2021 GEHA Medical Benefits Guide

Definitions.

Calendar year deductible

What you pay each year before the plan begins to pay out benefits.

Coinsurance

The percentage you pay for a covered health care service, after you‘ve met your deductible.

Copay

A fixed amount you pay for a service or prescription.

Portion of monthly HDHP premium that GEHA contributes to a Health Savings Account (HSA) or Health Reimbursement Arrangement (HRA). A health care provider who is a part of GEHA‘s provider network. These providers agree to limit what they will charge you. 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. The maximum amount you pay each year for coverage. Includes copays, deductibles and coinsurance, but not premiums. Once the limit is met, the plan pays the remainder of your covered health care expenses for the rest of the year. Cost of health care goods and services after subtracting the insurance company’s negotiated discount. For complete details see the definition of “Plan allowance” in Section 10 of any GEHA plan brochure. geha.com/PlanBrochure

GEHA contribution

In-network provider

Net deductible (HDHP)

Out-of-pocket max

Plan allowance

PPO

A preferred provider organization.

Premium

What you pay monthly or biweekly for coverage.

Prescription benefits

What you pay as a copay or percentage of coinsurance for medication.

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