2021 GEHA Medical Benefits Guide

MEDICAL PLANS 2021 GEHA

Choose from five unique medical plans designed to meet you where you are in life.

geha.com | 800.262.4342

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Choose from five unique medical plans for 2021.

Standard Option Page 8

geha.com/Standard

GEHA offers you five unique medical plans that empower you to achieve the health you need to live the life you want.

Whether you’re focused on wellness, saving for future health care needs or needing a lot of (or a little) health care, GEHA has an option that is right for you. All GEHA plans offer worldwide coverage and a mix of benefits. Choose possible.

X $15 copay for in-network primary care visits, $30 copay for in-network specialist visits. X Pay $0 for routine, in-network maternity care. X Pay $0 for unlimited telehealth visits, including pediatricians, licensed behavioral health therapists and dermatologists, through MDLIVE.

Elevate Plus Page 10

Elevate Page 4

geha.com/ElevatePlus

geha.com/Elevate

X 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 Fixed costs, no in-network deductible, copays for common medical expenses and out-of-network medical coverage. X Earn up to $500 for Self Only or $1,000 for Self Plus One and Self and Family through Wellness Pays rewards. X $0 out-of-pocket costs for common surgeries through BridgeHealth.

High Option Page 12

HDHP Page 6

geha.com/High

geha.com/HDHP

X An HSA-compatible plan with a low premium. X GEHA contributes $900 (Self Only) or $1,800 (Self Plus One or Self and Family) to your HSA, which can reduce the yearly net deductible¹ to $600 or $1,200 , respectively. X You pay only 5% of medical services after your low deductible is met. X Includes a complete vision benefit along with $0 in-network preventive dental benefits, all with no deductible.

X Comprehensive brand-name and specialty prescription coverage. X Low copays for doctor visits ( $20 primary and specialist). X $600 Medicare Part B premium reimbursement. X $2,500 hearing aid benefit. X Low cost-share for a variety of inpatient and outpatient services ( 10% coinsurance).

geha.com | 800.262.4342

1 Net deductible 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.

2

3

Elevate

Self Only premiums.

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 – Well-child visit; up to age 22 – Maternity; routine preventive care – Chiropractic X-rays $0 – 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 $10 – Specialist care; office visit $25 – Urgent care $50 – Emergency care – Hospital care; inpatient including maternity – Hospital care; outpatient – Lab services – Other diagnostic services – Outpatient professional surgical services 25% 1 – Inpatient professional surgical services $250

1 Calendar year deductible applies. 2 The 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 of covered services. This is a combined maximum for both medical care and prescriptions. 3 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. 4 Refer to geha.com/Prescriptions for formulary and specialty coverage for specific medications. 5 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. 6 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. 7 Subject to any eligibility limitations. See info.bridgehealth.com/GEHA for more information.

Enroll code 254 . geha.com/Enroll

$47.32

Non-Postal worker biweekly

Get rewarded for healthy living and enjoy GEHA's lowest premium plan.

$45.43

Postal worker biweekly – Category 1

$39.28

Postal worker biweekly – Category 2

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

$102.53

Retirees monthly

Self Plus One premiums.

Enroll code 256 . geha.com/Enroll

$108.84

Non-Postal worker biweekly

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

$104.49

Postal worker biweekly – Category 1

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

$90.34

Postal worker biweekly – Category 2

Vision discount 6

$235.83

Retirees monthly

Gym membership 6 Electric toothbrush 6

Self and Family premiums.

Teeth whitening 6

Enroll code 255 . geha.com/Enroll

$0 out-of-pocket surgery costs and concierge care coordinator through BridgeHealth 7

geha.com/BridgeHealth

$132.51

Non-Postal worker biweekly

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

$127.21

Postal worker biweekly – Category 1

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

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

Generic Preferred brand-name Non-preferred brand-name

$109.98

Postal worker biweekly – Category 2

30-day retail

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

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

$287.10

Retirees monthly

Self Only

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

30-day 5 specialty CVS exclusive

Self Plus One Self and Family

geha.com/Elevate 800.262.4342

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

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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HDHP

Self Only premiums.

Medical benefits for HDHP. What you pay in-network. 3 geha.com/Find-Care – Unlimited telehealth visits with MDLIVE geha.com/MDLIVE – Hospital care; inpatient maternity – Maternity; routine care $0 1,6 – Preventive care; adult routine screenings – Well-child visit; up to age 22 – Preventive dental care, twice yearly $0

1 Calendar year deductible applies. 2 The 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. 3 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 4 Refer to geha.com/Prescriptions for formulary and specialty coverage for specific medications. 5 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. 6 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. 7 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. 8 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

$61.37

Non-Postal worker biweekly

A lower-than-expected deductible. Low premiums. GEHA contributes to an HSA. X GEHA contributes $900 (Self Only) or $1,800 (Self Plus One or Self and Family) to your HSA, which can reduce the yearly net deductible 8 to $600 or $1,200 , respectively. X Reduce your out-of-pocket expenses with a health savings account (HSA). geha.com/HSA Benefits included with your HDHP plan. Unlimited telehealth visits with MDLIVE 6 geha.com/MDLIVE Vision benefit and discount 8 geha.com/Vision Hearing aid discount 7 geha.com/Hearing Gym membership 7 geha.com/Fitness Electric toothbrush 7 geha.com/Toothbrush Teeth whitening 7 geha.com/Whitening Health Advice Line geha.com/Healthline Medical alert system 7 geha.com/LifeAlert Biometric screening geha.com/Screenings

$58.91

Postal worker biweekly – Category 1

$50.94

Postal worker biweekly – Category 2

$132.96

Retirees monthly

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

Self Plus One premiums.

Enroll code 343 . geha.com/Enroll

$131.94

Non-Postal worker biweekly

5% ¹

$126.66

Postal worker biweekly – Category 1

$109.51

Postal worker biweekly – Category 2

$285.87

Retirees monthly

Self and Family premiums.

Balance after GEHA pays $20 per visit¹ Balance after GEHA pays $25 per year¹

Enroll code 342 . geha.com/Enroll

– Chiropractic X-rays

$159.04

Non-Postal worker biweekly

Yearly net deductible 8 for HDHP. What you pay in-network. 3

$152.68

Postal worker biweekly – Category 1

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

Yearly deductible Yearly net deductible after GEHA contribution

$132.01

Postal worker biweekly – Category 2

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

$1,500

$600

Self Only

$344.60

Retirees monthly

30-day retail

$3,000

$1,200

Self Plus One, Self and Family

Out-of-pocket max 2 for HDHP. What you pay in-network. 3 Self Only Out-of-pocket max

90-day mail service

geha.com/HDHP 800.262.4342

$5,000

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.

$10,000

Self Plus One, Self and Family

Out-of-pocket max

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Standard Option

Medical benefits for Standard. What you pay in-network. 3 geha.com/Find-Care – Unlimited telehealth visits with MDLIVE geha.com/MDLIVE – Preventive care; adult routine screenings – Well-child visit; up to age 22

Self Only premiums.

1 Calendar year deductible applies. 2 The 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. 3 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 4 Refer to geha.com/Prescriptions for formulary and specialty coverage for specific medications. 5 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. 6 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. 7 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 314 . geha.com/Enroll

$62.66

Non-Postal worker biweekly

Traditional coverage. Affordable premiums.

$0

$60.16

Postal worker biweekly – Category 1

– Maternity; routine preventive care – Hospital care; inpatient maternity – Lab Card services geha.com/LabCard

X $15 copay for in-network primary care visits, $30 copay for in-network specialist visits. X Pay $0 for routine, in-network maternity care. X Pay $0 for unlimited telehealth visits, including behavioral health therapists and dermatologists, through MDLIVE. X Plan works well with Medicare. geha.com/Medicare Benefits included with your Standard plan. Unlimited telehealth visits with MDLIVE geha.com/MDLIVE Vision discount 7 geha.com/Vision Hearing aid discount 7 geha.com/Hearing Gym membership 7 geha.com/Fitness Electric toothbrush 7 geha.com/Toothbrush Teeth whitening 7 geha.com/Whitening Health Advice Line geha.com/Healthline Medical alert system 7 geha.com/LifeAlert Biometric screening geha.com/Screenings Lab Card services geha.com/LabCard

$52.01

Postal worker biweekly – Category 2

$135.77

Retirees monthly

– MinuteClinic © (where available) geha.com/MinuteClinic

$10 $15 $30 $35 15%

– Primary physician office visit

Self Plus One premiums.

– Specialist care; office visit

Enroll code 316 . geha.com/Enroll

– Urgent care

– Lab services (non-Lab Card)

$134.73

Non-Postal worker biweekly

– Emergency care – Hospital care; inpatient and outpatient – Professional surgical services – X-ray services – Other diagnostic services – Acupuncture; up to 20 treatments per year

$129.35

Postal worker biweekly – Category 1

15% 1

$111.83

Postal worker biweekly – Category 2

$291.92

Retirees monthly

Self and Family premiums.

50%

– Preventive dental care; twice yearly

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

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

Enroll code 315 . geha.com/Enroll

$164.85

Non-Postal worker biweekly

– Chiropractic X-rays

$158.26

Postal worker biweekly – Category 1

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

$136.83

Postal worker biweekly – Category 2

$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

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

$357.17

Retirees monthly

30-day retail

$350 $6,500 $700 $13,000

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

Self Only

90-day mail service

geha.com/Standard 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. 8

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

30-day 6 specialty CVS exclusive

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Elevate Plus

Self Only premiums.

Medical benefits for Elevate Plus. What you pay in-network. 2 geha.com/Find-Care – Unlimited telehealth visits with MDLIVE geha.com/MDLIVE – Preventive care; adult routine screenings – Well-child visit; up to age 22 – Lab services $0 – MinuteClinic © (where available) geha.com/MinuteClinic $10 – Primary physician office visit – Chiropractic care; up to 15 visits per year (spinal manipulation therapy) – Acupuncture; up to 20 treatments per year $20 – Specialist care; office visit $35 – Urgent care $50 – Other diagnostic services $50 8 – Emergency care – Outpatient and in-office professional surgical services $150 – Inpatient professional surgical services $200

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. 2 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. 3 Refer to geha.com/Prescriptions for formulary and specialty coverage for specific medications. 4 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. 5 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. 6 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. 7 Subject to any eligibility limitations. For more information, see info.bridgehealth.com/GEHA 8 You pay 25% for advanced outpatient diagnostic tests such as, CT scans and MRIs. Refer to GEHA’s 2021 plan brochure RI 71-018 (Elevate and Elevate Plus) for a complete list at geha.com/PlanBrochure

Enroll code 251 . geha.com/Enroll

$75.36

Non-Postal worker biweekly

Predictable costs and no in-network deductible. Copays for common medical expenses and includes out-of-network medical coverage. X Earn up to $500 for Self Only or $1,000 for Self Plus One and Self and Family through Wellness Pays rewards. X $0 out-of-pocket surgery costs and concierge care coordinator through BridgeHealth. 7 X Low copays for chiropractic and acupuncture visits. X Digital tools to navigate your health care experience. Learn more at geha.com/ElevateLearn Benefits included with your Elevate Plus plan. Unlimited telehealth visits with MDLIVE geha.com/MDLIVE Vision discount 6 geha.com/Vision Hearing aid discount 6 geha.com/Hearing Gym membership 6 geha.com/Fitness Electric toothbrush 6 geha.com/Toothbrush Teeth whitening 6 geha.com/Whitening $0 out-of-pocket surgery costs and concierge care coordinator through BridgeHealth 7 geha.com/BridgeHealth

$72.35

Postal worker biweekly – Category 1

$62.55

Postal worker biweekly – Category 2

$163.28

Retirees monthly

Self Plus One premiums.

Enroll code 253 . geha.com/Enroll

$175.81

Non-Postal worker biweekly

$168.62

Postal worker biweekly – Category 1

$147.06

Postal worker biweekly – Category 2

$200 per day up to $1,000 per admission $200 per day per facility

– Hospital care; inpatient including maternity

$380.93

Retirees monthly

– Hospital care; outpatient

Self and Family premiums.

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

Enroll code 252 . geha.com/Enroll

$186.89

Non-Postal worker biweekly

$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

30-day retail

$179.42

Postal worker biweekly – Category 1

$155.12

Postal worker biweekly – Category 2

Yearly deductibles & out-of-pocket max 1 for Elevate Plus. What you pay in-network. 2

90-day mail service

$404.93

Retirees monthly

$0 $6,000 $0 $12,000

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

40% ($500 max 4 ) 40% 4

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

30-day 5 specialty CVS exclusive

Self Only

geha.com/ElevatePlus 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.

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

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High Option

Self Only premiums.

Medical benefits for High. What you pay in-network. 3 geha.com/Find-Care – Unlimited telehealth visits with MDLIVE geha.com/MDLIVE – Preventive care; adult routine screenings – Well-child visit; up to age 22 – Maternity; routine preventive care – Emergency care; accidental (must be within 72 hours) – Hospital care; inpatient maternity – Lab Card services geha.com/LabCard $0 – MinuteClinic © (where available) geha.com/MinuteClinic $10

1 Calendar year deductible applies. 2 The 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. 3 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 4 Refer to geha.com/Prescriptions for formulary and specialty coverage for specific medications. 5 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. 6 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. 7 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. 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. 8 These benefits are neither offered

Enroll code 311 . geha.com/Enroll

$108.14

Non-Postal worker biweekly

Comprehensive brand-name and specialty prescription coverage. Works best with Medicare and includes a $600 Medicare Part B premium reimbursement. geha.com/MRA X Low copays for doctor visits ( $20 primary and specialist). X $600 Medicare Part B premium reimbursement. geha.com/Medicare X $2,500 hearing aid benefit. X Low cost-share for a variety of inpatient and outpatient services ( 10% coinsurance). Benefits included with your High plan. Unlimited telehealth visits with MDLIVE geha.com/MDLIVE Vision discount 8 geha.com/Vision Hearing aid discount 8 geha.com/Hearing Gym membership 8 geha.com/Fitness Electric toothbrush 8 geha.com/Toothbrush Teeth whitening 8 geha.com/Whitening Health Advice Line geha.com/Healthline Medical alert system 8 geha.com/LifeAlert Biometric screening geha.com/Screenings Lab Card services geha.com/LabCard Yearly deductible & out-of-pocket max 2 for High. What you pay in-network. 3

$104.78

Postal worker biweekly – Category 1

$94.72

Postal worker biweekly – Category 2

$234.31

Retirees monthly

– Primary physician office visit – Specialist care; office visit

Self Plus One premiums.

$20

$35 10%

– Urgent care

Enroll code 313 . geha.com/Enroll

– Lab services (non-Lab Card)

$251.93

Non-Postal worker biweekly

– Emergency care; medical – Hospital care; outpatient – Professional surgical services – X-ray services – Other diagnostic services – Acupuncture; up to 20 treatments per year

$244.74

Postal worker biweekly – Category 1

10% 1

$223.18

Postal worker biweekly – Category 2

$545.85

Retirees monthly

$100 per admission plus 10%

– Hospital care; inpatient

Self and Family premiums.

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

Balance after GEHA pays $20 per visit

Enroll code 312 . geha.com/Enroll

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

– Chiropractic X-rays

– Preventive dental care, twice yearly

$314.13

Non-Postal worker biweekly

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

$306.32

Postal worker biweekly – Category 1

$282.90

Postal worker biweekly – Category 2

$10 6 25% ($150 max 5,6 ) 40% ($200 max 5,6 ) $20 25% ($350 max 5 ) 40% ($500 max 5 ) 25% ($150 max 5 ) 40% ($200 max 5 )

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

30-day retail

$680.61

Retirees monthly

$350 $5,000 $700 $10,000

90-day mail service

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

Self Only

geha.com/High 800.262.4342

Self Plus One Self and Family

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. 12

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Vision benefits & discounts for GEHA plans.

Hearing aid benefits & discounts for GEHA plans.

Included benefits & discounts.

Unlimited MDLIVE 4 telehealth visits Access certified doctors, including pediatricians, licensed behavioral health therapists and dermatologists, through MDLIVE. geha.com/MDLIVE Gym membership 3 10,000+ Active&Fit ™ fitness centers nationwide. geha.com/Fitness Electric toothbrush 2,3 70% off a cariPRO ™ premium electric toothbrush. geha.com/Toothbrush

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.

Three GEHA plans – Standard Option, Elevate Plus and High Option – offer a hearing aid benefit, with no deductible. When you combine with TruHearing discount pricing³, you can save thousands of dollars off the retail price for new hearing aids. 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. For more information, visit geha.com/Hearing Elevate Plus plan benefit. GEHA’s Elevate Plus hearing aid benefit is $1,500 per person every 36 months for adults. Subtract the GEHA benefit from the TruHearing discounted price to determine what you pay. Standard Option and High Option plan benefit. GEHA’s Standard and High hearing aid benefit is $2,500 per person every 36 months for adults. Subtract the GEHA benefit from the TruHearing discounted price to determine what you pay.

To learn more, visit geha.com/Vision

The HDHP plan also includes additional vision benefits. Learn more at geha.com/HDHPVision Examples of what you pay for common in-network 1 vision services for all plans. 3

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

What you pay Elevate HDHP Standard Elevate Plus

High

Eye exams retail price

Biometric screening Free screenings at select nationwide locations for HDHP, Standard Option and High Option plan members. geha.com/Screenings Medical alert system 3 Get free activation, plus a 10% monthly discount. geha.com/LifeAlert Teeth whitening 3 Discounts for Smile Brilliant home teeth whitening products such as trays, whitening and desensitizing gel. geha.com/Whitening

Example: Starkey® Livio ™ 1000

Standard

Elevate Plus

High

$0

$5

$5

$0

$5

Average retail price

- $3,590

- $3,590

- $3,590

$0 under $100 plus 80% over $100

Frames retail price

60% of price

60% of price

60% of price

60% of price

- $1,950

- $1,950

- $1,950

TruHearing discounted price

-$2,500

-$1,500

-$2,500

GEHA benefit pays

Eyeglass lenses, standard plastic single vision retail price

- $0

- $450

- $0

You pay

Up to $50 $10

Up to $50

Up to $50

Up to $50

$10 under $110 plus 85% over $110

Contact lens, conventional retail price

85% of price

85% of price

85% of price

85% of price

1 Elevate, Standard, Elevate Plus and High only when you visit an EyeMed provider. 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 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. 4 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.

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Elevate & Elevate Plus plans earn Wellness Pays rewards.

HDHP, Standard Option and High Option plans earn Health Rewards.

It’s easy to earn rewards with Wellness Pays.

GEHA‘s digital platform hosted by Rally A fun, interactive health and wellness portal that keeps you motivated to live healthier. geha.com/ElevateLearn

Earn Health Rewards for completing healthy activities like a health risk assessment, a biometric screening, and online wellness workshops such as weight management, stress management or smoking cessation.

Achieve your health & wellness goals on your terms and earn rewards for healthy living. Two adult members per household (18+) can earn dollars on a Wellness Pays rewards card as you complete activities. Earn up to $500 each (maximum $1,000 per household) per year.

Two adult members per household (18+) can earn dollars on a Health Rewards card as you complete activities. Earn up to $250 each (maximum $500 per household) per year. The money you earn can be used for qualified medical expenses with your Health Rewards card. Learn more about Health Rewards available for HDHP, Standard Option and High Option plans at geha.com/HealthRewards

Learn more at geha.com/WellnessPays

Health survey Get rewarded for healthy habits and get personalized recommendations for activities and programs that you can work into your daily routine.

Rewardable activities

Elevate

Elevate Plus

Rewardable activities

HDHP

Standard

High

$10 per month

$10 per month

– Achieve Stride step goal

$10 per workshop

$10 per workshop

$10 per workshop

– Online wellness workshops

– Flu shot – One MDLIVE telehealth visit – Complete three Rally missions – Complete wellness quizzes – Biometric screening

$25

$25

$25

– Flu shot

$50

$50

– Cervical cancer screening (Pap)* – Colorectal cancer screening (colonoscopy or in-home kit)* – Breast cancer screening (mammogram)*

Online health coaching This coaching program creates a personalized program for your preferred learning style and commitment level.

$50

$50

$50

– First trimester prenatal appointment – One MDLIVE telehealth visit per year

$75

$75

– Health survey

– Annual physical – Cervical cancer screening (Pap)* – Colorectal cancer screening (colonoscopy)* – Breast cancer screening (mammogram)* – First trimester prenatal appointment – Complete online Rally coaching

– Health risk assessment – Biometric screening

$75

$75

$75

Hit your Stride, online Use the app to monitor your daily Stride goal. Get rewarded monthly when you hit your goals.

$100

$100

$10 - $175

$10 - $175

$10 - $175

– Wellness portal activities and preventive services

* Restrictions may apply.

– Complete Real Appeal – Quit for Life

$200

$200

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Compare medical benefits for all plans.

Medical benefits. What you pay in-network. 2

Medical benefits. What you pay in-network. 2

geha.com/Find-Care

geha.com/Find-Care

Elevate Plus

High

Elevate

HDHP

Standard

$0 1,3

Unlimited telehealth visits with MDLIVE geha.com/MDLIVE $0

$0

Unlimited telehealth visits with MDLIVE geha.com/MDLIVE $0

$0

- Preventive care; adult routine screenings - Well-child visit; up to age 22 - Maternity; routine preventive care

- Preventive care; adult routine screenings - Well-child visit; up to age 22 - Maternity; routine preventive care

$0

$0

$0

$0

$0

MinuteClinic © (where available) geha.com/MinuteClinic Primary physician office visit geha.com/Find-Care

$10 $20 $35 $50

$10 $20 $20 $35

MinuteClinic © (where available) geha.com/MinuteClinic Primary physician office visit geha.com/Find-Care

$10 $10 $25 $50

5% 1 5% 1 5% 1 5% 1 5% 1 5% 1 5% 1 $0 1 5% 1 5% 1 5% ¹

$10 $15 $30 $35

Specialist care; office visit

Specialist care; office visit

Urgent care

Urgent care

$150 $150

$0 (must be within 72 hours)

25% 1 25% 1 25% 1 25% 1 25% 1 $250 25% 1

15% 1 15% 1 15% 1

Emergency care; accidental Emergency care; medical Hospital care; inpatient Hospital care; inpatient maternity

Emergency care; accidental Emergency care; medical Hospital care; inpatient Hospital care; inpatient maternity

10% 1

$200 per day up to $1,000 per admission $200 per day up to $1,000 per admission

$100 per admission plus 10%

$0

$0

$200 per day per facility

10% 1 10% 1 10% 1

15% 1 15% 1 15% 1

Hospital care; outpatient

Hospital care; outpatient

$200 $150

Inpatient professional surgical services Outpatient professional surgical services Lab Card services geha.com/LabCard

Inpatient professional surgical services Outpatient professional surgical services Lab Card services geha.com/LabCard

$0

$0

No benefit

No benefit

No benefit

$0

10% 10% 1

25% 1 25% 1

5% 1 5% ¹

15% 15% 1

Lab services (non-Lab Card) Other diagnostic services

Lab services (non-Lab Card) Other diagnostic services

$50 4

Balance after GEHA pays $20 per visit, up to 20 visits per year¹ Balance after GEHA pays $25 per year¹

Balance after GEHA pays $20 per visit, up to 20 visits per year Balance after GEHA pays $25 per year

Balance after GEHA pays $20 per visit, up to 20 visits per year

$10 per visit, up to 12 visits per year

$20 per visit, up to 15 visits per year

Chiropractic (spinal manipulation therapy)

Chiropractic (spinal manipulation therapy)

$0

Balance after GEHA pays $25 per year

$0

Chiropractic X-rays

Chiropractic X-rays

Balance after GEHA pays $22 per visit, twice yearly

$0 twice yearly, no deductible

50% twice yearly

Preventive dental care

No benefit

Preventive dental care

No benefit

$20

10% 1

$10

5% 1

15% 1

Acupuncture; up to 20 treatments per year

Acupuncture; up to 20 treatments per year

1

Calendar year deductible applies.

3 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. 4 You pay 25% for advanced outpatient diagnostic tests such as, CT Scans and MRI’s. Refer to GEHA’s 2021 plan brochure RI 71-018 (Elevate and Elevate Plus) for a complete list at geha.com/PlanBrochure

2 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 one of GEHA‘s 2021 plan brochures: RI 71-006 (High and Standard), RI 71-014 (HDHP) or RI 71-018 (Elevate and Elevate Plus) at geha.com/PlanBrochure

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19

Example: It pays to stay in-network.

Compare out-of-pocket max for all plans.

Whether it’s a fixed dollar amount, or a percentage, we want you to understand what you pay for in- or out-of-network services. We’ve included an example below for a plan with a 10% coinsurance 1 for services in-network and 25% coinsurance for services out-of-network .

Out-of-pocket maximum. 1 What you pay in-network. 2

Elevate

HDHP

Standard

Elevate Plus

High

Example

In-network

Out-of-network

Self Only

$7,000

$5,000

$6,500

$6,000

$5,000

$150

$150

Provider’s billed rate

Self Plus One Self and Family

$14,000

$10,000

$13,000

$12,000

$10,000

– In-network provider’s contracted rate with GEHA – GEHA’s plan allowance¹ for out-of-network providers

$100

$100

90% of $100: $90

75% of $100: $75

What GEHA pays

Compare deductibles for all plans.

10% of $100: $10

25% of $100: $25

What you pay (coinsurance)

Yes: $50

You also pay the difference between the provider’s billed rate and GEHA’s plan allowance

No

Yearly deductible. What you pay in-network. 2

What you pay total for this service

$10

$75

Elevate

HDHP

Standard

Elevate Plus

High

1 See page 26 for definition.

$1,500 Yearly deductible -$900 GEHA contribution $600 Your net deductible 3 -$3,000 Yearly deductible -$1,800 GEHA contribution -$1,200 Your net deductible 3

Self Only

$500

$350

$0

$350

Resources for all plans

Self Plus One Self and Family

$1,000

$700

$0

$700

800.262.4342

Talk to a Benefits Adviser who can help me choose a GEHA plan

800.821.6136

Talk to GEHA Customer Care

geha.com/Find-Care

Find an in-network provider near me

1 The 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. 2 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 one of GEHA‘s 2021 plan brochures: RI 71-006 (High and Standard), RI 71-014 (HDHP) or RI 71-018 (Elevate and Elevate Plus) at geha.com/PlanBrochure 3 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.

geha.com/Select-A-Plan

Help me select a plan

info.caremark.com/GEHA

Check my 2021 drug costs

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21

Compare premiums for all plans.

Self Only. What you pay.

Self Only. What you pay.

Learn how to enroll at geha.com/Enroll

Learn how to enroll at geha.com/Enroll

Elevate

HDHP

Standard

Elevate Plus

High

Enrollment codes

254

341

314

Enrollment codes

251

311

$47.32 $45.43 $39.28 $102.53

$61.37 $58.91 $50.94 $132.96

$62.66 $60.16 $52.01 $135.77

$75.36 $72.35 $62.55 $163.28

$108.14 $104.78

Non-Postal worker biweekly

Non-Postal worker biweekly

Postal worker biweekly – Category 1

Postal worker biweekly – Category 1

$94.72

Postal worker biweekly – Category 2

Postal worker biweekly – Category 2

$234.31

Retirees monthly

Retirees monthly

Self Plus One. What you pay.

Self Plus One. What you pay.

Elevate

HDHP

Standard

Elevate Plus

High

Enrollment codes

253

313

Enrollment codes

256

343

316

$108.84 $104.49

$131.94 $126.66 $109.51 $285.87

$134.73 $129.35 $111.83 $291.92

$175.81 $168.62 $147.06 $380.93

$251.93 $244.74 $223.18 $545.85

Non-Postal worker biweekly

Non-Postal worker biweekly

Postal worker biweekly – Category 1

Postal worker biweekly – Category 1

$90.34

Postal worker biweekly – Category 2

Postal worker biweekly – Category 2

$235.83

Retirees monthly

Retirees monthly

Self and Family. What you pay.

Self and Family. What you pay.

Elevate

HDHP

Standard

Elevate Plus

High

Enrollment codes

255

342

315

Enrollment codes

252

312

$132.51 $127.21 $109.98 $287.10

$159.04 $152.68 $132.01 $344.60

$164.85 $158.26 $136.83 $357.17

$186.89 $179.42 $155.12 $404.93

$314.13 $306.32 $282.90 $680.61

Non-Postal worker biweekly

Non-Postal worker biweekly

Postal worker biweekly – Category 1

Postal worker biweekly – Category 1

Postal worker biweekly – Category 2

Postal worker biweekly – Category 2

Retirees monthly

Retirees monthly

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.

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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23

Compare prescription coverage for all plans.

What you pay in-network. 2,3

What you pay in-network. 2,3

geha.com/Prescriptions

geha.com/Prescriptions

Elevate

HDHP

Standard

Elevate Plus

High

$4

25% 1

$10

$5

$10 5

Generic

Generic

50% ($500 max)

25% 1,4

50% ($200 max 4 )

$80 4

25% ($150 max 4,5 )

30-day retail

Preferred brand-name

30-day retail

Preferred brand-name

100%

40% 1,4

50% ($300 max 4 )

40% 4

40% ($200 max 4,5 )

Non-preferred brand-name

Non-preferred brand-name

25% 1

$20

$12

$20

Generic

No benefit

Generic

25% 1,4

50% ($500 max 4 )

$200 4

25% ($350 max 4 )

90-day mail service

Preferred brand-name

No benefit

90-day mail service

Preferred brand-name

40% 1,4

50% ($600 max 4 )

40% 4

40% ($500 max 4 )

Non-preferred brand-name

No benefit

Non-preferred brand-name

50% ($500 max)

25% 1,4

50% ($250 max 4 )

40% ($500 max 4 )

25% ($150 max 4 )

Generic and preferred brand-name

Generic and preferred brand-name

30-day 6 specialty CVS exclusive

30-day 6 specialty CVS exclusive

100%

40% 1,4

50% ($400 max 4 )

40% 4

40% ($200 max 4 )

Non-preferred brand-name

Non-preferred brand-name

Elevate and Elevate Plus do not have out-of-network pharmacy coverage and have a limited pharmacy network. Learn more about prescription coverage at geha.com/Prescriptions

Elevate and Elevate Plus do not have out-of-network pharmacy coverage and have a limited pharmacy network. Learn more about prescription coverage at geha.com/Prescriptions

You‘ve got options with retail prescriptions. Pay less for prescriptions that are filled at an in-network pharmacy location. Locations include any CVS Pharmacy location, but you don‘t have to go to a CVS to pay in-network prices.

Save more with mail order prescriptions.

1 Calendar year deductible applies. 2 The 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. 3 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, see one of GEHA‘s 2021 plan brochures: RI 71-006 (High and Standard), RI 71-014 (HDHP) or RI 71-018 (Elevate and Elevate Plus) at geha.com/PlanBrochure 4 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. 5 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. 6 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.

With CVS Caremark’s Mail Service Pharmacy, you can save money and have your routine prescriptions delivered to your home, postage- paid, within about 14 days from the time you submit your prescription. Mail order is not available for the Elevate plan option.

Find an in-network pharmacy location at geha.com/Find-Care

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25

Definitions.

Helpful resources.

If you have questions about the information contained in this benefits guide please call one of our helpful Benefits Advisers.

Calendar year deductible

What you pay each year before the plan begins to pay out benefits.

800.262.4342

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

Coinsurance

The percentage you pay for a covered health care service, after you‘ve met your deductible.

geha.com/Select-A-Plan

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

Copay

A fixed amount you pay for a service or prescription.

Portion of monthly HDHP premium that GEHA contributes to a Health Savings Account (HSA) or Health Reimbursement Arrangement (HRA). A health care provider who is a part of GEHA‘s provider network. These providers agree to limit what they will charge you. 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. The maximum amount you pay each year for coverage. Includes copays, deductibles and coinsurance, but not premiums. Once the limit is met, the plan pays the remainder of your covered health care expenses for the rest of the year. Cost of health care goods and services after subtracting the insurance company’s negotiated discount. For complete details see the definition of “Plan allowance” in Section 10 of any GEHA plan brochure. geha.com/PlanBrochure

Search our extensive nationwide network for a provider or a medical facility (including urgent care clinics) near you.

GEHA contribution

geha.com/Find-Care

In-network provider

geha.com/Prescriptions

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

Net deductible (HDHP)

geha.com/Rates

Get details on medical plans and supplemental benefits for each.

geha.com/Medicare

Explore how GEHA medical plans work with Medicare.

Out-of-pocket max

geha.com/MinuteClinic

Find a MinuteClinic® near you, where available.

Plan allowance

geha.com/OutsideUSA

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

U.S. Office of Personnel Management. The official source of information for federal employees eligible for FEHB plans.

opm.gov/Healthcare-Insurance

PPO

A preferred provider organization.

Premium

What you pay monthly or biweekly for coverage.

geha.com/Enroll

Tips for new enrollees or for those who are changing plans.

Prescription benefits

What you pay as a copay or percentage of coinsurance for medication.

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