2021 GEHA Medicare Benefits Guide

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.

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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

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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

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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.

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www.geha.com

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