HDHP
Welcome to your medical plan page
What’s new in 2023
- For out-of-network services, the deductible and out-of-pocket maximum will accumulate separately from in-network services. In-network costs will no longer apply to out-of-network amounts.
- Preventive colorectal cancer screening now covered at no cost at age 45
- Prediabetes screening age lowered to 35 instead of 40. Unlimited diabetes education provided.
HDHP coverage
Yearly deductible
| Yearly deductible in-network1,2 | Annual deductible | GEHA HSA contribution | You pay2 |
|---|---|---|---|
| Self Only | $1,500 | $900 | $600 |
| Self Plus One or Self and Family | $3,000 | $1,800 | $1,200 |
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 net deductible is the remaining amount after you subtract the annual GEHA contribution from the annual deductible. This is your out-of-pocket cost before plan benefits begin..
Out-of-pocket maximum
| Out-of-pocket maximum in-network1,2 | You pay |
|---|---|
| Self Only | $5,000 |
| Self Plus One or Self and Family | $10,000 |
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 | You pay |
|---|---|
|
$02,3 |
|
$02 |
|
$0 |
|
$5 |
|
5%2 |
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 Calendar year deductible applies.
3 HDHP members who have met their deductible will be charged by MDLIVE, but GEHA will reimburse the member 100% of the plan allowance.
Your prescription benefits
| Prescription benefits in-network1,2,3 | You pay |
|---|---|
| 30-day retail generic | 25% |
| 30-day retail preferred brand-name | 25%4 |
| 30-day retail non-preferred brand-name | 40%4 |
| 90-day mail service generic | 25% |
| 90-day mail service preferred brand-name | 25%4 |
| 90-day mail service non-preferred brand-name | 40%4 |
| 30-day specialty CVS exclusive generic and preferred brand-name | 25%4 |
| 30-day specialty CVS exclusive non-preferred brand-name | 40%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 Calendar year deductible applies.
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 and HDHP coverage
Yearly deductible
| Yearly deductible in-network1,2 | Annual deductible | GEHA HRA contribution | You pay2 |
|---|---|---|---|
| Self Only | $1,500 | $900 | $600 |
| Self Plus One or Self and Family | $3,000 | $1,800 | $1,200 |
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.
Out-of-pocket maximum
| Out-of-pocket max in-network1,2 | You pay |
|---|---|
| Self Only | $5,000 |
| Self Plus One or Self and Family | $10,000 |
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.
HDHP and Medicare medical benefits
| With Medicare A & B primary in-network1,2 | You pay |
|---|---|
|
$02,3 |
|
$0 |
|
$5 |
|
5%2 |
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 Calendar year deductible applies.
3 HDHP members who have met their deductible will be charged by MDLIVE, but GEHA will reimburse the member 100% of the Plan Allowance.
Your prescription benefits
| Prescription benefits in-network1,2,3 | You pay |
|---|---|
| 30-day retail generic | 25% |
| 30-day retail preferred brand-name | 25%4 |
| 30-day retail non-preferred brand-name | 40%4 |
| 90-day mail service generic | 25% |
| 90-day mail service preferred brand-name | 25%4 |
| 90-day mail service non-preferred brand-name | 40%4 |
| 30-day specialty CVS exclusive generic and preferred brand-name | 25%4 |
| 30-day specialty CVS exclusive non-preferred brand-name | 40%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 Calendar year deductible applies.
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
Understanding an HSA (Health Savings Account)
If you qualify for an HSA you will receive a welcome kit in the mail from HSA Bank. Most people qualify for an HSA.1 You can learn more about HSA eligibility at geha.com/IRS969. Investing your HSA money not only helps you save for future financial security, it offers some major tax advantages, too. All GEHA HSA contributions are pre-tax and are not taxed when you withdraw them for qualified medical expenses.2Your HSA has a triple tax advantage:
Tax-free contributions
that lower your monthly taxable income.
Tax-free interest
that grows your account over time.
Tax-free withdrawals
for qualified medical expenses.2
How an HSA is funded
GEHA's contribution is prorated based on the effective date of your HDHP enrollment.| Plan type | GEHA monthly contribution |
|---|---|
| Self Only |
$75 monthly ($900 annual max) |
| Self Plus One or Self and Family |
$150 monthly ($1,800 annual max) |
How you can use the money in your HSA
- Use the funds for current medical expenses, which lowers your yearly deductible
- Keep any unused money in an interest-bearing savings account or invest in stocks, bonds and mutual funds and use those funds for future medical expenses
-
You may make additional contributions up to the IRS-allowed annual maximum. Total 2023 HSA contributions, including GEHA's monthly contributions, cannot exceed:
- $3,850 for Self Only, $7,750 for Self Plus One or Self and Family
- Plus $1,000 in "catch up" contributions for individuals age 55+
- At age 65, you can use the funds in this account like you would an IRA
- For a list of qualified medical expenses, visit irs.gov/Pub502
1 Investment products are not FDIC insured, are not a deposit or other obligation or guaranteed by HSA Bank, and are subject to investment risks. The information provided is for informational purposes only. It should not be considered legal or financial advice. Consult with a professional to determine what may be best for your individual needs. See IRS Publications 502 and 969 for more information regarding qualified medical expenses, health savings accounts and health reimbursement arrangements.
2 See IRS Publications 502 and 969 for more information regarding qualified medical expenses, health savings accounts and health reimbursement arrangements.
Understanding an HRA (Health Reimbursement Arrangement)
If you do not qualify for an HSA, you will receive a health reimbursement arrangement (HRA) notification in the mail from GEHA. As you receive medical care, available funds in your HRA will be used tax-free to pay for qualified out-of-pocket expenses. For expenses that are not automatically deducted from your HRA account, like Medicare Part B premiums, use the HRA reimbursement form to submit your claim. Your provider is automatically reimbursed when claims are submitted through the GEHA HDHP. Our plan allows unused HRA funds to carry over from year to year. You will forfeit the money in your HRA if you leave federal employment or switch health insurance plans. If you retire, or remain covered under your HDHP, you may continue to accumulate and use funds in your HRA.
How an HRA is funded
For those who don't qualify for an HSA, the full annual HRA deposit is available for qualified medical expenses incurred on or after your effective date.| Plan type | GEHA lump sum contribution1 |
|---|---|
| Self Only |
$900 |
| Self Plus One or Self and Family |
$1,800 |
Features of an HRA
- Unused money rolls over year over year.
- No additional personal contributions are allowed.
- Tax-free withdrawals for qualified medical expenses.
- No account fees.
- You do not own the account.
- If you leave federal employment or change to another medical plan, including one of GEHA's other medical plans, the money in the HRA is forfeited.
- For a list of qualified medical expenses, visit irs.gov/Pub502
1 If you joined outside of Open Season the lump sum is prorated.
See IRS Publications 502 and 969 for more information regarding qualified medical expenses, health savings accounts, and health reimbursement arrangements.
Pharmacy benefits
Retail pharmacy
Mail service pharmacy
Estimate medication costs
Your exclusive discounts
Vision benefit & discount1
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 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 DuPontTM 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
Your team of health professionals
Health Rewards
How it works
HDHP members who are also enrolled in an HSA can only use their card for qualified dental and vision expenses until the yearly plan deductible has been satisfied.
Your Health Rewards reloadable debit card
Redeeming your rewards
Resources
Plan documents
| Topic |
Resource |
|---|---|
| 2023 HDHP Plan Brochure | Download (PDF) |
| 2023 HDHP 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 HDHP plan. Please read the Plan's Federal brochure (RI 71-014). All benefits are subject to the definitions, limitations, and exclusions set forth in the Federal brochure.