Example: It pays to stay in-network.
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 .
Example
In-network
Out-of-network
$150
$150
Provider’s billed rate
– 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
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
What you pay total for this service
$10
$75
1 See page 26 for definition.
Resources for all plans
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
geha.com/Select-A-Plan
Help me select a plan
info.caremark.com/GEHA
Check my 2021 drug costs
21
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