A low premium – and a lower-than-expected deductible.
High Deductible Health Plan 2020
View the 2019 High Deductible Health PlanTake advantage of comprehensive coverage and funds you can use to pay for future health care expenses.
This plan pairs lower premiums with a health savings account (HSA) or a health reimbursement arrangement (HRA).
Why you might like the HDHP:
- Pay nothing for in-network preventive medical care.
- You pay only 5% of medical services after your deductible is met.
- With our premium pass-through, GEHA contributes to your HSA/HRA to lower your net deductible.
- Vision benefits are included and you pay nothing for in-network preventive dental treatment, which includes two checkups and one X-ray annually.
- Your in-network out-of-pocket maximum for 2020 is only $5,000 for Self Only, or $10,000 for Self Plus One or Self and Family.
2020 Rates
These rates do not apply to all enrollees. If you are in a special enrollment category, please refer to the FEHB Program website or contact the agency or Tribal Employer that maintains your health benefits enrollment.
Costs for services in 2020
The table below summarizes your in-network cost for medical benefits with GEHA's High Deductible Health Plan. For complete information, refer to the GEHA Plan Brochure.
Copays
| Copay | What you pay in-network |
|---|---|
| Primary physician office visit | 5% after deductible* |
| Specialist | 5% after deductible* |
| MinuteClinic (where available) | 5% after deductible* |
| Urgent care | 5% after deductible* |
| Routine eye exam | $5 through EyeMed |
Other services
| Service | What you pay in-network |
|---|---|
| Preventive lab services | Nothing |
| Well-child visits; up to age 22 | Nothing |
| Adult routine screening | Nothing |
| Preventive dental care; twice yearly | Nothing |
Maternity care
| Service | What you pay in-network |
|---|---|
| Maternity; routine preventive care | Nothing* |
Out-of-pocket maximums and yearly deductibles
| Self Only | Self Plus One | Self and Family | |
|---|---|---|---|
| Out-of-pocket-maximum (in-network) | $5,000 | $10,000 | $10,000 |
| Calendar-year deductible (in-network) | $1,500 | $3,000 | $3,000 |
| GEHA’s HSA/HRA premium pass-through contribution | $900 | $1,800 | $1,800 |
| Net deductible after pass-through1 | $600 | $1,200 | $1,200 |
1Your “net deductible after pass-through” is the bottom-line amount you owe for health care services before GEHA begins to pay. If you have GEHA’s High Deductible Health Plan, GEHA’s pass-through contribution reduces your net deductible.
Prescriptions
The table below summarizes your cost for prescription drugs with GEHA’s HDHP. For complete benefit information, including details on specialty drugs that are injected or infused, refer to the GEHA Plan Brochure.
To find a drug cost based on your benefit plan and prescription dosage, check your drug costs.
Retail pharmacy – 30-day supply
| In-network | Out-of-network | |
|---|---|---|
| Generic and preferred brand-name medication | 25% of plan allowance, after deductible*¤ | 25% of plan allowance, after plan deductible,* plus difference between GEHA allowance and the cost of the drug¤ |
| Non-preferred brand-name medication | 40% of plan allowance, after deductible*¤ | 40% of plan allowance, after plan deductible,* plus difference between GEHA allowance and the cost of the drug¤ |
Mail service pharmacy – 90-day supply
| In-network | Out-of-network | |
|---|---|---|
| Generic or preferred brand-name medication | 25% of plan allowance, after deductible*¤ | n/a |
| Non-preferred brand-name medication | 40% of plan allowance, after deductible*¤ | n/a |
*Under the High Deductible Health Plan (HDHP), your deductible is $1,500 for Self Only coverage, and $3,000 for Self Plus One or Self and Family coverage. With the exception of preventive care, vision and dental, you must pay the full deductible before GEHA pays for your health care. You can use funds in your health savings account or health reimbursement arrangement to cover your deductible and other medical expenses.
¤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.
Videos: How an HSA or an HRA works with an HDHP
Key plan features
VISION BENEFITS
HEALTH REWARDS
ELECTRIC TOOTHBRUSH DISCOUNT
^GEHA supplemental 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. For information on year-round savings for GEHA dental members, visit Savings for GEHA dental members.
# To open an HSA, you must meet IRS eligibility requirements. Contribution amounts are subject to IRS limits. Please see the plan brochure for more information.
This is a brief description of the features of the GEHA High Deductible Health Plan (HDHP). Before making a final decision, 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.