2021 GEHA Medical Benefits Guide

Compare medical benefits for all plans.

Medical benefits. What you pay in-network. 2

geha.com/Find-Care

Elevate

HDHP

Standard

$0 1,3

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

$0

$0

$0

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

Urgent care

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

$0

15% 1 15% 1 15% 1

Hospital care; outpatient

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

$0

No benefit

No benefit

25% 1 25% 1

5% 1 5% ¹

15% 15% 1

Lab services (non-Lab Card) Other diagnostic services

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

$10 per visit, up to 12 visits per year

Chiropractic (spinal manipulation therapy)

$0

Chiropractic X-rays

$0 twice yearly, no deductible

50% twice yearly

Preventive dental care

No benefit

$10

5% 1

15% 1

Acupuncture; up to 20 treatments per year

1

Calendar year deductible applies.

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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