High Option

GEHA High Option offers a comprehensive plan with low copayments and low coinsurance on both medical care and prescription drugs. Here are the 2014 highlights:

  • Within the provider network, 100% coverage for hospital room
    and board and 90% for other charges after per admission deductible.
  • Nationwide network with more than 1 million health care
    providers – yours is probably one of them.
  • Lab Card® program pays 100% of covered lab services.
  • 24-hour health advice line.
  • Vision coverage for no additional premium, plus discounts on glasses and contact lenses.*
  • Freedom to choose a provider outside the network and still
    receive benefits.
  • Prescription coverage with no annual deductible and $10 copay
    for a 30-day supply of generic prescription drugs.
  • No referral needed to see a specialist.
  • Special savings on hearing and dental care at no additional cost.
  • Your health coverage goes wherever you travel, even overseas.
High Option Premium Rates for 2014
Non-Postal Premium Postal Premium Biweekly
Code Biweekly Monthly (Retirees) Category 1 Category 2
Self Only 311 $93.77 $203.17 $71.91 $85.57
Self + Family 312 $222.97 $483.10 $174.35 $204.74

Click to find out how to enroll in any GEHA health plan. Our free How to Choose a Health Plan can help you select the federal health plan that's right for you and your family.

High Option Prescription Benefits
Under the High Option plan, we divide prescription drugs into three categories or tiers: generic, single-source brand-name and multi-source brand-name.

When an approved generic equivalent is available, that is the drug you will receive unless you or your physician specifies that the prescription must be filled as written. When an approved generic is not available, you will pay the single-source brand-name copayment. If an approved generic equivalent is available, but you or your physician specifies that the prescription must be filled as written, you will pay the multi-source brand-name copayment.

  • Generic drugs are chemically and therapeutically equivalent to the corresponding brand-name drug, but are available at a lower price. Information About Generics can help you learn more about the safety and effectiveness of generic drugs.
  • Single-source brand-name drugs are available from only one manufacturer and are patent protected. No generic equivalent is available.
  • Multi-source brand-name drugs are available from more than one manufacturer and have at least one generic equivalent alternative available.

The chart below shows a summary of your cost for prescription drugs with GEHA High Option. Health plan members with Medicare Parts A & B primary pay a reduced copayment for prescription drugs. For complete benefit information, including details on specialty drugs that are injected or infused, refer to the GEHA Plan Brochure.

High Option Prescription Benefits for 2014
Prescriptions You Pay – In-Network You Pay – Out-of-Network
Retail pharmacy – 30-day supply
Generic $10 copay** $10**, plus difference between plan allowance and cost of drug
Single-source brand
(generic not available)
25%, up to $150 max** 25% (up to $150 max)**, plus difference between plan allowance and cost of drug
Multi-source brand
(generic is available)
$10, plus difference in cost of brand-name drug over generic equivalent**
$10, plus difference in cost of brand-name drug over generic equivalent**, plus difference between plan allowance and cost of drug
Mail-order pharmacy – 90-day supply
Generic $20 copay n/a
Single-source brand
(generic not available)
25% (up to $350 max) n/a
Multi-source brand
(generic is available)
$20, plus additional cost of brand-name drug over generic equivalent n/a

Other GEHA Health Plans
To learn more about other GEHA health plan benefits, click on the plan you'd like to read about:

Health Savings Advantage HDHP  ♦  Standard Option  ♦  Medicare and GEHA

* Connection Vision benefits are not part of the FEHB contract or premium.

**Costs for initial fill and first refill. For subsequent refills at retail, you pay the greater of 50% or the amount described above. For long-term prescriptions, please use Mail Order.