Dependable coverage with affordable premiums.
Standard Option 2020
Traditional coverage. Affordable premiums.
With comprehensive care, this medical plan is the one you know and trust, with familiar benefits and coverage
When you enroll in GEHA’s Standard Option, you:
- Pay nothing for online doctor visits with access to certified doctors, including dermatologists, and licensed therapists through MDLIVE.
- Pay nothing for routine, in-network maternity care.
- Get a complete range of prescription services.
More Standard Option highlights:
- A 30-day supply of generic medication costs just $10.
- You can visit your primary care doctor for only a $15 copay each visit.
- This plan covers 100% of preventive care costs when you see an in-network provider.
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 Standard Option. For complete information, refer to the GEHA Plan Brochure.
Copays
| Copay | What you pay in-network |
|---|---|
| Primary physician office visit | $15 |
| Specialist | $30 |
| MinuteClinic (where available) | $10 |
| Urgent care | $35 |
| Annual eye exam | $5 through EyeMed |
Other services
| Service | What you pay in-network |
|---|---|
| Preventive lab services | Nothing with Lab Card |
| Well-child visit; up to age 22 | Nothing |
| Adult routine screening | Nothing |
| Preventive dental care | 50% of allowance, twice yearly |
Maternity care
| Service | What you pay in-network |
|---|---|
| Routine provider care | Nothing |
| Inpatient care | Nothing |
Out-of-pocket maximums and yearly deductibles
| Self Only | Self Plus One | Self and Family | |
|---|---|---|---|
| Calendar-year deductible (in-network) | $350 | $700 | $700 |
| Out-of-pocket-maximum (in-network) | $6,500 | $13,000 | $13,000 |
Prescriptions
The table below summarizes your cost for prescription drugs with GEHA’s Standard Option. 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 | $10 | $10, plus difference between plan allowance and cost of drug |
| Preferred brand-name | 50%, up to $200 max¤ | 50%, up to $200 max, plus difference between plan allowance and cost of drug**¤ |
| Non-preferred brand-name | 50%, up to $300 max¤ | 50%, up to $300 max, plus difference between plan allowance and cost of drug**¤ |
Mail service pharmacy – 90-day supply
| In-Network | Out of Network | |
|---|---|---|
| Generic | $20 | n/a |
| Preferred brand-name | 50%, up to $500 max¤ | n/a |
| Non-preferred brand-name | 50%, up to $600 max¤ | n/a |
¤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.
**Retail fills eligible for a greater than a 30-day supply will be subject to the 50% coinsurance up to the maximum of $500 for preferred or $600 for non-preferred.
Key plan features
HEALTH REWARDS
GYM DISCOUNTS
^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.
This is a brief description of the features of the GEHA Standard Option medical plan. Before making a final decision, 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.