2021 GEHA Medicare Benefits Guide

2021 GEHA

MEDICARE BENEFITS

Learn how GEHA’s five medical plans work with your Medicare benefits.

geha.com/Medicare | 800.262.4342

1

Medicare + GEHA.

Compare premiums for all plans.

Self Only. What you pay.

GEHA works with Medicare Parts A & B.

Learn how to enroll at geha.com/Enroll

With a GEHA medical plan to supplement your Medicare coverage, a sudden hospital stay, a prolonged illness or a major surgical procedure won’t overwhelm your budget. GEHA offers five unique medical plan options, each with comprehensive coverage that coordinates with Medicare. Compare how GEHA plans work with Medicare.

Elevate

HDHP

Standard

Elevate Plus

High

Enrollment codes Retirees monthly

254

341

314

251

311

$102.53

$132.96

$135.77

$163.28

$234.31

Elevate + Medicare

HDHP + Medicare

Standard + Medicare

Elevate Plus + Medicare

High + Medicare

Self Plus One. What you pay.

Learn how to enroll at geha.com/Enroll

Coverage for in- and out-of-network care

Elevate

HDHP

Standard

Elevate Plus

High

1

Vision discounts or benefit³

Enrollment codes Retirees monthly

256

343

316

253

313

$235.83

$285.87

$291.92

$380.93

$545.85

2

2

2

Hearing aid discounts or benefits³

Coverage for care outside of the United States

Self and Family. What you pay.

Learn how to enroll at geha.com/Enroll

Mail service pharmacy

Elevate

HDHP

Standard

Elevate Plus

High

Non-preferred drug coverage

Enrollment codes Retirees monthly

255

342

315

252

312

$287.10

$344.60

$357.17

$404.93

$680.61

100% medical coverage (copays and deductibles waived) with Medicare A & B primary

$600 Medicare Part B reimbursement geha.com/MRA

Learn more with free e-books and videos. Learn more about your options with Medicare and GEHA at geha.com/Medicare

1 The HDHP plan also includes additional vision benefits. Learn more at geha.com/HDHPVision 2 Standard Option, Elevate Plus and High Option also include additional hearing aid benefits. Learn more at geha.com/Hearing 3 These benefits are neither offered nor guaranteed under contract with the FEHB Program, but are made available to all enrollees who become members of GEHA and their eligible family members.

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.

2

3

Vision benefits & discounts for GEHA plans.

Hearing aid benefits & discounts for GEHA plans.

Included benefits & discounts. Unlimited MDLIVE 3 telehealth visits Access certified doctors, including pediatricians, licensed behavioral health therapists and dermatologists, through MDLIVE. geha.com/MDLIVE

With all GEHA medical plans, you get discounts on eye exams, frames and lenses through EyeMed. ™ The EyeMed network includes LensCrafters, Target Optical, independent eye doctors and top optical retailers. Members also save on LASIK at participating locations. To learn more, visit geha.com/Vision

The HDHP plan also includes additional vision benefits. Learn more at geha.com/HDHPVision

All five GEHA plans offer access to TruHearing’s discounted pricing. 1 Most people see savings of 30% to 60% averaging more than $2,100 per pair.

Gym membership 1 10,000+ Active&Fit ™ fitness centers nationwide. geha.com/Fitness Electric toothbrush 1,2 70% off a cariPRO ™ premium electric toothbrush. geha.com/Toothbrush

Examples of what you pay for common in-network 4 vision services for all plans. 1

What you pay

Elevate

HDHP

Standard

Elevate Plus

High

Three GEHA plans – Standard Option, Elevate Plus and High Option – offer a hearing aid benefit. This benefit is per person, every 36 months for adults. TruHearing discount pricing can be combined with the Standard, Elevate Plus or High hearing aid benefit for even greater savings. Although GEHA’s Elevate and HDHP plans don’t include hearing aid benefits, members of those plans can use the TruHearing hearing aid discount program.

Eye exams retail price Frames retail price

$0

$5

$5

$0

$5

60% of price

$0 under $100 plus 80% over $100

60% of price

60% of price

60% of price

Health Advice Line Talk with a nurse 24/7. geha.com/Healthline

Eyeglass lenses, standard plastic single vision retail price Contact lens, conventional retail price

Up to $50

$10

Up to $50

Up to $50

Up to $50

Biometric screening Free screenings at select nationwide locations for HDHP, Standard Option and High Option plan members. geha.com/Screenings

85% of price

$10 under $110 plus 85% over $110

85% of price

85% of price

85% of price

For more hearing aid savings examples, visit geha.com/Hearing

GEHA’s benefit pays

Medical alert system 1 Get free activation, plus a 10% monthly discount. geha.com/LifeAlert

Standard

Elevate Plus

High

$2,500

$1,500

$2,500

1 These benefits are neither offered nor guaranteed under contract with the FEHB Program, but are made available to all enrollees who become members of GEHA and their eligible family members. 2 The cariPRO TM premium toothbrush removes seven times more plaque than a regular brush, is completely waterproof and comes with a two-year manufacturer‘s warranty. Replacement brush heads with high-quality DuPont TM bristles are also available at this exclusive, member-only price. 3 If deductible is met, HDHP member will be charged by MDLIVE but GEHA will then reimburse the member 100% of the billed charge. 4 Elevate, Standard, Elevate Plus and High only when you visit an EyeMed provider.

Teeth whitening 1 Discounts for Smile Brilliant home teeth whitening products such as trays, whitening and desensitizing gel. geha.com/Whitening

4

5

Elevate + Medicare

Medical benefits for Elevate. What you pay in-network. 3 geha.com/Find-Care – Unlimited telehealth visits with MDLIVE geha.com/MDLIVE – Preventive care; adult routine screenings

Self Only premiums.

1 2

Calendar year deductible applies.

The in-network out-of-pocket maximum is the maximum amount of coinsurance, copays and deductibles you pay for all family members before GEHA begins paying for 100% of covered services. This is a combined maximum for both medical care and prescriptions. 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. Refer to geha.com/Prescriptions for formulary and specialty coverage for specific medications. Over 30-day specialty copay based on days of therapy. The drug cost share is two times for drugs that provide 60 days‘ worth of therapy and three times the copay for drugs that provide 90 days‘ worth of therapy. These benefits are neither offered nor guaranteed under contract with the FEHB Program, but are made available to all enrollees who become members of a GEHA medical plan and their eligible family members.

Enroll code 254. geha.com/Enroll

$0

$102.53

Retirees monthly

Get rewarded for healthy living and enjoy GEHA’s lowest premium plan. X Earn up to $500 for Self Only or $1,000 for Self Plus One and Self and Family through Wellness Pays rewards. X Low $10 copays for unlimited primary care visits and $25 copays for unlimited specialist visits. X Low copays for chiropractic and acupuncture visits. X Digital tools to navigate your health care experience. Learn more at geha.com/ElevateLearn

Self Plus One premiums.

– Primary physician office visit – MinuteClinic © (where available) geha.com/MinuteClinic – Chiropractic care; up to 12 visits per year (spinal manipulation therapy) – Acupuncture; up to 20 treatments per year

3

Enroll code 256 . geha.com/Enroll

$10

4

$235.83

Retirees monthly

Self and Family premiums.

5

– Specialist care; office visit

$25

Enroll code 255 . geha.com/Enroll

– Urgent care

$50

$287.10

Retirees monthly

– Emergency care – Hospital care; inpatient and outpatient – Outpatient professional surgical services

6

25% 1

Benefits included with your Elevate plan. Unlimited telehealth visits with MDLIVE

geha.com/MDLIVE geha.com/Vision geha.com/Hearing geha.com/Fitness geha.com/Toothbrush geha.com/Whitening

How to enroll If you are a retired federal

– Inpatient professional surgical services

$250

Vision discount 6

employee, you can sign up for a GEHA medical plan by completing OPM form 2809, available through the Office of Personnel Management. Learn more at geha.com/Enroll OPM Open Season online system: retireefehb.opm.gov/Annuitant OPM Open Season Express: 800.332.9798

Hearing aid discount 6 Gym membership 6 Electric toothbrush 6 Teeth whitening 6

Prescription benefits for Elevate. What you pay in-network. 3,4 geha.com/Prescriptions

$4 50% ($500 max) 100% 50% ($500 max) 100%

Generic Preferred brand-name Non-preferred brand-name

30-day retail

Yearly deductible & out-of-pocket max 2 for Elevate. What you pay in-network. 3

Generic and preferred brand-name Non-preferred brand-name

30-day 5 specialty CVS exclusive

$500 $7,000 $1,000 $14,000

Yearly deductible Out-of-pocket max Yearly deductible Out-of-pocket max

Self Only

To provide a low premium, this plan does not include mail order prescriptions or out-of-network pharmacy coverage. It has a limited pharmacy network. Find a pharmacy at geha.com/Find-Care

geha.com/Medicare 800.262.4342

Self Plus One Self and Family

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.

6

7

HDHP + Medicare

Medical benefits for HDHP. What you pay in-network. 3 geha.com/Find-Care – Unlimited telehealth visits with MDLIVE geha.com/MDLIVE $0 1,6 – Preventive care; adult routine screenings – Preventive lab services – Preventive dental care, twice yearly $0

Self Only premiums.

1 2

Calendar year deductible applies.

The in-network out-of-pocket maximum is the maximum amount of coinsurance, copays and deductibles you pay for all family members before GEHA begins paying for 100% of covered services. This is a combined maximum for both medical care and prescriptions. 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, refer to GEHA’s 2021 plan brochure RI 71-014 (HDHP) at geha.com/PlanBrochure Refer to geha.com/Prescriptions for formulary and specialty coverage for specific medications. 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. If deductible is met, high deductible health plan (HDHP) member will be charged by MDLIVE but GEHA will then reimburse the member 100% of the billed charge. These benefits are neither offered nor guaranteed under contract with the FEHB Program, but are made available to all enrollees who become members of a GEHA medical plan and their eligible family members. Net deductible: This is the remaining amount after you subtract the annual GEHA contribution from the annual deductible. This is your out-of-pocket cost before plan benefits begin.

Enroll code 341 . geha.com/Enroll

$132.96

Retirees monthly

A lower-than-expected deductible. Low premiums. GEHA contributes to an HRA. X Pay 5% of medical services after deductible is met. X GEHA contributes $900 (Self Only) or $1,800 (Self Plus One or Self and Family) to your HRA, which can reduce the yearly net deductible 8 to $600 or $1,200 , respectively. X You can use HRA funds to reimburse Medicare premiums. Benefits included with your HDHP plan. Unlimited telehealth visits with MDLIVE 6 geha.com/MDLIVE Vision benefit and discount 7 geha.com/Vision Hearing aid discount 7 geha.com/Hearing Gym membership 7 geha.com/Fitness Health Advice Line geha.com/Healthline Medical alert system 7 geha.com/LifeAlert Biometric screening geha.com/Screenings Out-of-pocket max 2 for HDHP. What you pay in-network. 3 Self Only Out-of-pocket max $5,000 Self Plus One, Self and Family Out-of-pocket max $10,000 Yearly net deductible 8 for HDHP. What you pay in-network. 3 Yearly deductible Yearly net deductible after GEHA contribution Self Only $1,500 $600 Self Plus One, Self and Family $3,000 $1,200

Self Plus One premiums.

3

Enroll code 343 . geha.com/Enroll

– Primary physician office visit – Specialist care; office visit – Urgent care – Emergency care – Hospital care; inpatient and outpatient – MinuteClinic © (where available) geha.com/MinuteClinic – Lab (non-preventive) and X-ray services – Professional surgical services; inpatient and outpatient – Chiropractic care; up to 20 visits per year (spinal manipulation therapy)

$285.87

Retirees monthly

4

Self and Family premiums.

5

5% ¹

Enroll code 342 . geha.com/Enroll

$344.60

Retirees monthly

6

Balance after GEHA pays $20 per visit ¹ Balance after GEHA pays $25 per year ¹

7

How to enroll If you are a retired federal

– Chiropractic X-rays

employee, you can sign up for a GEHA medical plan by completing OPM form 2809, available through the Office of Personnel Management. Learn more at geha.com/Enroll OPM Open Season online system: retireefehb.opm.gov/Annuitant OPM Open Season Express: 800.332.9798

8

Prescription benefits for HDHP. What you pay in-network. 1,3,4,5 geha.com/Prescriptions

25% 40% 25% 40% 25% 40%

Generic and preferred brand-name Non-preferred brand name Generic and preferred brand-name Non-preferred brand-name Generic and preferred brand-name Non-preferred brand-name

30-day retail

90-day mail service

geha.com/Medicare 800.262.4342

30-day specialty CVS exclusive

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.

8

9

Standard Option + Medicare

Self Only premiums.

Medical benefits for Standard with Medicare A & B primary. What you pay in- or out-of-network. geha.com/Find-Care – Unlimited telehealth visits with MDLIVE geha.com/MDLIVE

1

These benefits are neither offered nor guaranteed under contract with the FEHB Program, but are made available to all enrollees who become members of a GEHA medical plan and their eligible family members. The in-network out-of-pocket maximum is the maximum amount of coinsurance, copays and deductibles you pay for all family members before GEHA begins paying for 100% of covered services. This is a combined maximum for both medical care and prescriptions. 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, refer to GEHA’s 2021 plan brochure RI 71-006 (High and Standard) at geha.com/PlanBrochure Refer to geha.com/Prescriptions for formulary and specialty coverage for specific medications. If you choose a brand-name medication when a generic is available, you will be charged the generic copay plus the Over 30-day specialty copay based on days of therapy. The drug cost share is two times for drugs that provide 60 days‘ worth of therapy and three times the copay for drugs that provide 90 days‘ worth of therapy. difference in cost between the brand-name and the generic.

Enroll code 314 . geha.com/Enroll

$135.77

Retirees monthly

– Preventive care; adult routine screenings – Lab, X-ray and diagnostic test services – MinuteClinic © (where available) geha.com/MinuteClinic – Primary physician office visit – Specialist care; office visit – Urgent care – Emergency care – Hospital care; inpatient and outpatient – Professional surgical services; inpatient and outpatient

2

Self Plus One premiums. Enroll code 316 . geha.com/Enroll

Low premiums and a good choice for Medicare A & B primary members who take generic prescriptions. X You pay $0 for deductibles, copays and coinsurance whether your provider is in- or out-of-network. X You pay $0 for inpatient and outpatient hospital services, surgeries and office visits. X You pay $0 for unlimited telehealth visits, including licensed behavioral health therapists and dermatologists, through MDLIVE. X You pay $0 for deductibles and copays outside the United States. X $2,500 hearing aid benefit. Benefits included with your Standard plan. Unlimited telehealth visits with MDLIVE geha.com/MDLIVE Vision discount 1 geha.com/Vision Hearing aid discount 1 geha.com/Hearing Gym membership 1 geha.com/Fitness Electric toothbrush 1 geha.com/Toothbrush Teeth whitening 1 geha.com/Whitening Health Advice Line geha.com/Healthline Medical alert system 1 geha.com/LifeAlert Biometric screening geha.com/Screenings Out-of-pocket max 2 for Standard. What you pay in-network. 3 Self Only Out-of-pocket max $6,500 Self Plus One, Self and Family Out-of-pocket max $13,000

$0

$291.92

Retirees monthly

3

Self and Family premiums.

Enroll code 315 . geha.com/Enroll

– Chiropractic care; up to 20 visits per year (spinal manipulation therapy)

Balance after GEHA pays $20 per visit Balance after GEHA pays $25 per year

4

$357.17

Retirees monthly

5

– Chiropractic X-rays

How to enroll If you are a retired federal

– Preventive dental care; twice yearly

50% ³

6

employee, you can sign up for a GEHA medical plan by completing OPM form 2809, available through the Office of Personnel Management. Learn more at geha.com/Enroll OPM Open Season online system: retireefehb.opm.gov/Annuitant OPM Open Season Express: 800.332.9798

Prescription benefits for Standard. What you pay in-network. 3,4 geha.com/Prescriptions

$10 50% ($200 max 5 ) 50% ($300 max 5 ) $20 50% ($500 max 5 ) 50% ($600 max 5 ) 50% ($250 max 5 ) 50% ($400 max 5 )

Generic Preferred brand-name Non-preferred brand-name Generic Preferred brand-name Non-preferred brand-name

30-day retail

90-day mail service

Generic and preferred brand-name Non-preferred brand-name

30-day 6 specialty CVS exclusive

geha.com/Medicare 800.262.4342

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.

10

11

Elevate Plus + Medicare

Self Only premiums.

Medical benefits for Elevate Plus with Medicare A & B primary. What you pay in- or out-of-network. geha.com/Find-Care

1

The in-network out-of-pocket maximum is the maximum amount of coinsurance and copays you pay for all family members before GEHA begins paying for 100% of covered services. This is a combined maximum for both medical care and prescriptions. 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. Refer to geha.com/Prescriptions for formulary and specialty coverage for specific medications. If you choose a brand-name medication when a generic is available, you will be charged the generic copay plus the Over 30-day specialty copay based on days of therapy. The drug cost share is two times for drugs that provide 60 days‘ worth of therapy and three times the copay for drugs that provide 90 days‘ worth of therapy. These benefits are neither offered nor guaranteed under contract with the FEHB Program, but are made available to all enrollees who become members of a GEHA medical plan and their eligible family members. difference in cost between the brand-name and the generic.

Enroll code 251 . geha.com/Enroll

– Unlimited telehealth visits with MDLIVE geha.com/MDLIVE – Preventive care; adult routine screenings – Lab, X-ray and diagnostic test services – MinuteClinic © (where available) geha.com/MinuteClinic

$163.28

Retirees monthly

X You pay $0 for medical deductibles, copays and coinsurance whether your provider is in- or out-of-network. X Earn up to $500 for Self Only or $1,000 for Self Plus One and Self and Family through Wellness Pays rewards. X Comprehensive drug list and mail order service for prescriptions. info.caremark.com/GEHA X $1,500 hearing aid benefit. X Digital tools to navigate your health care experience. Learn more at geha.com/ElevateLearn Medicare A & B primary members get rewarded for healthy living and enjoy mail order prescription benefits with affordable premiums.

2

Self Plus One premiums.

Enroll code 253 . geha.com/Enroll

– Primary physician office visit – Specialist care; office visit – Urgent care – Emergency care

3

$380.93

Retirees monthly

$0

4

Self and Family premiums.

– Hospital care; inpatient and outpatient – Chiropractic care; up to 15 visits per year (spinal manipulation therapy) – Acupuncture; up to 20 treatments per year – Professional surgical services; inpatient and outpatient

Enroll code 252 . geha.com/Enroll

5

$404.93

Retirees monthly

6

How to enroll If you are a retired federal

Benefits included with your Elevate Plus plan. Unlimited telehealth visits with MDLIVE

Prescription benefits for Elevate Plus. What you pay in-network. 2,3 geha.com/Prescriptions

geha.com/MDLIVE geha.com/Vision geha.com/Hearing geha.com/Fitness geha.com/Toothbrush geha.com/Whitening geha.com/Healthline geha.com/LifeAlert geha.com/Screenings

employee, you can sign up for a GEHA medical plan by completing OPM form 2809, available through the Office of Personnel Management. Learn more at geha.com/Enroll OPM Open Season online system: retireefehb.opm.gov/Annuitant OPM Open Season Express: 800.332.9798

Vision discount 6

$5 $80 4 40% 4 $12 $200 4 40% 4

Generic Preferred brand-name Non-preferred brand-name Generic Preferred brand-name Non-preferred brand-name

Hearing aid discount 6 Gym membership 6 Electric toothbrush 6 Teeth whitening 6 Health Advice Line Medical alert system 6 Biometric screening

30-day retail

90-day mail service

40% ($500 max 4 ) 40% 4

Generic and preferred brand-name Non-preferred brand-name

30-day 5 specialty CVS exclusive

Out-of-pocket max 1 for Elevate Plus. What you pay in-network. 2 Self Only Out-of-pocket max $6,000 Self Plus One, Self and Family Out-of-pocket max $12,000

This plan has no out-of-network pharmacy coverage and has a limited pharmacy network. Find a pharmacy at geha.com/Find-Care

geha.com/Medicare 800.262.4342

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.

12

13

High Option + Medicare

Self Only premiums.

Medical benefits for High with Medicare A & B primary. What you pay in- or out-of-network. geha.com/Find-Care – Unlimited telehealth visits with MDLIVE geha.com/MDLIVE

1

These benefits are neither offered nor guaranteed under contract with the FEHB Program, but are made available to all enrollees who become members of a GEHA medical plan and their eligible family members. The in-network out-of-pocket maximum is the maximum amount of coinsurance, copays and deductibles you pay for all family members before GEHA begins paying for 100% of covered services. This is a combined maximum for both medical care and prescriptions. 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, refer to GEHA’s 2021 plan brochure RI 71-006 (High and Standard) at geha.com/PlanBrochure Refer to geha.com/Prescriptions for formulary and specialty coverage for specific medications. If you choose a brand-name medication when a generic is available, you will be charged the generic copay plus the Costs for initial prescription and first refill. You pay 50% for third and additional refills at retail for 30-day supply. For long-term prescriptions, use mail order or your local retail CVS Pharmacy store (90-day supply) for greater cost savings. Over 30-day specialty copay based on days of therapy. The drug cost share is two times for drugs that provide 60 days‘ worth of therapy and three times the copay for drugs that provide 90 days‘ worth of therapy. difference in cost between the brand-name and the generic.

Enroll code 311 . geha.com/Enroll

$234.31

Retirees monthly

Medicare A & B primary members pay less for brand-name prescription medications. Plan includes a $600 Medicare Part B premium reimbursement. geha.com/MRA X You pay $0 for deductibles, copays and coinsurance whether your provider is in- or out-of-network. X You pay $0 for inpatient and outpatient hospital services, surgeries and office visits. X You pay $0 for unlimited telehealth visits, including licensed behavioral health therapists and dermatologists, through MDLIVE. X You pay $0 for deductibles and copays outside the United States. X $2,500 hearing aid benefit. Benefits included with your High plan. Unlimited telehealth visits with MDLIVE geha.com/MDLIVE Vision discount 1 geha.com/Vision Hearing aid discount 1 geha.com/Hearing Gym membership 1 geha.com/Fitness Electric toothbrush 1 geha.com/Toothbrush Teeth whitening 1 geha.com/Whitening Health Advice Line geha.com/Healthline Medical alert system 1 geha.com/LifeAlert Biometric screening geha.com/Screenings Out-of-pocket max 2 for High. What you pay in-network. 3 Self Only Out-of-pocket max $5,000 Self Plus One, Self and Family Out-of-pocket max $10,000

2

– Preventive care; adult routine screenings – Lab, X-ray and diagnostic test services – MinuteClinic © (where available) geha.com/MinuteClinic

Self Plus One premiums.

Enroll code 313 . geha.com/Enroll

$0

– Primary physician office visit – Specialist care; office visit – Urgent care – Emergency care – Hospital care; inpatient and outpatient – Professional surgical services; inpatient and outpatient

$545.85

Retirees monthly

3

Self and Family premiums.

Enroll code 312 . geha.com/Enroll

4

$680.61

Retirees monthly

Balance after GEHA pays $20 per visit Balance after GEHA pays $25 per year Balance after GEHA pays $22 per visit

– Chiropractic care; up to 20 visits per year (spinal manipulation therapy)

5

How to enroll If you are a retired federal

– Chiropractic X-rays

6

employee, you can sign up for a GEHA medical plan by completing OPM form 2809, available through the Office of Personnel Management. Learn more at geha.com/Enroll OPM Open Season online system: retireefehb.opm.gov/Annuitant OPM Open Season Express: 800.332.9798

– Preventive dental care

Prescription benefits for High with Medicare A & B primary. What you pay in-network. 3,4 geha.com/Prescriptions

7

$10 6 20% ($150 max 5,6 ) 35% ($200 max 5,6 ) $15 15% ($350 max 5 ) 30% ($500 max 5 ) 15% ($150 max 5 ) 30% ($200 max 5 )

Generic Preferred brand-name Non-preferred brand-name Generic Preferred brand-name Non-preferred brand-name

30-day retail

90-day mail service

geha.com/Medicare 800.262.4342

Generic and preferred brand-name Non-preferred brand-name

30-day 7 specialty CVS exclusive

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.

14

15

Helpful resources.

Talk to a Benefits Adviser who can help you choose from GEHA’s portfolio of plans.

800.262.4342

geha.com/Medicare 800.262.4342

retireefehb.opm.gov/ Annuitant

OPM Open Season online system.

/gehahealth

800.332.9798

OPM Open Season Express.

/company/gehahealth

Explore how GEHA medical plans work with Medicare.

© 2020-2021 Government Employees Health Association, Inc. All rights reserved. Please recycle. To find out more information about plans available under the FEHB Program, including SBCs for other FEHB plans, please visit opm.gov/Insure Notice of Summary of Benefits and Coverage (SBC): Availability of Summary Health Information: The Federal Employees Health Benefit (FEHB) Program offers numerous health benefits plans and coverage options. Choosing a health plan and coverage option is an important decision. To help you make an informed choice, each FEHB plan makes available a Summary of Benefits and Coverage (SBC) about each of its health coverage options, online and in paper. The SBC summarizes important information in a standard format to help you compare plans and options. GEHA’s SBCs are available on the internet at geha.com/SBC Paper copies are also available, free of charge, by calling 800.821.6136 . This is a brief description of the features of Government Employees Health Association, Inc.’s medical plans. Before making a final decision, please read the GEHA Federal brochures available at geha.com/PlanBrochure . All benefits are subject to the definitions, limitations and exclusions set forth in the Federal brochure. Download the plan brochure For information and changes to GEHA’s medical plans, see our three plan brochures – RI 71-006 (High and Standard Options), RI 71-014 (HDHP) and RI 71-018 (Elevate and Elevate Plus) – which are available at geha.com/PlanBrochure

geha.com/Medicare

Search our extensive nationwide network for a provider or an urgent care clinic near you.

geha.com/Find-Care

Answer a few questions to see which plan may be your best fit.

geha.com/Select-A-Plan

Verify drug costs based on your benefit plan and prescription dosage.

geha.com/Prescriptions

Learn about your coverage when you’re outside of the United States.

geha.com/OutsideUSA

If you are a retired federal employee, you can sign up for a GEHA medical plan by completing OPM form 2809, available through the Office of Personnel Management.

geha.com/Enroll

OS-BKT-0920-002

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