2021 GEHA Medical Benefits Guide

Compare prescription coverage for all plans.

What you pay in-network. 2,3

What you pay in-network. 2,3

geha.com/Prescriptions

geha.com/Prescriptions

Elevate

HDHP

Standard

Elevate Plus

High

$4

25% 1

$10

$5

$10 5

Generic

Generic

50% ($500 max)

25% 1,4

50% ($200 max 4 )

$80 4

25% ($150 max 4,5 )

30-day retail

Preferred brand-name

30-day retail

Preferred brand-name

100%

40% 1,4

50% ($300 max 4 )

40% 4

40% ($200 max 4,5 )

Non-preferred brand-name

Non-preferred brand-name

25% 1

$20

$12

$20

Generic

No benefit

Generic

25% 1,4

50% ($500 max 4 )

$200 4

25% ($350 max 4 )

90-day mail service

Preferred brand-name

No benefit

90-day mail service

Preferred brand-name

40% 1,4

50% ($600 max 4 )

40% 4

40% ($500 max 4 )

Non-preferred brand-name

No benefit

Non-preferred brand-name

50% ($500 max)

25% 1,4

50% ($250 max 4 )

40% ($500 max 4 )

25% ($150 max 4 )

Generic and preferred brand-name

Generic and preferred brand-name

30-day 6 specialty CVS exclusive

30-day 6 specialty CVS exclusive

100%

40% 1,4

50% ($400 max 4 )

40% 4

40% ($200 max 4 )

Non-preferred brand-name

Non-preferred brand-name

Elevate and Elevate Plus do not have out-of-network pharmacy coverage and have a limited pharmacy network. Learn more about prescription coverage at geha.com/Prescriptions

Elevate and Elevate Plus do not have out-of-network pharmacy coverage and have a limited pharmacy network. Learn more about prescription coverage at geha.com/Prescriptions

You‘ve got options with retail prescriptions. Pay less for prescriptions that are filled at an in-network pharmacy location. Locations include any CVS Pharmacy location, but you don‘t have to go to a CVS to pay in-network prices.

Save more with mail order prescriptions.

1 Calendar year deductible applies. 2 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. 3 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, see 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 4 If you choose a brand-name medication when a generic is available, you will be charged the generic copay plus the difference in cost between the brand-name and the generic. 5 Costs for initial prescription and first refill. You pay 50% for third and additional refills at retail for 30-day supply. For long-term prescriptions, use mail order or your local retail CVS Pharmacy store (90-day supply) for greater cost savings. 6 Over 30-day specialty copay based on days of therapy. The drug cost share is two times for drugs that provide 60 days‘ worth of therapy and three times the copay for drugs that provide 90 days‘ worth of therapy.

With CVS Caremark’s Mail Service Pharmacy, you can save money and have your routine prescriptions delivered to your home, postage- paid, within about 14 days from the time you submit your prescription. Mail order is not available for the Elevate plan option.

Find an in-network pharmacy location at geha.com/Find-Care

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