Contraceptive coverage

G.E.H.A members have access to contraceptive coverage at no additional cost. This benefit includes at least one option for each contraceptive method, as well as related screenings, education, counseling and follow-up care. For more information about covered contraceptive options, refer to the Birth Control Guide (chart).

Medical contraceptives

G.E.H.A covers FDA-approved contraceptive devices, services and procedures. Covered FDA-approved contraceptive options do not require prior authorization and are not limited by brand.

Medical contraceptive exception process

If you or your physician believe you need a contraceptive device, service or procedure that is not FDA-approved or is not included among G.E.H.A’s covered contraceptive options, you may request a review through the prior authorization process. To begin, you or your physician should call G.E.H.A at 1-800-821-6136 and select the prior authorization option.

Pharmacy contraceptive exception process

If your physician believes a non-formulary contraceptive is medically necessary for you, an exception review can be initiated by your physician. Providers can contact the CVS Caremark Prior Authorization Department to obtain the appropriate exception form at 1-855-240-0536, or you may download the Preventive Services Contraceptive Zero Copay Exceptions Form and provide to your provider for completion and submission to CVS Caremark.

Reimbursement process

Reimbursement for over-the-counter contraceptives (prescription required) can be submitted by sending in your original prescription receipt with the prescription number included, obtained from your pharmacy, to:

CVS Caremark
P.O. Box 52136
Phoenix, AZ 85072-2136

Members planning on submitting receipts for reimbursement are encouraged to not use their HSA, health FSA or HRA, including any related debit cards, to purchase the contraceptives.

Additional information

• Contraception coverage (OPM) — For questions about contraceptive services or difficulty accessing contraception coverage or other reproductive health care, contact the Office of Personnel Management (OPM) at contraception@opm.gov.
• Consumer Protections
• For additional questions, please call CVS Caremark at 1-844-4-GEHARX or 1-844-443-4279; visit CVS Caremark's website; or review Section 5(f) of your Plan Brochure.