Standard Option
Medical benefits for Standard. What you pay in-network. 3 geha.com/Find-Care – Unlimited telehealth visits with MDLIVE geha.com/MDLIVE – Preventive care; adult routine screenings – Well-child visit; up to age 22
Self Only premiums.
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, refer to GEHA’s 2021 plan brochure RI 71-006 (High and Standard) at geha.com/PlanBrochure 4 Refer to geha.com/Prescriptions for formulary and specialty coverage for specific medications. 5 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. 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. 7 These benefits are neither offered nor guaranteed under contract with the FEHB Program, but are made available to all enrollees who become members of a GEHA medical plan and their eligible family members.
Enroll code 314 . geha.com/Enroll
$62.66
Non-Postal worker biweekly
Traditional coverage. Affordable premiums.
$0
$60.16
Postal worker biweekly – Category 1
– Maternity; routine preventive care – Hospital care; inpatient maternity – Lab Card services geha.com/LabCard
X $15 copay for in-network primary care visits, $30 copay for in-network specialist visits. X Pay $0 for routine, in-network maternity care. X Pay $0 for unlimited telehealth visits, including behavioral health therapists and dermatologists, through MDLIVE. X Plan works well with Medicare. geha.com/Medicare Benefits included with your Standard plan. Unlimited telehealth visits with MDLIVE geha.com/MDLIVE Vision discount 7 geha.com/Vision Hearing aid discount 7 geha.com/Hearing Gym membership 7 geha.com/Fitness Electric toothbrush 7 geha.com/Toothbrush Teeth whitening 7 geha.com/Whitening Health Advice Line geha.com/Healthline Medical alert system 7 geha.com/LifeAlert Biometric screening geha.com/Screenings Lab Card services geha.com/LabCard
$52.01
Postal worker biweekly – Category 2
$135.77
Retirees monthly
– MinuteClinic © (where available) geha.com/MinuteClinic
$10 $15 $30 $35 15%
– Primary physician office visit
Self Plus One premiums.
– Specialist care; office visit
Enroll code 316 . geha.com/Enroll
– Urgent care
– Lab services (non-Lab Card)
$134.73
Non-Postal worker biweekly
– Emergency care – Hospital care; inpatient and outpatient – Professional surgical services – X-ray services – Other diagnostic services – Acupuncture; up to 20 treatments per year
$129.35
Postal worker biweekly – Category 1
15% 1
$111.83
Postal worker biweekly – Category 2
$291.92
Retirees monthly
Self and Family premiums.
50%
– Preventive dental care; twice yearly
Balance after GEHA pays $20 per visit Balance after GEHA pays $25 per year
– Chiropractic care; up to 20 visits per year (spinal manipulation therapy)
Enroll code 315 . geha.com/Enroll
$164.85
Non-Postal worker biweekly
– Chiropractic X-rays
$158.26
Postal worker biweekly – Category 1
Prescription benefits for Standard. What you pay in-network. 3,4 geha.com/Prescriptions
$136.83
Postal worker biweekly – Category 2
$10 50% ($200 max 5 ) 50% ($300 max 5 ) $20 50% ($500 max 5 ) 50% ($600 max 5 ) 50% ($250 max 5 ) 50% ($400 max 5 )
Generic Preferred brand-name Non-preferred brand-name Generic Preferred brand-name Non-preferred brand-name
Yearly deductible & out-of-pocket max 2 for Standard. What you pay in-network. 3
$357.17
Retirees monthly
30-day retail
$350 $6,500 $700 $13,000
Yearly deductible Out-of-pocket max Yearly deductible Out-of-pocket max
Self Only
90-day mail service
geha.com/Standard 800.262.4342
Self Plus One Self and Family
These rates do not apply to all enrollees. If you are in a special enrollment category, please refer to the FEHB Program website or contact the agency or Tribal Employer that maintains your health benefits enrollment. 8
Generic and preferred brand-name Non-preferred brand-name
30-day 6 specialty CVS exclusive
9
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