High
Welcome to your medical plan page
What’s new in 2023
- No Lab Card® required. You’ll pay $0 for in-network outpatient labs
- Medicare Part B reimbursement increasing from $800 to $1,000 annually
- Colorectal screening now covered at no cost at age 45 instead of 50
- Prediabetes screening covered at no cost at age 35 instead of 40. Unlimited diabetes education provided.
High coverage
Yearly deductible
| Yearly deductible in-network1 | You pay |
|---|---|
| Self Only | $350 |
| Self Plus One or Self and Family | $700 |
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. For out-of-network benefits, refer to GEHA’s 2023 plan brochure RI 71-006 (High and Standard)..
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 |
|---|---|
|
$0 |
|
$5 |
| $10 | |
|
$20 |
| $35 | |
|
10%3 |
|
$100 per admission plus 10% |
|
Balance after GEHA pays $22 per visit |
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.
Your prescription benefits
| Prescription benefits in-network1,2 | You pay |
|---|---|
| 30-day retail generic | $103 |
| 30-day retail preferred brand-name | 25% ($150 max3,4) |
| 30-day retail non-preferred brand-name | 40% ($200 max3,4) |
| 90-day mail service generic | $20 |
| 90-day mail service preferred brand-name | 25% ($350 max4) |
| 90-day mail service non-preferred brand-name | 40% ($500 max4) |
| 30-day specialty CVS exclusive generic and preferred brand-name | 25% ($150 max4) |
| 30-day specialty CVS exclusive non-preferred brand-name | 40% ($200 max4) |
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 Costs for initial prescription and first refill. You pay 50% for third and additional refills at retail for 30-day supply. For long-term prescriptions, use mail order or your local retail CVS Pharmacy store (90-day supply) for greater cost savings.
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.
High and Medicare coverage
Yearly deductible
| Yearly deductible with Medicare A & B primary 1 | 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 | $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. For out-of-network benefits, refer to GEHA’s 2022 plan brochure RI 71-006 (High and Standard).
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.
High and Medicare medical benefits
| Medical benefits with Medicare A & B primary in-network1,2 | You pay |
|---|---|
|
$0 |
|
$5 |
|
Balance after GEHA pays $22 per visit |
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.
High and Medicare prescription benefits
| Prescription benefits in-network1,2 | You pay |
|---|---|
| 30-day retail generic | $103 |
| 30-day retail preferred brand-name | 20% ($150 max3,4) |
| 30-day retail non-preferred brand-name | 35% ($200 max3,4) |
| 90-day mail service generic | $15 |
| 90-day mail service preferred brand-name | 15% ($350 max4) |
| 90-day mail service non-preferred brand-name | 30% ($500 max4) |
| 30-day specialty CVS exclusive generic and preferred brand-name | 15% ($150 max4) |
| 30-day specialty CVS exclusive non-preferred brand-name | 30% ($200 max4) |
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 Costs for initial prescription and first refill. You pay 50% for third and additional refills at retail for 30-day supply. For long-term prescriptions, use mail order or your local retail CVS Pharmacy store (90-day supply) for greater cost savings.
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
Pharmacy benefits
Retail pharmacy
Mail service pharmacy
Estimate medication costs
CVS ExtraCare Health Benefit
Your exclusive discounts
Vision discount1,2
Medical alert discount1
Hearing aid discount1,3
Electric toothbrush discount1,4
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 Only when you visit an EyeMed provider.
3 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.
4 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
Your Health Rewards reloadable debit card
Redeeming your rewards
Resources
Plan documents
| Topic |
Resource |
|---|---|
| 2023 High Plan Brochure | Download (PDF) |
| 2023 High 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 High Option plan. Please read the Plan’s Federal brochure (RI 71-006). All benefits are subject to the definitions, limitations, and exclusions set forth in the Federal brochure.