2021 GEHA Medical Benefits Guide

Medical benefits. What you pay in-network. 2

geha.com/Find-Care

Elevate Plus

High

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

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

$10 $20 $35 $50

$10 $20 $20 $35

Specialist care; office visit

Urgent care

$150 $150

$0 (must be within 72 hours)

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

$200 per day per facility

10% 1 10% 1 10% 1

Hospital care; outpatient

$200 $150

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

$0

No benefit

$0

10% 10% 1

Lab services (non-Lab Card) Other diagnostic services

$50 4

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

$20 per visit, up to 15 visits per year

Chiropractic (spinal manipulation therapy)

$0

Balance after GEHA pays $25 per year

Chiropractic X-rays

Balance after GEHA pays $22 per visit, twice yearly

Preventive dental care

No benefit

$20

10% 1

Acupuncture; up to 20 treatments per year

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

19

www.geha.com

Powered by