Medical member resources

*2025* FEHB Elevate Plus and Elevate Options Medical Plan Brochure

This brochure (RI 71-018) describes the benefits, exclusions, limitations and maximums of the FEHB Elevate and Elevate Plus medical plans for 2025.

*2025* FEHB HDHP Medical Plan Brochure

This brochure (RI 71-014) describes the benefits, exclusions, limitations and maximums of the FEHB HDHP for 2025.

*2025* FEHB Health Benefits Guide

Choose from five health plans that are packed with extra benefits to help you get the most from your coverage.

*2025* FEHB High and Standard Options Medical Plan Brochure

This brochure (RI 71-006) describes the benefits, exclusions, limitations and maximums of the FEHB High and Standard medical options for 2025.

*2025* PSHB Elevate Plus and Elevate Options Medical Plan Brochure

This brochure (RI 71-022) describes the benefits, exclusions, limitations and maximums of the PSHB Elevate and Elevate Plus medical plans for 2025.

*2025* PSHB HDHP Medical Plan Brochure

This brochure (RI 71-026) describes the benefits, exclusions, limitations and maximums of the PSHB HDHP for 2025.

*2025* PSHB Health Benefits Guide

Postal workers, we’ve got your back. Choose from five health plans customized for the needs of federal employees, retirees and their families.

*2025* PSHB High and Standard Options Medical Plan Brochure

This brochure (RI 71-021) describes the benefits, exclusions, limitations and maximums of the PSHB High and Standard medical options for 2025.

2024 Elevate Plus and Elevate Options Medical Plan Brochure

This brochure (RI 71-018) describes the benefits, exclusions, limitations and maximums of the Elevate and Elevate Plus medical plans for 2024.

2024 HDHP Medical Plan Brochure

This brochure (RI 71-014) describes the benefits, exclusions, limitations and maximums of the HDHP for 2024.

2024 High and Standard Options Medical Plan Brochure

This brochure (RI 71-006) describes the benefits, exclusions, limitations and maximums of the High and Standard medical options for 2024.

2025 FEHB Elevate Plus Summary of Benefits and Coverage

2025 FEHB Elevate Summary of Benefits and Coverage

2025 FEHB HDHP Summary of Benefits and Coverage

2025 FEHB High Summary of Benefits and Coverage

2025 FEHB Standard Summary of Benefits and Coverage

2025 PSHB Elevate Plus Summary of Benefits and Coverage

2025 PSHB Elevate Summary of Benefits and Coverage

2025 PSHB HDHP Summary of Benefits and Coverage

2025 PSHB High Summary of Benefits and Coverage

2025 PSHB Standard Summary of Benefits and Coverage

Accident or Injury Form

Advance care planning

Apelaciones Anteriores al Servicio — Designación de un Representante Autorizado (en espanol)

Utilice este formulario si desea designar a un representante autorizado. El representante autorizado es una persona con plena autoridad para actuar y recibir notificaciones en su nombre con respecto a la determinación inicial de una reclamación, las solicitudes de documentos relacionados con la reclamación y la facultad de apelar una determinación adversa de beneficios sobre una reclamación en su nombre.

Apelaciones después del Servicio — Designación de un Representante Autorizado (en espanol)

Utilice este formulario si desea designar un representante autorizado, alguien que pueda actuar en nombre del miembro con respecto a un reclamo de beneficios.

Appeal process FAQs

Learn what types of decisions can be appealed and how the G.E.H.A appeal process works.

Connection Vision Plan Brochure

This brochure provides complete information on the Connection Vision powered by EyeMed vision program.

Continuity of Care Form

Use this form to apply for continuity of care. Members or their providers can return this completed form, along with relevant medical records and information, by mail or fax.

Cuestionario para miembros: Solicitud de información sobre otros seguros médicos (en espanol)

Este formulario se presenta para informarnos sobre todas las coberturas de seguro médico disponibles para usted. Si tiene otro seguro además de su cobertura de G.E.H.A, necesitamos la información sobre su otro seguro. Al coordinar los beneficios con todas las compañías de seguros, el miembro recibe los máximos beneficios disponibles.

Enrollment Questionnaire (online form)

Complete this form to help speed up access to your benefits.

Enrollment Questionnaire (PDF)

Complete the PDF if you're unable to use the online form.

EyeMed Out-Of-Network Vision Services Claim Form (online form)

You only need to complete this form if you visit a provider that is not in the EyeMed network.

EyeMed Out-Of-Network Vision Services Claim Form (PDF)

If the online form won't work for you, you can download this PDF version to print, complete and return by mail.

Formulario de Continuidad del Cuidado de la Salud (en espanol)

Utilice este formulario para solicitar la continuidad de la atención. Los miembros o sus proveedores pueden devolver este formulario completo, junto con la información y los registros médicos pertinentes, por correo postal o fax.

Formulario de Presentación de Reclamo del Miembro (en espanol)

Utilice este formulario para presentar una reclamación médica cuando su proveedor no la presente en su nombre. Debe enviar su recibo o estado de cuenta detallado, el formulario completo y cualquier otra documentación de respaldo a través de su portal seguro para miembros, la aplicación MyGEHA, correo electrónico, fax o correo postal.

Formulario de reembolso para prueba de COVID-19 de venta sin receta (OTC) en el domicilio (en espanol)

Utilice este formulario para solicitar el reembolso por la compra de una prueba de COVID-19 de venta libre para realizar en el hogar.

Formulario de Solicitud de Apelación Posterior al Servicio de G.E.H.A (en espanol)

Utilice este formulario para solicitar la revisión de una determinación adversa de beneficios médicos o la denegación de una reclamación. Los miembros pueden completar el formulario electrónicamente y enviarlo por correo a la dirección indicada.

Formulario de solicitud de información — apelaciones (en espanol)

Utilice este formulario para solicitar registros relevantes a una determinación de beneficios realizada por G.E.H.A.

Formulario para Reclamo del Acuerdo de Reembolso para la Salud (HRA) (en espanol)

Este formulario es para uso exclusivo de los miembros de planes de salud con deducible alto que tienen Acuerdos de Reembolso para la Salud (Health Reimbursement Arrangement, HRA). No se requiere un formulario para reclamo para una cuenta de ahorros para la salud (health savings account, HSA).

G.E.H.A Networks by State

To ensure that we have in-network providers in all 50 states, G.E.H.A has entered into arrangements with the networks listed on this chart.

G.E.H.A Post-Service Appeal Request Form

Use this form to request a review of an adverse medical benefit determination or claim denial. Members may fill the form out electronically and mail it in to the listed address.

Health Reimbursement Arrangement (HRA) Claim Form

This form is for use only by HDHP (high deductible health plan members) with HRAs. No claim form is required for a health savings account (HSA).

How To Read Your Medical Explanation Of Benefits

Information request form — Appeals

Use this form to request records relevant to a benefit determination made by G.E.H.A.

Medicare Reimbursement Account Claims Form

High Option health plan members with Medicare Parts A & B can use this form to submit a paper claim by fax or mail for up to $1,000 for Part B premiums.

Member Claim Submission Form

Use this form to submit a medical claim when your provider doesn’t file one on your behalf. You must submit your receipt or itemized statement, the completed form and any other supporting documentation through your secure member portal, the MyGEHA app, email, fax or mail.

Member Questionnaire: Request for other medical insurance information

This required form asks members to inform G.E.H.A about any additional medical insurance coverage you may have. It must be filled out and returned even if the member has no other medical insurance coverage.

Member Rights and Responsibilities

No Surprises Act: Your Rights and Protections Against Surprise Medical Bills

When you get out-of-network emergency care or get treated by an out-of-network provider at an in-network hospital or ambulatory surgical center, you are protected from surprise billing or balance billing.

Over-the-counter (OTC) at-home COVID-19 test reimbursement form

Use this form to request reimbursement for the purchase of an over-the-counter at-home COVID-19 test.

Post-Service Appeals — Designation of Authorized Representative

Use this form if you want to appoint an authorized representative, someone who can act on the member's behalf regarding a benefit claim.

Pre-Service Appeals — Designation of Authorized Representative

Use this form if you want to appoint an authorized representative. The authorized representative is someone with full authority to act and receive notices on the your behalf with respect to an initial claim determination, requests for claim-related documents and the ability to appeal an adverse benefit determination on a claim on your behalf.

Prescription Drug Plan disenrollment form

Solicitud de transición del cuidado de la salud (en espanol)

Utilice este formulario si desea realizar la transición de atención cuando su tratamiento ya está en marcha y su plan de beneficios cambia.

Transition of Care Request

Use this form if you want to transition care when your treatment is already underway and your benefit plan changes.