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Standard Option Benefits
The chart below shows a summary of your cost for prescription drugs with GEHA
Standard Option. Health plan members with Medicare Part A & B primary pay
the same copayment for prescription drugs. For complete benefit information,
refer to the GEHA Plan Brochure.
| 2012 PLAN YEAR |
Standard Option |
| Prescriptions |
You Pay - In-Network |
You Pay - Out-of-Network |
| Mail order Generic |
Nothing (most new prescriptions), then $15 copay |
N/A |
| (90-day supply) Brand name(all) |
50%, up to $500 max |
N/A |
| Retail pharmacy Generic |
$5 copay |
$5, plus difference between plan allowance and cost of drug |
| (30-day supply) Brand name(all) |
50%, up to $200 max |
50%, up to $200 max, plus difference between plan allowance and cost of drug* |
| For specialty drugs which are injected or infused, see the GEHA plan brochure. |
| * Retail fills eligible for a greater than a 30-day supply will be subject to the 50% coinsurance up to the maximum of $500. |
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