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
20
21
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