Standard
Welcome to your medical plan page
What’s new in 2023
- There is an out-of-network deductible of $700 for Self Only and $1,400 for Self Plus One or Self and Family. The in-network deductible remains the same, $350 for Self Only and $700 for Self Plus One or Self and Family.
- Primary care physician copay increasing from $15 to $20
- Specialist visit copay is increasing from $30 to $35
- Prescription copay maximums apply per each 30-day supply at retail and CVS Specialty
- Preventive colorectal cancer screening covered at age 45 instead of 50
- Prediabetes screening covered at age 35 instead of 40. Unlimited diabetes education provided.
Standard 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 max in-network1,2 | You pay |
|---|---|
| Self Only | $6,500 |
| Self Plus One or Self and Family | $13,000 |
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 |
|
15% |
|
15%3 |
|
50% |
|
$100 |
|
$150 |
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 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.
3 Calendar year deductible applies.
Your prescription benefits
| Prescription benefits in-network1,2 | You pay |
|---|---|
| 30-day retail generic | $10 |
| 30-day retail preferred brand-name | 50% ($200 max3) |
| 30-day retail non-preferred brand-name | 50% ($300 max3) |
| 90-day mail service generic | $20 |
| 90-day mail service preferred brand-name | 50% ($500 max3) |
| 90-day mail service non-preferred brand-name | 50% ($600 max3) |
| 30-day specialty CVS exclusive generic and preferred brand-name | 50% ($250 max) |
| 30-day specialty CVS exclusive non-preferred brand-name | 50% ($400 max3) |
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 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.
Standard and Medicare coverage
Yearly deductible with Medicare A & B primary1
| Yearly deductible with Medicare A & B primary1 | You pay |
|---|---|
| Self Only | $0 |
| Self Plus One or Self and Family | $0 |
Out-of-pocket maximum
| Out-of-pocket max in-network1,2 | You pay |
|---|---|
| Self Only | $6,500 |
| Self Plus One or Self and Family | $13,000 |
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.
Standard and Medicare medical benefits
| Medical benefits with Medicare A & B primary in-network1,2 | You pay |
|---|---|
|
$0 |
|
$5 |
|
50% |
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.
Standard and Medicare prescription benefits
| Prescription benefits in-network1,2 | You pay |
|---|---|
| 30-day retail generic | $10 |
| 30-day retail preferred brand-name | 50% ($200 max3) |
| 30-day retail non-preferred brand-name | 50% ($300 max3) |
| 90-day mail service generic | $20 |
| 90-day mail service preferred brand-name | 50% ($500 max3) |
| 90-day mail service non-preferred brand-name | 50% ($600 max3) |
| 30-day specialty CVS exclusive generic and preferred brand-name | 50% ($250 max) |
| 30-day specialty CVS exclusive non-preferred brand-name | 50% ($400 max3) |
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 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
Your exclusive discounts
Vision discount1
Medical alert discount1
Hearing aid discount1,2
Electric toothbrush discount1,3
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.
3The 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 card
Redeeming your rewards
Resources
Plan documents
| Topic |
Resource |
|---|---|
| 2023 Standard Plan Brochure | Download (PDF) |
| 2023 Standard 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 Standard 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.