Elevate Plus
Welcome to your medical plan page
What’s new in 2023
- Elevate Plus will have a $150 deductible for Self Only, and a $300 deductible for Self Plus One or Self and Family. Deductible will apply to certain inpatient and outpatient benefits with a 15% coinsurance.
- Primary care provider copay is increasing from $25 to $30
- Specialist visit copay is increasing from $40 to $45
- Preventive colorectal cancer screening now covered at age 45 instead of 50
- Prediabetes screening covered at age 35 instead of 40. Unlimited diabetes education provided.
- No plan perk offered in 2023
Elevate Plus coverage
Yearly deductible
| Yearly deductible in-network1,2 | You pay |
|---|---|
| Self Only | $150 |
| Self Plus One or Self and Family | $300 |
Out-of-pocket maximum
| Out-of-pocket maximum in-network1,2 | You pay |
|---|---|
| Self Only | $6,000 |
| Self Plus One or Self and Family | $12,000 |
1 In-network providers agree to limit what they will charge you. You pay a fixed dollar amount or a percentage of the provider’s negotiated amount.
2 The out-of-pocket maximum is the maximum amount of coinsurance, copays and deductibles you pay for all family members before GEHA begins paying for 100% of covered services. This is a combined maximum for both medical care and prescriptions.
Your medical benefits
| Medical benefits in-network1,2 | You pay |
|---|---|
|
$0 |
| $10 | |
|
$30 |
|
$45 |
| $50 | |
|
$504 |
|
15%5 |
1 In-network providers agree to limit what they will charge you. You pay a fixed dollar amount or a percentage of the provider’s negotiated amount.
2 This plan has no out-of-network coverage.
3 These benefits are neither offered nor guaranteed under contract with the FEHB Program, but are made available to all Enrollees who become members of a GEHA medical plan and their eligible family members.
4 You pay $175 ($100 professional fee, $75 facility fee) for advanced outpatient High Tech Imaging such as MRI, CT, PET, etc. Refer to GEHA’s 2023 plan brochure RI 71-018 (Elevate and Elevate Plus).
5 Calendar year deductible applies.
Your prescription benefits
| Prescription benefits in-network1,2,3 | You pay |
|---|---|
| 30-day retail generic | $10 |
| 30-day retail preferred brand-name | $80 4 |
| 30-day retail non-preferred brand-name | 50%4 |
| 90-day mail service generic | $20 |
| 90-day mail service preferred brand-name | $2004 |
| 90-day mail service non-preferred brand-name | 50%4 |
| 30-day specialty CVS exclusive generic and preferred brand-name | 40%($500 max4) |
| 30-day specialty CVS exclusive non-preferred brand-name | 50%4 |
1 In-network providers agree to limit what they will charge you. You pay a fixed dollar amount or a percentage of the provider’s negotiated amount.
2 Refer to geha.com/Prescriptions for formulary and specialty coverage for specific medications.
3 This plan has no out-of-network pharmacy coverage.
4 If you choose a brand-name medication when a generic is available, you will be charged the generic copay plus the difference in cost between the brand-name and the generic.
Medicare + Elevate Plus coverage
Yearly deductible
| Yearly deductible in-network1,2 | You pay |
|---|---|
| Self Only | $0 |
| Self Plus One or Self and Family | $0 |
Out-of-pocket maximum
| Out-of-pocket maximum in-network1,2 | You pay |
|---|---|
| Self Only | $6,000 |
| Self Plus One or Self and Family | $12,000 |
1 In-network providers agree to limit what they will charge you. You pay a fixed dollar amount or a percentage of the provider’s negotiated amount.
2The out-of-pocket maximum is the maximum amount of coinsurance, copays and deductibles you pay for all family members before GEHA begins paying for 100% of covered services. This is a combined maximum for both medical care and prescriptions.
Elevate Plus and Medicare medical benefits
| Medical benefits with Medicare A & B primary in-network1,2 | You pay |
|---|---|
|
$0 |
1 In-network providers agree to limit what they will charge you. You pay a fixed dollar amount or a percentage of the provider’s negotiated amount.
2 With Medicare A & B primary, go to any provider that accepts Medicare assignment.
3 These benefits are neither offered nor guaranteed under contract with the FEHB Program, but are made available to all Enrollees who become members of a GEHA medical plan and their eligible family members.
Your prescription benefits
| Prescription benefits in-network1,2,3 | You pay |
|---|---|
| 30-day retail generic | $10 |
| 30-day retail preferred brand-name | $804 |
| 30-day retail non-preferred brand-name | 50%4 |
| 90-day mail service generic | $20 |
| 90-day mail service preferred brand-name | $2004 |
| 90-day mail service non-preferred brand-name | 50%4 |
| 30-day specialty CVS exclusive generic and preferred brand-name | 40%($500 max4) |
| 30-day specialty CVS exclusive non-preferred brand-name | 50%4 |
1 In-network providers agree to limit what they will charge you. You pay a fixed dollar amount or a percentage of the provider’s negotiated amount.
2 Refer to geha.com/Prescriptions for formulary and specialty coverage for specific medications.
3 This plan has no out-of-network pharmacy coverage.
4 If you choose a brand-name medication when a generic is available, you will be charged the generic copay plus the difference in cost between the brand-name and the generic.
Included benefits & savings
Pharmacy benefits
Retail pharmacy
Mail service pharmacy
Estimate medication costs
CVS ExtraCare Health Benefit
Your exclusive discounts
Vision discounts1
Medical alert discount1
Hearing aid discount1
Electric toothbrush discount1,2
Teeth whitening discount1
1 These benefits are neither offered nor guaranteed under contract with the FEHB Program, but are made available to all enrollees who become members of a GEHA medical plan and their eligible family members.
2 This benefit is per person, every 36 months for adults. TruHearing discount pricing can be combined with the hearing aid benefit for even greater savings.
3 The cariPRO® premium toothbrush removes seven times more plaque than a regular brush, is completely waterproof and comes with a two-year manufacturer’s warranty. Replacement brush heads with high-quality DuPont™ bristles are also available at this exclusive, member-only price.
Find care
Choose the right care
For helpful instructions on how to find in-network primary, specialty and urgent care using GEHA’s Find Care tool, watch this video.
Other care resources
Maternity resources
Rally Health portal
Wellness Pays rewards
How it works
Your Wellness Pays prepaid debit card
Redeeming your rewards
Resources
Plan documents
| Topic |
Resource |
|---|---|
| 2023 Elevate Plus Plan Brochure | Download (PDF) |
| 2023 Elevate Plus Member Guide | Browse the e-book |
| 2023 Medical Benefits Guide | Browse the e-book |
| 2023 Summary of Benefits Coverage | Download (PDF) |
Helpful resources
| Topic |
Resource |
|---|---|
| Create your GEHA web account | geha.com/Register |
| Complete your Enrollment Questionnaire | geha.com/EQ |
| Talk with GEHA Customer Care | geha.com/Contact |
| Use the Find Care Tool | geha.com/Find-Care |
| View the frequently asked questions | geha.com/FAQs |
| Access the GEHA App | Visit the App Store or Google Play |
This is a brief description of the features of the Elevate Plus plan. Please read the Plan's Federal brochure (RI 71-018). All benefits are subject to the definitions, limitations, and exclusions set forth in the Federal brochure.