2021 GEHA Medical Benefits Guide

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

www.geha.com

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