New member FAQ
I came from an HMO plan. How is GEHA different?
When do I get my GEHA ID card?
How do I use my GEHA ID card?
What is my deductible and when do I pay it?
What's the difference between a coinsurance and a copayment?
What's the GEHA catastrophic limit?
How do I find a GEHA doctor or hospital?
How do I get lab tests covered at 100%?
How can I check my GEHA claims?
How do I get plan materials, including the benefit brochure?

GEHA is a Preferred Provider Organization (PPO) plan. With this plan, you pay a deductible and coinsurance or copayment for some care. We have a network of doctors and hospitals contracted with us to provide discounts for medical services. You have freedom of choice; you can get care at a doctor outside the GEHA provider network, but you will pay a higher amount for care outside the GEHA provider network.

If you enrolled at Open Season, your coverage is effective in January and you'll receive your ID card after we receive confirmation of your plan change from your payroll office.

You can get a temporary member ID card by logging into Member Web Services. A temporary GEHA member ID card will show only the name of the GEHA member but may be used by a covered dependent. This temporary member ID card expires 30 days after printing.

If you need a new permanent ID card, please call Customer Service at (800) 821-6136 or email cs.geha@geha.com.

You get three ID cards when you join the GEHA health plan. Each card is issued with the name of the member eligible for the health plan through FEHB. If you are the member, your spouse's card will have your name on it.

1. Your health plan ID card.
   Use this card for:
   • Medical care at a doctor or hospital
   • Prescriptions at a Medco network pharmacy
   
   
   
   
   Important note: GEHA partners with a number of medical networks across the country. If you call your provider to confirm that he or she is in the GEHA network, please have your GEHA ID card handy. You'll want to ask the provider if he/she participates in the network indicated on your card. Network logos are placed on the front of the card. The back of the ID card tells the provider where to submit claims.



2. Your Lab Card ID card (Not Applicable if Medicare Part B is Primary)
   Use this card for:
   • Lab services covered at 100%. You must present your card and confirm the lab is part of the Lab Card network.




3. Your Connection Programs ID card.
   Use this card for non-FEHB services:
   • CONNECTION Vision
   • CONNECTION Hearing
   • CONNECTION Dental

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.

Coinsurance — a percentage of medical costs that you pay.

If you have the GEHA Standard Option plan, you pay 15% of the plan allowance for hospital charges and GEHA pays 85%, after you pay the calendar year deductible. If you have High Option, the split is 10%/90%. You pay your deductible, then 10% of the allowable charge.

Copayment — a fixed dollar amount that you pay for a covered service.

For physician office visits and generic drugs, you pay a set dollar amount rather than a percentage of the cost. Low copays for these services help make your routine care more affordable. For example, with our Standard Option and High Option plans, you pay a low $5 copay for a 30-day supply of a generic drug.

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

To find a doctor, hospital, dentist or pharmacy in the GEHA network, click on our online Provider Search. The online tool allows you to print a personalized directory.

Please remember that if you have Medicare A&B primary, you can choose any provider for your care. Medicare and GEHA together will pay 100% of your costs for doctor visits, surgical care, lab services and hospitalization, in- or out-of-network for covered services.

Important note: GEHA partners with a number of medical networks across the country. If you call your provider to confirm that he or she is in the GEHA network, please have your GEHA ID card handy. You'll want to ask the provider if he/she participates in the network indicated on your card. Network logos are placed on the front of the card. The back of the ID card tells the provider where to submit claims.

When you use your Lab Card, GEHA pays outpatient laboratory testing at 100%. With Lab Card, you pay nothing - no deductible, no copay and no coinsurance.

Each non-Medicare Standard Option and High Option member* will receive a Lab Card following enrollment in the health plan. You will need to show your card each time you receive lab services. Lab Card is an optional program. Members who choose not to use Lab Card will continue to pay deductibles and coinsurance/copayments for covered outpatient lab work.

To find a listing of Lab Card provider locations in your area:

• Go to www.LabCard.com or
• Call (800) 646-7788

Please note that the lab network is different than the GEHA provider network. If your doctor draws a specimen in his/her office, Lab Card must be called to pick up the specimen (toll-free number) in order to get 100% coverage. For more information, see our Lab Card webpage.

*GEHA Standard Option and High Option members with Medicare are not eligible for the Lab Card program and will not receive Lab Cards. The Medicare program covers outpatient laboratory testing.

For quick access, you'll want to open an online Member Web Account.

GEHA web accounts give authorized users online access to GEHA claims and eligibility information. When you make a claims inquiry, you will see a list of your plan claims processed by GEHA. Click on an individual claim to view the online version of a GEHA explanation of benefits (EOB) form. The claim detail includes the date of service and the dollar amounts for charges and benefits. When you make an eligibility inquiry, you will see a list of the GEHA health and dental plans that provide benefits to the patient. Click on the plan description to get a summary of benefits and check amounts applied toward calendar-year deductibles and out-of-pocket maximums.

Click Forms & Brochures to download materials or request materials by mail.