2022 Standard rates*
|Self Only||Self Plus One||Self and Family|
|Biweekly – employed||$62.66||$134.73||$164.85|
|Monthly – retired||$135.77||$291.92||$357.17|
*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 (in-network)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, check the GEHA Plan Brochure.
|What you pay|
|Unlimited telehealth visits, including behavioral health, with MDLIVE||$0|
|Preventive care; adult routine screenings||$0|
|Well-child visit; up to age 22||$0|
|Maternity; routine care||$0|
|Hospital care; inpatient maternity||$0|
|Lab Card services||$0|
|MinuteClinic (where available)||$10|
|Primary physician office visit||$15|
|Specialist care; office visit||$30|
|Lab services (other than Lab Card)||15%|
|Hospital care; inpatient and outpatient||15%1|
|Professional surgical services||15%1|
|X-ray and other diagnostic services||15%1|
|Acupuncture; up to 20 treatments per year||15%1|
|Preventive dental care, twice yearly||50%|
|Chiropractic care (manipulative therapy), including X-rays; up to 20 visits per year||$30|
|Outpatient professional High Tech Imaging (MRI, CT, PET, etc.)||$100|
|Outpatient facility High Tech Imaging (MRI, CT, PET, etc.)||$150|
Prescriptions – 30-day supplyThe table below summarizes your cost for prescription drugs with the Standard plan. For details on specialty drugs that are injected or infused, check the GEHA Plan Brochure. For added convenience and management of medications, prescription benefits include access to presorted multi-dose packets. Packets can be delivered to your home or, if available, picked up at a retail location. To find drug costs with the Standard plan, use this handy check your drug costs tool.
|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
|Preferred brand-name||50%, up to $500 max¤||No benefit|
|Non-preferred brand-name||50%, up to $600 max¤||No benefit|
Highlights that are special to Standard
Pregnancy and Childbirth
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.
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