Get started
- Your GEHA medical plan ID card, which you should have received in the mail.
- Information on any other medical plans you or your family have that will coordinate with your GEHA benefits.
- Your mobile device if you'd like to download and set up the GEHA mobile app.
Your onboarding steps
High Option coverage
Your yearly deductible & out-of-pocket max
What you pay for in-network benefits.1
| Plan type | Benefit | What you pay |
|---|---|---|
| Self Only |
Yearly deductible Out-of-pocket max2 |
$350
$5,000 |
| Self Plus One |
Yearly deductible Out-of-pocket max2 |
$700 $10,000 |
| Self and Family |
Yearly deductible Out-of-pocket max2 |
$700 $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 2021 plan brochure RI 71-006 (High and Standard) at geha.com/PlanBrochure
2 The out-of-pocket max 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 prescription benefits
In-network benefts.1 Visit geha.com/Prescriptions to learn more.2
| Prescription | Type | What you pay |
|---|---|---|
| 30-day retail | Generic Preferred brand-name Non-preferred brand-name |
$103 25% ($150 max3,4) 40% ($200 max3,4) |
| 90-day mail service | Generic Preferred brand-name Non-preferred brand-name |
$20 25% ($350 max4) 40% ($500 max4) |
| 30-day5 specialty CVS exclusive | Generic Preferred brand-name Non-preferred brand-name |
25% ($150 max) 25% ($150 max4) 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. For out-of-network benefits, refer to GEHA's 2021 plan brochure RI 71-006 (High and Standard) at geha.com/PlanBrochure
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 different in cost between the brand-name and the generic.
5 Over 30-day specialty copay based on days of therapy. The drug cost share is two times for drugs that provide 60 days‘ worth of therapy and three times the copay for drugs that provide 90 days‘ worth of therapy.
Your medical benefits
What you pay for common in-network services.1
| Benefit | What you pay |
|---|---|
| Unlimited telehealth visits with MDLIVE geha.com/MDLIVE Preventive care; adult routine screenings Well-child visit; up to age 22 Maternity; routine care Emergency care; accidental (must be within 72 hours) Hospital care; inpatient maternity Lab Card services geha.com/LabCard |
$0 |
| MinuteClinic© (where available) geha.com/MinuteClinic |
$10 |
| Primary physician office visit Specialist care; office visit |
$20 |
| Urgent care geha.com/Find-Care | $35 |
| Lab services (non-Lab Card) | 10% |
| Emergency care; medical Hospital care; outpatient Professional surgical services X-ray services Other diagnostic services Acupuncture; up to 20 treatments per year |
10%2 |
| Hospital care; inpatient | $100 per admission plus 10% |
| Chiropractic care; up to 20 visits per year (spinal manipulation therapy) | Balance after GEHA pays $20 per visit |
| Chiropractic X-rays | Balance after GEHA pays $25 per year |
| Preventive dental care; twice yearly | 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. For out-of-network benefits, refer to GEHA’s 2021 plan brochure RI 71-006 (High and Standard) at geha.com/PlanBrochure
2 Calendar year deductible applies.
Medicare + High Option coverage
Your out-of-pocket max
What you pay for in-network benefits.1
| Plan type | Benefit | What you pay |
|---|---|---|
| Self Only | Out-of-pocket max2 | $5,000 |
| Self Plus One | Out-of-pocket max2 | $10,000 |
| Self and Family | Out-of-pocket max2 | $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 2021 plan brochure RI 71-006 (High and Standard) at geha.com/PlanBrochure
2 The out-of-pocket max 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 prescription benefits
In-network benefits.1 Visit geha.com/Prescriptions to learn more.2
| Prescription | Type | What you pay |
|---|---|---|
| 30-day retail | Generic Preferred brand-name Non-preferred brand-name |
$103 20% ($150 max3,4) 35% ($200 max3,4) |
| 90-day mail service | Generic Preferred brand-name Non-preferred brand-name |
$15 15% ($350 max4) 30% ($500 max4) |
| 30-day5 specialty CVS exclusive | Generic Preferred brand-name Non-preferred brand-name |
15% ($150 max) 15% ($150 max4) 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. For out-of-network benefits, refer to GEHA's 2021 plan brochure RI 71-006 (High and Standard) at geha.com/PlanBrochure
2 Refer to geha.com/Prescriptions for formulary and specialty coverage for specific medications.
3 Costs for initial prescriptions 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 different in cost between the brand-name and the generic.
5 Over 30-day specialty copay based on days of therapy. The drug cost share is two times for drugs that provide 60 days‘ worth of therapy and three times the copay for drugs that provide 90 days‘ worth of therapy.
Your medical benefits
What you pay for common in- and out-of-network network services.
| Benefit | What you pay |
|---|---|
| Unlimited telehealth visits with MDLIVE geha.com/MDLIVE Preventive care; adult routine screenings Lab, X-ray and diagnostic test services MinuteClinic© (where available) geha.com/MinuteClinic Primary physician office visit Specialist care; office visit Urgent care geha.com/Find-Care Emergency care Hospital care; inpatient and outpatient Professional surgical services; inpatient and outpatient |
$0 |
| Chiropractic care; up to 20 visits per year (spinal manipulation therapy) |
Balance after GEHA pays $20 per visit |
| Chiropractic X-rays | Balance after GEHA pays $25 per year |
| Preventive dental care; twice yearly | Balance after GEHA pays $22 per visit |
Included benefits
Pharmacy benefits
Estimate medication costs
Find an in-network pharmacy
CVS ExtraCare Health Benefit
Included benefits and discounts
Telehealth benefit
Vision discount1
Hearing aid discount1
Gym membership discount1
Electric toothbrush discount1,2
Teeth whitening discount1
Medical alert system1
Biometric screening
1 These benefits are neither offered nor guaranteed under contract with the FEHB, but are made available to all enrollees and
family members who become members of a GEHA medical plan.
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 DuPont™ bristles are also available at this exclusive, member-only price.
Health Rewards
How it works
Your Health Rewards card
Redeeming your rewards
Find care
How to get care
Other care resources
Maternity resources
Your care team
Second Opinion
1 If Medicare is your primary payer, you are not eligible for this program. Covered family members are still eligible if Medicare is not their primary payer.
This is a brief description of the features of Government Employees Health Association, Inc.'s High Option medical plan. Please read the Plan's Federal brochure (RI 71-006), available at geha.com/PlanBrochure. All benefits are subject to the definitions, limitations and exclusions set forth in the federal brochure.
Resources
Plan documents
| Topic |
Resource |
|---|---|
| 2021 High Option Plan Brochure | Download (PDF) |
| 2021 High Option Member Guide | Download |
| 2021 Medical Benefits Guide | Download |
| 2021 Summary of Benefits Coverage | Download (PDF) |
Helpful resources
| Topic |
Resource |
|---|---|
| GEHA Customer Care | geha.com/Contact |
| Find Care Tool | geha.com/Find-Care |
| Frequently asked questions | geha.com/FAQs |