Low premium, low copays, the best value for healthy people.
Affordable premiums and low copays make Standard Option the top choice of new GEHA members.
Here are the 2016 highlights:
One of the lowest premiums in the FEHB program.
Low $15 copays for primary care visits.
Low $10 copay for a 30-day supply of generic prescription drugs. If you take brand-name drugs, you'll pay 50% of the cost.
Vision coverage for no additional premium with discounts on glasses and contact lenses.*
Lab Card® program pays 100% of covered lab services.
24-hour health advice line.
No referral needed to see a specialist. (However, you might need prior plan approval for certain services.)
Nationwide network with a million provider locations – yours is probably one of them.
Freedom to choose a provider outside the network and still receive benefits.
Preventive dental care covered at 50% of plan allowance, without a deductible.
Special savings on hearing and dental care at no additional cost.
Your health coverage goes wherever you travel, even overseas.
Standard Option Premium Rates for 2016
||Postal Premium Biweekly
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.
Standard Option Prescription Benefits
In 2016, the Standard Option plan will use a Preferred Drug List that divides prescription drugs into three tiers: generic, preferred and non-preferred medications. When an approved generic equivalent is available, that is the drug you will receive, unless you or your physician specifies the prescription must be dispensed as written. When an approved generic equivalent is not available, you will pay the preferred or non-preferred applicable plan coinsurance. If an approved generic equivalent is available, but you or your physician specifies that the prescription must be dispensed as written with the brand medication, you will pay the generic copay plus the difference between the cost of the generic drug and the brand drug unless your physician has provided clinical necessity for the drug. When brand-name drugs are approved over generic, your coinsurance will be the applicable brand coinsurance.
Your physician may request the brand-name drug be approved through a medical necessity review. If your brand-name drug is approved as medically necessary, your coinsurance will be the applicable brand-name coinsurance.
- 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.
- Preferred drugs are FDA-approved prescription medications included on the Preferred Drug List developed by CVS/caremark. This list is developed by an independent panel of doctors and pharmacists who ensure that the medications are clinically appropriate and cost-effective.
- Non-Preferred drugs are FDA-approved prescription medications that are covered by GEHA but are not included on the CVS/caremark Preferred Drug List. Most commonly utilized medications have generic or preferred medications available.
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, including details on specialty drugs that are injected or infused, refer to the GEHA Plan Brochure.
Standard Option Prescription Benefits for 2016
||You Pay – In-Network
||You Pay – Out-of-Network
|Retail pharmacy – 30-day supply
||$10, plus difference between plan allowance and cost of drug
|Preferred brand medication
||50%, up to $200 max¤
||50%, up to $200 max, plus difference between plan allowance and cost of drug**¤
|Non-preferred brand medication
||50%, up to $300 max¤
||50%, up to $300 max, plus difference between plan allowance and cost of drug**¤
|Mail-order pharmacy – 90-day supply
Preferred brand medication
|50%, up to $500 max¤
Non-preferred brand medication
|50%, up to $600 max¤
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 ♦ High Option ♦ Medicare and GEHA
*Connection Vision benefits are not part of the FEHB contract or premium.
**Retail fills eligible for a greater than a 30-day supply will be subject to the 50% coinsurance up to the maximum of $500 for preferred or $600 for non-preferred.
¤If you choose a brand medication when a generic is available, you will be charged the generic copay plus the difference in cost between the brand and the generic.