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Transparency in coverage


The Transparency in coverage Final Rule (for ease of reference, the “Rule”) was published by the Department of Health and Human Services (HHS), the Department of Labor (DOL) and the Department of the Treasury (DOT) on November 12, 2020. This Rule is applicable to hospitals, health plans and insurance payers, and contains certain regulatory requirements that must be implemented.

The Rule is intended to provide access to information that can be used by health care consumers and others to better understand the cost of health care services and assist with making cost-conscious decisions. The information required to be made available will initially be in “machine-readable” files that will be updated monthly. The machine-readable files (MRFs) are displayed in JSON format as required by the Rule and may not be easily readable. GEHA has provided access to the MRFs through the links below, which contain the following information:

  • In-network rates: These files contain a roster of all in-network providers and contracted items and services.
  • Out-of-network rates: Historical payments to, and billed charges from, out-of-network providers.

Please note the following when reviewing these files: The in-network MRFs are reflective of all in-network providers and their prevailing contracts with our network partner. These files do not guarantee coverage of any or all services, and many services require the plan’s authorization in advance based on the plan’s criteria. Please refer to the GEHA plan brochures for the plan’s coverage and benefit rules. All benefits are subject to the definitions, limitations and exclusions set forth in the GEHA plan brochures.

GEHA is committed to price and cost transparency, and as such, we believe that all members should understand their projected costs in advance. In addition to the MRFs, GEHA also offers user-friendly cost estimate tools that take into consideration plan design, deductibles and provider contract. For full access to these tools, including the member’s specific cost share and accumulators, please sign in to your GEHA member portal.

  • Members enrolled in a GEHA HDHP, Standard or High medical plan may access the cost estimate tool powered by Healthcare Bluebook.
  • Members enrolled in a GEHA Elevate or Elevate Plus plan may access the cost estimate tool powered by Rally Health.
In-network MRFs: Medical and behavioral health networks

GEHA partners with UnitedHealthcare and Aetna Signature Administrators to provide access to medical networks. We assign members a “home network” based on the GEHA plan and state where the subscriber lives. The member’s home network is displayed on the GEHA ID card. Please refer to the chart below to determine your home network and MRF.

GEHA plan and subscriber home state Home network/Medical MRF Mental/Behavioral health network
HDHP, Standard, High
Alaska, Arizona, Colorado, Connecticut, Georgia, Kentucky, Maine, Massachusetts, Michigan, Nevada, New Hampshire, New Jersey, New York, Ohio, Pennsylvania, Rhode Island, Vermont, Washington Aetna Signature Administrators UnitedHealthcare Behavioral Health             
Alabama, Arkansas, Delaware, Florida, Hawaii, Idaho, Illinois, Indiana, Iowa, Kansas, Louisiana, Maryland, Minnesota, Mississippi, Missouri, Montana, Nebraska, New Mexico, North Carolina, North Dakota, Oklahoma, Oregon, South Carolina, South Dakota, Tennessee, Texas, Virginia, Washington DC, West Virginia, Wisconsin, Wyoming UnitedHealthcare Choice Plus UnitedHealthcare Choice Plus
Utah UnitedHealthcare Options PPO              UnitedHealthcare Options PPO             
California UnitedHealthcare Select Plus              UnitedHealthcare Select Plus  
Elevate, Elevate Plus
All members UnitedHealthcare Choice Plus              UnitedHealthcare Choice Plus             
In-network MRFs: Ancillary networks

GEHA offers our members access to ancillary provider networks to augment our medical and mental health provider networks. The following table summarizes the ancillary networks and associated MRFs by plan.

GEHA Plan Telehealth network Transplant Network Dental Network
HDHP, Standard, High MDLIVE
see below by plan
LifeTrac GEHA Connection Dental
see below by plan
Elevate, Elevate Plus MDLIVE
see below by plan
Optum n/a
Out-of-network MRFs

The out-of-network MRFs are available below by plan.

Our Benefits Advisers are available Mon. – Fri. from 7 a.m. – 7 p.m. Central time and are ready to answer your questions.
Are you a current GEHA member?
Medical questions: 800.821.6136
Dental questions: 877.434.2336