2021 GEHA Medical Benefits Guide

Compare out-of-pocket max for all plans.

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

Elevate

HDHP

Standard

Elevate Plus

High

Self Only

$7,000

$5,000

$6,500

$6,000

$5,000

Self Plus One Self and Family

$14,000

$10,000

$13,000

$12,000

$10,000

Compare deductibles for all plans.

Yearly deductible. What you pay in-network. 2

Elevate

HDHP

Standard

Elevate Plus

High

$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

Self Plus One Self and Family

$1,000

$700

$0

$700

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.

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