage for dependent children ends at age 22 in the FEDVIP program.

Redondo Beach, California (GEHA High Option, Connection Dental Plus): Why didn’t my GEHA premiums reduce when I became 65 and started paying Part B premiums?

Richard Miles: FEHB laws do not allow for a FEHB plan to charge different premiums to members enrolled in the same plan option regardless of other coverage. However when Medicare A & B are primary, GEHA pays 100% of covered hospital and medical expenses after Medicare. You pay no deductible or copays for hospital and medical benefits with GEHA Standard Option or High Option.

Indianapolis, Indiana: When can I change from my current carrier to GEHA?

Richard Miles: You can enroll in GEHA health and dental plans during the upcoming Open Season, which begins on November 12 and ends on December 10.

Deal, New Jersey (GEHA Standard Option): Is there any way to lower the brand-name prescriptions cost from 50% to 25% on my plan?

Richard Miles: GEHA does offer a High Option plan with more comprehensive prescription benefits. Under High Option, the brand-name drug copay is 25% of the cost of the medication when you use mail order.

Sacramento, California (GEHA Standard Option, Connection Dental Federal (FEDVIP) Standard): I am a member of the GEHA Standard Option plan. How soon after enrollment can we be covered and submit a claim? Thank you.

Richard Miles: There are no waiting periods for Class A, Class B or Class C services. Benefits are available from the first day of coverage. Services are subject to plan benefits and limitations as described in the plan brochure.

Oklahoma City, Oklahoma (GEHA Standard Option, Connection Dental Federal (FEDVIP) High): I currently have GEHA Connection Dental High Option, Self plus One. When can I update my dental policy to a Self and Family plan? Please advise.

Richard Miles: Enrollment changes for dental can be made through BENEFEDS during Open Season or when you have another qualifying life event such as marriage or birth of a child. You can contact BENEFEDS at www.BENEFEDS.com or (888) 877-3337. Open Season starts November 12 and ends on December 10.

Cerritos, California (GEHA Standard Option): My daughter is 25 years old, and I know she is covered until age 26. Is there a health plan you can offer to us when her coverage expires?

Richard Miles: When your daughter is no longer eligible for coverage under your GEHA Standard Option plan, she can enroll in a temporary continuation of coverage (TCC) policy for up to 36 months. To learn more about TCC, see your employment office or visit OPM’s Temporary Continuation of Coverage webpage. Once your daughter has exhausted TCC, she may be eligible to convert to a GEHA non-group policy.

Huntsville, Alabama (GEHA High Option): How will my rates change for next year?

Richard Miles: The 2013 rates are not yet available. They are normally announced by OPM in September. If you sign up for the GEHA First to Know alert, we will send you either an email or a text message as soon as the 2013 GEHA health and dental rates are available.

Denver, Colorado (GEHA Standard Option): Does GEHA have some sort of health hotline I could call if I have a health question but my doctor’s office is closed?

Richard Miles: Yes. The number for the GEHA Health Advice Line is (888) 257-4342. You can use it to speak with a registered nurse 24 hours a day. It’s for GEHA health members, so please have your member ID number available when you call.

It’s a great resource. For example, you can call it at 3 a.m. when you’re trying to decide if you or a family member needs you need emergency care or urgent care (or can it wait till you can make an appointment with your doctor). The nurse can also let you know if there self-care techniques that you can apply at home.

If you’re calling the Advice Line from outside the United States, call collect at (709) 835-8243.

When you call the GEHA Health Advice Line, you can also choose to listen to recorded messages on more than 1,000 health topics.

Wichita, Kansas (GEHA High Option): I would like to know if Medco will start auto refills? A phone call, an email notice or a note in the refill med package mailed to us could be used to make us aware when the prescription is running out.

Richard Miles: Good question. Your mail-order prescription label, on the bottle, does have an order-after date -- as does the invoice included with the medication.

You may request a mail order refill by either visiting www.medco.com or calling (800) 4RE-FILL. Or you can mail the enclosed Refill Slip with the order form and your payment to Medco.

Refill reminders can be requested if you are registered at www.medco.com.

Laguna Hills, California (Connection Dental Federal (FEDVIP) Standard): What is the criteria for selecting a dentist for Connection Dental Federal? How often are they re-certified and/or reviewed for participation in the program?

Richard Miles: Dental providers may apply for selection to the network or members may "nominate" a provider that they would like to see to the network. Before a provider applicant can be included as participating in the network, they are reviewed to determine if they meet quality guidelines. Initially, the dental applicants are analyzed under the initial credentialing process which includes, but is not limited to, reviewing information submitted by the provider as well as querying the National Practitioner Data Bank for potential quality assurance issues.

The network has also established recredentialing criteria for providers to assure a provider’s information is updated every 3 years. This process includes reviewing the provider’s entire file, including any quality assurance issues that are part of the provider’s permanent file.

Beckley, West Virginia (GEHA Standard Option, Connection Dental Federal (FEDVIP) Standard): Is there anyone with GEHA whose job is to actively seek doctors/facilities/dentists to become in-network providers of GEHA?

Richard Miles: Yes. We are always interested in adding quality medical providers and dentists to the network. Of course we can’t force them to join, but nominations from patients are sometimes effective in getting a dentist or medical provider to consider joining a network.

To nominate a dentist to the dental network, please click on our online dental nomination form.

Memphis, Tennessee (Connection Dental Federal (FEDVIP) Standard): Will my dental plan cover me for a root canal? If not, does the plan pay any part of the charge to have a root canal performed?

Richard Miles: Our Connection Dental Federal plan covers root canal therapy as a Class C service. Class C services are reimbursed at 35% of the plan allowance in Standard Option.

Centennial, Colorado (GEHA Standard Option, Connection Dental Federal (FEDVIP) Standard): What measures might GEHA implement to retain present members during Open Season and encourage new members to be a part of the GEHA Family with all the choices offered?

Richard Miles: GEHA works to attract and retain members by providing good value, comprehensive benefits, excellent service and competitive rates. If you’re an active employee and your agency is hosting an Open Season health fair, stop by and see us. Each year, we attend more than 1,800 health fairs at federal agencies nationwide. Thank you for your membership.

Carrollton, Texas (GEHA High Option): What provisions of the Affordable Health Care law will affect GEHA benefits in 2013. How about after 2013?

Richard Miles: Several provisions within the Patient Protection and Affordable Care Act (PPACA) such as coverage for preventive health benefits, prohibition against denial for pre-existing conditions and limitations on premiums were already in place within the FEHB program. While, we don’t anticipate any major changes, we are concerned about the assessments to health insurance plans such as the "cadillac tax" that will become effective in 2017. These taxes on health plans may result in an increase of premiums.

As a non-profit association for federal employees, you can be assured, we will do everything possible to keep premiums as low as possible.

Washington, DC (GEHA Standard Option, Connection Dental Federal (FEDVIP) Standard): What info would a family member need other than an insurance card to receive treatment?

Richard Miles: In general, showing your GEHA ID card is all you need to do to receive treatment. Of course, you’ll want to understand what benefits are covered and what providers are in the GEHA network. There are also some services and prescriptions that require authorizations.

For information, see your GEHA health plan brochure or dental plan brochure.

Sebastian, Florida (GEHA Standard Option, Connection Dental Federal (FEDVIP) High): Do you expect any changes in benefits or premiums for a person who has Medicare in the next year or two? I just became eligible for Medicare and was looking forward to no copays. When I read the news, I am afraid that my coverage will change before I get to use it.

Richard Miles: Over the next couple years, we don’t expect major changes for our members, including those with Medicare. We’ll keep you informed of any health care legislation that could impact GEHA health care coverage.

Newton, Kansas (GEHA Standard Option, Connection Dental Federal (FEDVIP) Standard): If we have GEHA dental and no one in town is in the network, what do we do?

Richard Miles: Our dental plan allows you to use any provider. However, your out-of-pocket expense may be more when you use a provider that does not participate in our network. If you would like to nominate your provider we will be happy to contact them with information on how to become a Connection Dental provider. The decision to join is up to the dentist, but nominations from patients are sometimes often effective in the dentist’s decision to join the network.

Woodward, Oklahoma (GEHA Standard Option): I am a senior citizen on Medicare. Will GEHA pay for chiropractic care and/or physical therapy for back problems?

Richard Miles: Yes, the plan does offer benefits for chiropractic care and physical therapy.

Chiropractic services are limited to:

• 12 visits per person per calendar year for manipulation of the spine
• X-rays, used to detect and determine nerve interferences due to spinal subluxations or misalignments
• $25 per person per calendar year for chiropractic X-rays

Plantation, Florida: Does the dental plan cover implants?

Richard Miles: Connection Dental Federal covers implants to replace a single functioning natural tooth extracted or lost while you are covered under this plan. We limit payment on covered implants including any abutment and implant crown to a maximum of $400 per tooth, once every 5 calendar years, up to your annual maximum. This benefit does not apply to an implant supported partial denture (bridge), full denture or other implant procedures not specifically listed in the Dental Plan Brochure .

Tampa, Florida: I have a different health plan currently. What are the advantages of GEHA?

Richard Miles: GEHA health plans offer a great combination of benefits, rates, providers and service. There are online tools, including one at opm.gov and another at plansmartchoice.com, that can help you compare plans and make your decision. Thanks for considering GEHA.

Omaha, Nebraska (GEHA High Option): I am a spouse of a member and will turn 65 in January. Do I need to do anything to alert GEHA? Are claims automatically submitted to GEHA after Medicare pays as primary, or do I need to submit the claim? Just want to be ready. You have always provided great service. Thanks.

Richard Miles: Once you have received your Medicare card, you are welcome to contact our Customer Service Department to provide us with your effective date and Medicare number. You will also receive a letter from us about two months prior to your 65th birthday that will provide information regarding how we coordinate with Medicare. The letter will also include information about the electronic transfer of claims and the option to participate in this program.

Oceanside, California (GEHA High Option, Connection Dental Federal (FEDVIP) High): Hi. I would like to know if I can still carry my GEHA dental plan after I retire from the government?

Richard Miles: Yes, the FEDVIP program is available to federal employees that retire. Generally, there is no action that needs to be taken when you retire. Your current employing agency should notify BENEFEDS when you retire and their system should automatically update with the change in payroll to the annuity office. However, during the interim stage, some retirees enter a special pay situation and may need to pay premiums directly to BENEFEDS until the change to the annuity is adjudicated.

We recommend you call or contact BENEFEDS directly to advise them once you have a final retirement date. You can contact them by visiting www.BENEFEDS.com, by email to service@BENEFEDS.com or by phone at (877) 888-3337.

Muskogee, Oklahoma (Connection Dental Federal (FEDVIP) High): Is there a limit on visits or cleaning trips to the dentist per year?

Richard Miles: The dental plan limits exams and cleanings to two per calendar year.

Los Angeles, California (GEHA High Option): Do you guys have GEHA service in St. Croix, USVI?

Richard Miles: GEHA benefits are available to you when you live or travel outside the United States.

Covered providers outside the United States will be paid at the PPO level of benefits. Claims can be mailed or sent via email to overseas@geha.com.

Mesa, Arizona (GEHA High Option): When will Express Scripts merge with Medco? How will that work for GEHA members?

Richard Miles: Express Scripts and Medco have completed their merger. The combined company is in the process of changing the name on all its communications to "Express Scripts." Until the renaming process is complete, you’ll sometimes see the Medco name in pharmacy communications and on the web.

For now, GEHA members should continue to refill your prescriptions as you normally would by using your current prescription drug ID card, refill order forms, Medco website or the toll-free member services telephone number on your ID card.

Tacoma, Washington (GEHA Standard Option): I submit bills in Euros, which are converted to a dollar amount and paid in dollars. What exchange rate do you use? Date of service? I appear to lose money on the exchange.

Richard Miles: Benefits are reimbursed in US Dollars based on the exchange rate for the date of service.

Cinnaminson, New Jersey (GEHA Standard Option): I am retired and soon will be 65 and on Medicare. My wife works and has GEHA, and I’m on her policy. My question is which insurance is primary coverage? Will GEHA coverage act like a Medicare supplemental policy? Would you suggest that I also pay for Plan B coverage with Medicare and why? Thanks for your time.

Richard Miles: While she is still actively working, GEHA will be primary for you and Medicare is your secondary carrier. Once she retires, then Medicare would be primary and GEHA would be secondary. When you have both Medicare Part A and Part B, once your wife retires you will no longer have GEHA plan deductibles and coinsurance. Usually most medical expenses will be paid in full.

Making those decisions can be challenging; feel free to email us or call Customer Service at (800) 821-6136.

Duluth, Georgia (GEHA Standard Option): Why does my migraine headache medication require an annual "prior authorization" renewal? This is medicine I keep on hand 24/7 and probably will take for the balance of my life. Having to call in a reauthorization every year takes up my doctor’s time and causes a delay in getting my prescription refilled. Thank you.

Richard Miles: Because health status/factors can change in a year, prior-authorizations for migraine medications are allowed up to one year.

GEHA does participate in a renewal reminder program for prior-authorizations – a letter is sent about 45 days before the end date with instructions on how to initiate a renewal.

Several weeks before the end date, please contact Medco’s Coverage Review Department at (800)753-2851. This will minimize the potential for a delay in your medication.

Las Vegas, Nevada (GEHA Standard Option): How do I create an account for the Virtual Lifestyle Management services offered in connection with GEHA?

Richard Miles: The Virtual Lifestyle Management (VLM) program only has a few openings each year. Participants are taken on a first-come, first-served basis, and they need to meet specific qualifications, including:

• You need to have 30 pounds or more to lose; and
• You need to have a history of diabetes, heart disease or high cholesterol.

Columbus, Ohio (GEHA Standard Option): For preventative health, it would be advantageous for GEHA to pay for the YMCA. Please consider. Much thanks.

Richard Miles: When we last checked, YMCA did not offer an option for a nationwide contract.

All GEHA health plan options include our Connection Fitness program by GlobalFit at no additional cost to our members or their covered dependents. GlobalFit offers discounts on gym memberships at nearly 10,000 fitness clubs nationwide. For more information, click on www.globalfit.com/geha.

Cherry Hill, New Jersey (GEHA Standard Option): This is not really a question as much as it is a comment. I am so happy as a member of GEHA, I hope you can continue to provide such a wonderful plan at a reasonable cost. Will the new national health plan allow that to continue?

Richard Miles: Thank you so much for the glowing compliment. We appreciate our members. We continue to closely monitor any legislative issues that will impact your GEHA coverage and will let our members know of any changes that will affect them.

Kansas City, Missouri (GEHA Standard Option, Connection Dental Federal (FEDVIP) Standard): Will these questions and responses be available for reference to review when I have more time?

Richard Miles: Yes. We’ll leave this transcript up right here at this same webpage for several weeks.

Also, you can mark your calendar now for my next live chat, which will be October 23 at noon Eastern. We’ll know our 2013 rates and benefits by then, so I’m sure we’ll find something to talk about.

Parsonsburg, Maryland (GEHA Standard Option): I will be going on Medicare in January, and I was wondering how much deductible I will be paying for GEHA starting at that time? Will my premium stay the same?

Richard Miles: If you choose both Medicare Part A and Part B your GEHA deductibles will be waived so you pay zero in deductible. Also your coinsurance is also eliminated for your covered medical care. The premiums under the FEHB program remain the same when you have Medicare as your primary insurance.

East Orange, New Jersey (GEHA High Option, Connection Dental Plus): Would I be able to keep this plan after retirement if I’ve been a member less than 5 years? And, if so, what would be the cost?

Richard Miles: There is no 5-year rule to continue coverage in Connection Dental Plus when you retire. You remain eligible, and there is no difference in the premium after you retire.

Washington, DC, Maryland (GEHA High Option, Connection Dental Federal (FEDVIP) High): I have the High Option dental plan. Does this pay for all my dental work and is there a copay?

Richard Miles: Reimbursement percentages are based on the “Class” of services. For example: Class A is preventive such as cleaning, exam and X-rays, etc.. Class B is extractions and fillings, etc., Class C is for big ticket items such as crowns and root canals, etc., and Class D is for orthodontics. We will base the following percentage of reimbursement on either the billed charge or the plan allowance, whichever is less.

For "High" Option – Based on our Allowable:
• Class A – We pay 100%, you pay nothing
• Class B – We pay 80%, you pay 20%
• Class C – We pay 50%, you pay 50%
• Class D – We pay 50%, you pay 50%

Dublin, Georgia (Connection Dental Federal (FEDVIP) Standard): Are partial dentures covered under the plan I have?

Richard Miles: Yes, benefits are available for partial dentures, the plan covers the replacement of an existing partial that is at least 5 years old and unserviceable. Or a new partial when teeth are extracted while covered under the plan.

Muskogee, Oklahoma (GEHA High Option): How does the Lab Card work, and what facilities accept them?

Richard Miles: You may use this voluntary program for covered outpatient lab tests. You show your Lab Card Program identification card and tell your physician you would like to use the Lab Card benefit. If the physician draws the specimen, he/she can call (800) 646-7788 for pick up or you can go to an approved collection site and show your Lab Card along with the test requisition from your physician and have the specimen drawn there.

Please Note: You must show your Lab Card each time you obtain lab work whether in the physician’s office or collection site. To find an approved collection site near you, call (800) 646-7788 or visit labcard.com.

And the service is payable at 100%. This program is available for our Members who do not have Medicare Part B. If you have Part B as your primary insurance, Medicare usually pays these lab expenses in full.

Columbus, Ohio (GEHA Standard Option): For 2013, how much will my Standard Option be?

Richard Miles: I’m sorry, but it’s too early to share rates for next year. OPM works with FEHB health plans, including GEHA, to finalize rates and benefits through the end of the summer. OPM will announce rates in September and we’ll post to our website at that time. If you sign up for the GEHA First to Know alert, we will send you either an email or a text message as soon as the 2013 rates are available.

Brunswick, Georgia (GEHA High Option, Connection Dental Federal (FEDVIP) High): Why are we not able to put money on our card? There are times when I have the money to do this and other times when I would need it to go to see a doctor.

Richard Miles: Since you are describing an account card, you may be a member of the Health Savings Advantage High Deductible Health Plan with a health savings account. You are able to add money to your health savings account to pay for your out-of-pocket medical expenses. Please see our website for more information. If you are not an HDHP member, we’re not sure what type of card you are referring to.

Knoxville, Tennessee (GEHA Standard Option, Connection Dental Federal (FEDVIP) High): Do you know when it is a good time to switch from the Standard Plan to the High option, i.e., is there a calculation for when it is best to take the High Option? Thanks.

Richard Miles: The most significant difference between GEHA’s High and Standard plans is the coverage for brand-name prescription drugs. In general, if you take only generic drugs, the Standard Option plan provides great benefits at an affordable premium. If you take more expensive brand-name drugs on a regular basis, High Option might be a better fit for your needs. Both plans include the same provider network, low copays for office visits, and free preventive care and exams in-network.

Cypress, Texas (GEHA High Option): Are there any major changes coming in 2013?

Richard Miles: GEHA is not able to release rates and benefits for 2013 until OPM announces rates for all plans. That usually occurs in September.

Washington, DC (Connection Dental Federal (FEDVIP) Standard): Does the dental plan work for extraction of wisdom teeth?

Richard Miles: Extraction are covered under Class B services. Services are reimbursed at 55% of our allowable under the Connection Dental Federal plan, Standard Option. You may also have coverage for the removal of impacted wisdom teeth under your medical plan.

Scottsdale, Arizona: We would like to become patients at the Mayo Clinic in Arizona. I believe they ONLY take GEHA from all the federal plans. If so, do you know of any change to their participation for the 2013 plan year?

Richard Miles: We are happy that such a renowned clinic is in our network and their participation with us will continue into 2013.

Glasgow, Missouri: Do you have a chart that compares your health plan to other FEHB plans? I have not been very happy with my carrier for a long time. I also have Medicare.

Richard Miles: The OPM website, www.opm.gov/insure, has a comparison tool to help you look at plans side-by-side. It currently shows 2012 benefits but will be updated in November to show 2013 benefits. Open Season this year is November 12 through December 10.

For a comparison of GEHA plans, our plan brochure has a helpful chart on page 98. Feel free to call our Customer Service number 800-821-6136 for any detailed questions you may have. We will be happy to help you.

Ironically, I was just in Glasgow, Missouri, last week. My 90-year-old mother was born and raised on a farm just outside of Glasgow. Great town, great people.

Colorado Springs, Colorado (Connection Dental Federal (FEDVIP) High): I learned that, unlike our health care plan, that my daughter’s dental coverage ends at age 22. I thought they were now covered until age 26?

Richard Miles: The changes concerning coverage of dependent children up to age 26 as a result of the Affordable Care Act for 2011 did not affect the Federal Employees Dental and Vision Insurance Program (FEDVIP). Health care reform does not extend coverage for children until age 26 or provide coverage for married dependent children under the FEDVIP program.

In the FEDVIP program, eligible children include your unmarried dependent children under age 22. This includes legally adopted children and recognized natural children who meet certain dependency requirements. This also includes stepchildren and foster children who live with you in a regular parent-child relationship. Under certain circumstances, you may also continue coverage for a disabled child 22 years of age or older who is incapable of self-support.

Portland, Oregon (GEHA Standard Option, Connection Dental Plus): I will be living away from my home state for over a month. I need some dental work done. Are my benefits paid for the state I am living in for the month or so, or my home state?

Richard Miles: You are covered anywhere in the United States or even out of the country. Your premiums are based on your primary residence, while your allowable amount will be based on the ZIP code of the provider performing services.

Columbus, Mississippi (GEHA High Option): I am retired. How do I sign up for the dental plan?

Richard Miles: To join Connection Dental Federal, our FEDVIP plan, you would need to enroll via the BENEFEDS system during open season. BENEFEDS has been contracted to administer the FEDVIP program. They are responsible for enrollment, eligibility and premiums.

You may contact them by visiting their website at www.BENEFEDS.com, e-mailing them at service@BENEFEDS.com or calling 1(877) 888-3337.

To enroll in CONNECTION Dental Plus, click enroll online.

Newark, New Jersey (GEHA High Option, Connection Dental Plus): What’s the biggest difference in Dental Connection Plus and Connection Dental Federal?

Richard Miles: Connection Dental Plus is offered by GEHA to federal employees and annuitants. Enrollment is open year round. Premiums are paid directly to GEHA for this coverage by members; there is no payroll deduction option available. This plan has only one plan option, which includes deductibles and waiting periods for major treatment. The cost for this plan is lower and it covers dependent children up to age 25. Information can be found by visiting Connection Dental Plus.

Connection Dental Federal is part of the Federal Employees Dental and Vision Insurance Program (FEDVIP) offered by OPM to federal employees. Premiums for this plan are made via payroll deduction and can be made on a pre-tax basis for active employees. This plan has two plan options, High and Standard. Enrollment is only available during open season except for new federal employees or current employees that have a qualifying life event. You must enroll via the BENEFEDS system at www.BENEFEDS.com. Detailed information can be found at gehadental.com.

Herndon, Virginia (GEHA High Option): Why do you only approve 3 sessions at a time for Physical Therapy, with 1 of them needing to be a reevaluation?

Richard Miles: Physical Therapy services are covered based on each individual’s condition, plan of treatment and progress toward recovery. Your progress toward recovery would be measured by periodic evaluations by your therapist. Based on that evaluation your therapist will develop an updated plan of treatment that will be reviewed to determine the number of sessions approved before the next evaluation.

Charleston, South Carolina (GEHA High Option): I am piggybacking on the question from Mexia, Texas, regarding a broader option for self, self plus family, with the desire for self plus one as an additional category. Richard Miles stated FEHB law does not currently allow for a Self plus One option under the FEHB health plans. Help me understand the difference with FEHB and FEDVIP, which allows for this other category? Also, who do we have to write to change this?

Richard Miles: When Congress passed authorization for the FEDVIP program, they included three options, self only, self plus one dependent and self and family. This was not enacted for the FEHB program.

El Paso, Texas (GEHA Standard Option, Connection Dental Federal(FEDVIP) High): I have Medicare A&B and GEHA Standard. Are hepatitis shots covered?

Richard Miles: Yes hepatitis A, B and C injections are a covered expense under your GEHA medical plan. You may want to contact Medicare regarding their benefit for this service.

St. Clair, Missouri (GEHA High Option): When my husband retires, will he still be on this plan, and can I be added to his plan after I retire from teaching?

Richard Miles: GEHA is a proud provider of health plans to federal retirees/annuitants. Yes, existing federal employees who have been continuously enrolled for five years or more may continue to qualify for health insurance coverage under the FEHB program. Here is an excellent resource to help answer your questions regarding retirement: GEHA’s Retirement Planning Guide .

Jeffersonville, Indiana: Why it is GEHA does not participate in the Medicare Part B Pilot Program?

Richard Miles: GEHA did participate in the Medicare Part B pilot program in 2011. Very few of our members chose to join, so we are not again participating in 2012.

Memphis, Tennessee (GEHA Standard Option): I have a disabled adult daughter who is currently covered under my husband’s health insurance. Since he will be retiring soon, can I add her to my GEHA insurance?

Richard Miles: There are provisions under FEHB that allow coverage for an overage dependent. If you are currently enrolled in a self and family plan, please contact your personnel or retirement office. They will determine if your daughter’s disability qualifies for coverage.

Topeka, Kansas (Connection Dental Federal (FEDVIP) High): On your health plans, what is covered on chiropractic treatments? How many visits a year? Cost of copays?

Richard Miles: The plan does offer benefits for chiropractic care.

Chiropractic services are limited to:

• 12 visits per person per calendar year for manipulation of the spine. The benefit for these 12 visits is $20 per visit.
• chiropratic X-rays, used to detect and determine nerve interferences due to spinal subluxations or misalignments. We cover $25 per person per calendar year for chiropractic X-rays.

Mission, Texas (GEHA High Option, Connection Dental Federal (FEDVIP) High): My daughter will turn 26 on December 12. Will she be dropped from my GEHA plan then, or will it be December 31?

Richard Miles: As long as you are still enrolled in family coverage at the time your dependent turns 26, they will be eligible for a 31 day grace period following their 26th birthday.

Northport, New York (Connection Dental Federal (FEDVIP) High): Does the annual maximum of $5,000 apply to what the dentist submits or to what GEHA pays out? Also, how can I find out what those two dollar amounts are?

Richard Miles: The annual maximum applies to the amount paid by GEHA. To find how much the plan has paid out for you this year, you can call our Customer Service at 877-434-2336.

Tamarac, Florida (GEHA Standard Option): Does my plan cover an endoscopy procedure, and do I need a referral?

Richard Miles: Benefits are available for endoscopies there are no referrals necessary under your GEHA plan.

Austin, Texas (GEHA Standard Option): I am with another FEHB provider. If I change to GEHA during the open enrollment, how can I preview the PPO list before I change?

Richard Miles: You can use our online provider search to see if your doctor is in our network.

Thanks for giving GEHA a look.

Carmel, California (GEHA High Option): If I disenroll in GEHA to enroll in TriCare, may I re-enroll in GEHA if TriCare does not prove to be suitable?

Richard Miles: These eligibility decisions are determined by the personnel or retirement offices. There are some situations that allow you to suspend your FEHB coverage for TriCare.

Bedford, Virginia (GEHA Standard Option): Hi. I was recently diagnosed with renal failure and wanted to inquire about transplant and which GEHA plan -- High Option or Standard Option -- is best to go with when I am able to change enrollment and what would or might be covered. Thanks.

Richard Miles: Kidney transplants are paid under the GEHA medical benefit and not the transplant benefit. I have included the difference in the out of pocket expenses for you. To help you better understand your out of pocket costs, find out if your provider and the hospital are in the GEHA network. Additionally, learn more about the types of medications you will need before, during and after the transplant. You Medication co-pays are less on the high option. It would be important for you to talk with your physician to determine the types of services.

Here are highlights from the GEHA health plan brochure:

A calendar year deductible is a fixed dollar amount that you pay for medical care before GEHA pays benefits. Copayments and coinsurance amounts do not count toward any deductible.

If you have GEHA Standard Option or High Option plan, you pay a $350 deductible for Self Only coverage (or $700 for Self and Family coverage for some types of medical care). After the $350 deductible is satisfied for an individual, covered services are payable for that individual. Under a Self and Family enrollment, all family members’ individual deductibles are considered to be satisfied when the family members’ deductibles are combined and reach $700.

You pay the deductible (the deductible applies) for these types of medical care: surgery, chiropractic care, hospitalization, emergency room visits.

For other care, including physician office visits, preventive care, accidental injury and prescriptions, you do not have to meet the deductible (the deductible does not apply) before GEHA pays benefits.

A per-in-hospital admission deductible is paid by members in the High Option plan. The amount is $100 in-network or $300 out-of-network.

The catastrophic limit is the maximum amount in coinsurance and deductibles you pay for all family members before GEHA begins paying for 100% of your care. In a single calendar year, your out-of-pocket expenses for coinsurance and deductibles are capped at this amount.

The catastrophic limit varies by plan option.

Plan Option	Enrollment Code	In-network	Out-of-network
Standard Option	314 - Self Only	$5,000	$7,000
	315 - Self and Family	$5,000	$7,000
High Option	311 - Self Only	$4,000	$6,000
	312 - Self and Family	$4,000	$6,000
HDHP Option	341 - Self Only	$5,000	$5,000
	342 - Self and Family	$10,000	$10,000

Medications will also be a factor.

Cleveland, Ohio (GEHA High Option): I am 64 years old. Do I have to pay a deductible for A1C blood test? I thought all blood tests were covered for free.

Richard Miles: You can avoid deductibles and coinsurance on your A1C test by using your Lab Card. Be sure to show your Lab Card to your physician’s office and let them know you would like to use your Lab Card benefit. There are also collection sites where you can go and obtain the lab tests with a physician’s order. To learn more you can go to our Lab Card webpage.

Long Beach, California: If a shingles shot is given by a pharmacy instead of at a physician’s office, will GEHA reimburse member for the entire cost?

Richard Miles: Participating pharmacies are able to submit the shingles vaccine claim electronically, leaving you with a zero copay and no claim to file. If you pay the full price, and submit a direct claim, reimbursement will be based on GEHA’s costs had you used a participating pharmacy.

Arlington, Texas (GEHA Standard Option): My husband, who is our policy holder, is qualified for Medicare in October 2012. I do not qualify until May 2013. How do I continue my coverage with GEHA?

Richard Miles: As long as your husband continues to be enrolled in family coverage, GEHA will continue to be your primary carrier until you reach age 65.

Bel Air, Maryland (GEHA Standard Option): I am 9 months pregnant. When can I enroll in a Family Plan? And who does that cover? Also, are all hospital expenses covered for my labor and delivery or does that depend on the hospital?

Richard Miles: Congratulations! If you have a Self Only enrollment, you may change to a Self and Family enrollment when you give birth. You may change your enrollment 31 days before to 60 days after that event. The Self and Family enrollment begins on the first day of the pay period in which the child is born or becomes an eligible family member. If you use an in-Network Hospital benefits are payable at 100% of the plan allowable for labor and delivery.

Saint Petersburg, Florida (GEHA Standard Option): I’m often told (for instance when scheduling a mammogram)NOT to say that I have GEHA, but rather to say I have "United Health Network." Why is that?

Richard Miles: Some providers do not recognize our name as the health insurance company, but they may recognize the name of the network of providers in your local area. GEHA leases the network of providers for most states.

Raleigh, North Carolina (GEHA High Option, Connection Dental Federal (FEDVIP) High): If your coverage under FEDVIP is Self and Family, and your child turns 22 -- does it automatically convert to Self plus One?

Richard Miles: We would recommend you contact BENEFEDS to be sure your option is updated. BENEFEDS has been contracted to administer the FEDVIP program enrollment and premium process. You should contact them anytime you have a change in your enrollment option by visiting their website at www.BENEFEDS.com, e-mailing them at service@BENEFEDS.com or calling (877) 888-3337.

Ramstein AB (GEHA HDHP Option): I’m not a dental member, but I would like to know if my HDHP covers any portion of preventative dental coverage and also if I am allowed to use my health savings account for preventative dental?

Richard Miles: Your HDHP covers 50% of the plan allowance for diagnostic/preventive dental services twice per year. But, yes, you may use funds in your HSA for any qualified medical expense, including preventive dental services.

Council Bluffs, Iowa: My grandson is now living with us. We have legal power of attorney for him. He is now 17 and in high school as a senior. Can we put him on our family plan? If so, for how long?

Richard Miles: Eligibility for grandchildren is determined by the personnel or retirement offices. If they decide your grandson is eligible, he can be covered under FEHB until age 26.

Manchester, New Hampshire (Connection Dental Federal (FEDVIP) High): If I join the GEHA Standard Option health plan this Open Season, will GEHA cover a procedure that Medicare does not accept? Medicare A and B are my primary health provider. Thank you.

Richard Miles: It will depend whether that procedure is covered. Please contact us at (800) 821-6136, and we will provide you with your answer.

Urbana, Illinois (GEHA Standard Option): How much do I pay for lab services if there is no approved lab card collection site nearby?

Richard Miles: If you use a Lab service other than the Lab Card, you will pay 10% of the Plan allowance for in-network/PPO provided tests. For any non-PPO lab services, 25% of the plan allowance and any difference between our allowance and the billed amount will be your responsibility.

Our chat is complete. Thanks for joining us today. If I did not answer your question during the chat, we will follow up by email if you provided us a valid email address.

I want to thank all of our current GEHA members. Almost half of our health plan members have been with GEHA for 10 years or more, and we appreciate that loyalty. If you’re not currently with GEHA, I hope you’ll take a closer look at our plans to see if we’re a good fit for you and your family.

I also want to thank all of the staff members at GEHA who have assisted me with today’s chat.

Best wishes to you all.

Richard Miles
GEHA President

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Better choices
Here are some GEHA wellness programs that help our members make better choices for healthy living:

GEHA Health Rewards	GEHA health members and their spouses participating in this fun GEHA Health Rewards program can earn rewards for healthy activities.
Connection Fitness	Through our Connection Fitness program by GlobalFit, GEHA members get discounts on gym memberships, at-home workout equipment and Nutrisystem® meals.
Connection Vision	Get annual eye exam for just $5 and discounts on eyeglasses and contacts, all at no additional premium.

For information about our FEHB health plans, go to www.geha.com or call us at (800) 262-GEHA.

For information about our FEDVIP dental plan, GEHA Connection Dental Federal, go to www.gehadental.com or call (877) 434-2336.

If you have comments about this online chat format, or if you would like to offer suggestions for future chats, please send an email to editor@geha.com.