2021 GEHA Medicare Benefits Guide

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.

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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

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

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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

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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.

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www.geha.com

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