2022 GEHA Medicare Benefits Guide

2022 GEHA MEDICARE BENEFITS Learn how GEHA’s five medical plans work with your

Medicare benefits. 800.262.4342

geha.com/Medicare

Medicare + GEHA All GEHA medical plans work with Medicare Parts A & B With a GEHA medical plan to supplement your Medicare coverage, a sudden hospital stay, a prolonged illness or a major surgical procedure won’t overwhelm your budget. geha.com/Medicare

Contents

02

Medicare + GEHA

03

Compare premiums for all plans

04

Vision benefits & discounts

05

Hearing aid benefits & discounts

05

NEW! Exclusive plan perk for Elevate & Elevate Plus subscribers in 2022

Elevate + Medicare

HDHP + Medicare

Standard + Medicare

Elevate Plus + Medicare

High + Medicare

Plan service

NEW! Choice of plan perk 1 NEW! $800 Medicare Part B reimbursement

Yes

Yes

No

No

No

06

Elevate + Medicare

Yes

No

No

No

No

08

HDHP + Medicare

Coverage for in- and out-of-network care 2

10

Standard + Medicare

Yes

Yes

Yes

Yes

Yes

12

Elevate Plus + Medicare

100% medical coverage (copays and deductibles waived) with Medicare A & B primary

14

High + Medicare

Yes

Yes

Yes

No

No

16

GEHA has a medical plan for your needs

Yes Yes

Yes Yes

Yes Yes

Yes Yes

Mail service pharmacy

No No

Non-preferred drug coverage 3

Vision and hearing aid discounts or benefit 4,5, 6

Yes

Yes

Yes

Yes

Yes

Coverage for care outside of the United States

Yes

Yes

Yes

Yes

Yes

NEW! in 2022 Elevate and Elevate Plus subscribers can select a plan perk from several health and wellness options, including SilverSneakers fitness benefit for Elevate Plus only. To learn more, see page 5 or visit geha.com/PlanPerk

1 These benefits are neither offered nor guaranteed under contract with the FEHB program, but are made available to subscribers who become a member of GEHA’s Elevate and Elevate Plus medical plans. 2 Though the Elevate Plus plan on its own does not provide out-of-network medical coverage when it’s combined with Medicare and the provider accepts Medicare assignment, out-of-network cost shares are waived. There are no out-of-network pharmacy benefits for Elevate and Elevate Plus. 3 With High plan, when Medicare A & B is primary, you pay a lower coinsurance for preferred and non-preferred brand medications. 4 These benefits are neither offered nor guaranteed under contract with the FEHB program, but are made available to all enrollees who become members of GEHA and their eligible family members. 5 The HDHP plan also includes additional vision benefits. Learn more at geha.com/HDHPVision 6 Standard, Elevate Plus and High also include additional hearing aid benefits. Learn more at geha.com/Hearing

02 2022 GEHA MEDICARE BENEFITS

Compare premiums for all plans If you are a retired federal employee, you can sign up for a GEHA medical plan by completing OPM form 2809, available through the Office of Personnel Management at opm.gov

Elevate What you pay

HDHP What you pay

Standard What you pay

Elevate Plus What you pay

High What you pay

Self only

Enrollment codes

254

341

314

251

311

$105.61

$136.95

$135.77

$171.44

$227.20

Monthly (retirees)

Elevate What you pay

HDHP What you pay

Standard What you pay

Elevate Plus What you pay

High What you pay

Self Plus One

Enrollment codes

256

343

316

253

313

$242.90

$294.44

$291.92

$395.44

$530.31

Monthly (retirees)

Elevate What you pay

HDHP What you pay

Standard What you pay

Elevate Plus What you pay

High What you pay

Self and Family

Enrollment codes

255

342

315

252

312

$295.71

$361.83

$357.17

$413.04

$654.87

Monthly (retirees)

Free e-books and videos Learn more about your options with Medicare and GEHA at geha.com/Medicare

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.

03 2022 GEHA MEDICARE BENEFITS

Vision benefits & discounts With all GEHA medical plans, you get low copays on eye exams, and discounts on frames and lenses through EyeMed. ™ The EyeMed network includes LensCrafters, Target Optical, independent eye doctors and top optical retailers. Members also save on LASIK at participating locations. To learn more, visit geha.com/Vision Examples of what you pay for common in-network vision services for all plans. 1

Elevate and Elevate Plus What you pay

Standard and High What you pay

HDHP What you pay

Vision service

$0

$5

$5

Eye exams, retail price

$0 under $100 plus 80% over $100

60% of price

60% of price

Frames, retail price

Eyeglass lenses, standard plastic single vision, retail price Up to $50

Up to $50

$10

$10 under $110 plus 85% over $110

85% of price

85% of price

Contact lens, conventional retail price

GEHA’s HDHP plan includes a complete vision benefit in addition to vision discounts through EyeMed. Learn more about this benefit at geha.com/HDHPVision

Included in all plans

$0 telehealth visits 2 geha.com/MDLIVE Free 24/7 Health Advice Line geha.com/Healthline

Medical alert system discount 1 geha.com/LifeAlert Gym membership discount 1 geha.com/Fitness

Electric toothbrush discount 1,3 geha.com/Toothbrush Teeth whitening discount 1 geha.com/Whitening

1 These benefits are neither offered nor guaranteed under contract with the FEHB program, but are made available to all enrollees who become members of GEHA and their eligible family members. 2 If deductible is met, HDHP member will be charged by MDLIVE but GEHA will then reimburse the member 100% of the billed charge. 3 The cariPRO TM premium toothbrush removes seven times more plaque than a regular brush, is completely waterproof and comes with a two-year manufacturer’s warranty. Replacement brush heads with high-quality DuPont TM bristles are also available at this exclusive, member-only price.

04 2022 GEHA MEDICARE BENEFITS

NEW! Exclusive plan perk for Elevate & Elevate Plus subscribers in 2022

Hearing aid benefits & discounts All five GEHA plans offer access to TruHearing’s discounted pricing. 1 Three plans – Standard, Elevate Plus and High – also offer a hearing aid benefit. This benefit is per person, every 36 months for adults. TruHearing discount pricing can be combined with the hearing aid benefit for even greater savings. Find more information and hearing aid savings examples at geha.com/Hearing

GEHA’s unique position as a nonprofit member association allows us to offer this plan perk. We don’t have stockholders, which means our priority is putting money back into supporting our members. Beginning in 2022, Elevate and Elevate Plus plan subscribers are eligible annually to choose one plan perk from the following options:

SilverSneakers Exclusively for Elevate Plus plan subscriber and spouse enrolled in Medicare Part A and/or B

Fitbit wearable device including monthly Fitbit Premium Membership

What GEHA pays for hearing aid benefit.

Standard

Elevate Plus

High

$125 gift card for DICK’S Sporting Goods or REI

$2,500

$1,500

$2,500

Daily Burn virtual fitness subscription

Learn more at geha.com/PlanPerk

1 These benefits are neither offered nor guaranteed under contract with the FEHB program, but are made available to all enrollees who become members of GEHA and their eligible family members.

These benefits are neither offered nor guaranteed under contract with the FEHB program, but are made available to subscribers who become a member of GEHA’s Elevate and Elevate Plus medical plans.

05 2022 GEHA MEDICARE BENEFITS

Elevate + Medicare geha.com/Elevate 800.262.4342 • GEHA’s lowest premium plan • Low copays for non-traditional care, like chiropractic and acupuncture • Engaging digital wellness portal powered by Rally ® How this plan pays you back • NEW! Subscribers can select an annual plan perk. See page 5. geha.com/PlanPerk • Earn Wellness Pays rewards up to $500 (Self Only) or $1,000 (Self Plus One or Self and Family) annually geha.com/WellnessPays

Self Only What you pay

Self Plus One What you pay

Self and Family What you pay

Premiums

254

256

255

Enrollment codes Monthly – retired

$105.61 $295.71 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. $242.90

Yearly deductible in-network 1

What you pay

$500

Self Only

$1,000

Self Plus One and Self and Family

What you pay

Prescription benefits in-network 1 ,2,3

• 30-day retail generic

$4

• 30-day retail preferred brand-name • 30-day retail non-preferred brand-name

50% ($500 max)

100%

• 30-day specialty CVS exclusive generic and preferred brand-name • 30-day specialty CVS exclusive non-preferred brand-name

50% ($500 max)

100%

Check prescription costs at geha.com/Prescriptions

Health care style: wellness-focused, cost-conscious

To provide a low premium, this plan does not include mail-order prescriptions or out-of-network pharmacy coverage, and it has a limited pharmacy network. Find a pharmacy at geha.com/Find-Care

How often you use your plan

Low

Average

High

Prescription medication need

Low

Average

High

1 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. Refer to GEHA’s 2022 plan brochure RI 71-018 (Elevate and Elevate Plus) at geha.com/PlanBrochure 2 Refer to geha.com/Prescriptions for formulary and specialty coverage for specific medications. 3 To provide a low premium, this plan does not include mail-order prescriptions or out-of-network pharmacy coverage, and it has a limited pharmacy network. Find a pharmacy at geha.com/Find-Care

06 2022 GEHA MEDICARE BENEFITS

Included with Elevate

Medical benefits with Medicare A & B primary in-network 1

What you pay

Telehealth visits, including behavioral health and dermatology geha.com/MDLIVE Vision discount 5 (see page 4) geha.com/Vision Hearing aid discount 5 geha.com/Hearing Gym membership discount 5 geha.com/Fitness Electric toothbrush discount 5 geha.com/Toothbrush Teeth whitening discount 5

• Unlimited telehealth visits, including behavioral health with MDLIVE geha.com/MDLIVE • Preventive care; adult routine screenings • Primary physician office visit • MinuteClinic © (where available) geha.com/MinuteClinic • Chiropractic care (manipulative therapy), including X-rays; up to 12 visits per year • Acupuncture; up to 20 treatments per year

$0

$10

• Specialist care; office visit

$25 $50

• Urgent care

• Emergency care • Hospital care; inpatient and outpatient • Outpatient professional surgical services • Inpatient professional surgical services

25% 2

$250

geha.com/Whitening For a complete list of included benefits visit geha.com/Savings

Out-of-pocket maximum in-network 1 ,3

What you pay

$7,000 $14,000

Self Only

Self Plus One and Self and Family

5 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.

NEW! Subscribers can select an annual plan perk. Options include a Fitbit wearable device including Monthly Premium Membership, $125 gift card for DICK’S Sporting Goods or REI, or a Daily Burn virtual fitness subscription. 4 See page 5. geha.com/PlanPerk

Ready to enroll? opm.gov | 800.332.9798

1 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 2022 plan brochure RI 71-018 (Elevate and Elevate Plus) at geha.com/PlanBrochure 2 Calendar year deductible applies. 3 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. 4 These benefits are neither offered nor guaranteed under contract with the FEHB program, but are made available to subscribers who become a member of GEHA’s Elevate and Elevate Plus medical plans.

07 2022 GEHA MEDICARE BENEFITS

HDHP + Medicare geha.com/HDHP 800.262.4342 • Low premiums with a lower net deductible than many traditional FEHB plans • GEHA contributes to your HRA. Use your HRA money to reduce your net deductible or reimburse Medicare premiums. How this plan pays you back • Earn up to $250 (maximum $500 per household) per year in Health Rewards geha.com/HealthRewards • GEHA contributes $900 (Self Only) or $1,800 (Self Plus One or Self and Family) to your HRA

Self Only What you pay

Self Plus One What you pay

Self and Family What you pay

Premiums

341

343

342

Enrollment codes Monthly – retired

$136.95 $361.83 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. $294.44

Yearly deductible you pay after GEHA contribution to your HRA 2

Yearly deductible in-network 1

Plan type

$600

$1,500 $3,000

Self Only

$1,200

Self Plus One and Self and Family

What you pay

Prescription benefits in-network 1 ,3,4

• 30-day retail generic

25% 25% 5 40% 5 25% 25% 5 40% 5 25% 5 40% 5

• 30-day retail preferred brand-name • 30-day retail non-preferred brand-name

• 90-day mail service generic

• 90-day mail service preferred brand-name • 90-day mail service non-preferred brand-name

Health care style: analytical consumer, focused on savings

• 30-day specialty CVS exclusive generic and preferred brand-name • 30-day specialty CVS exclusive non-preferred brand-name

How often you use your plan

Check prescription costs at geha.com/Prescriptions

Low

Average

High

Prescription medication need

1 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 2022 plan brochure RI 71-014 (HDHP) at geha.com/PlanBrochure 2 The net deductible 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. 3 Calendar year deductible applies. 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.

Low

Average

High

08 2022 GEHA MEDICARE BENEFITS

Included with HDHP

Medical benefits with Medicare A & B primary in-network 1

What you pay

Telehealth visits, including behavioral health and dermatology 2,3 geha.com/MDLIVE Vision benefit and discount 5 (see page 4) geha.com/HDHPVision Hearing aid discount 5 geha.com/Hearing Gym membership discount 5 geha.com/Fitness Electric toothbrush discount 5 geha.com/Toothbrush Teeth whitening discount 5 geha.com/Whitening Medical alert system discount 5

• Unlimited telehealth visits, including behavioral health with MDLIVE geha.com/MDLIVE

$0

2,3

• Preventive care; adult routine screenings • Preventive dental care, twice yearly

$0

• Primary physician office visit • Specialist care; office visit • Urgent care • Emergency care • Hospital care; inpatient and outpatient • MinuteClinic © (where available) geha.com/MinuteClinic • Lab services • Other diagnostic services • Professional surgical services • Chiropractic care (manipulative therapy), including X-rays; up to 20 visits per year • Acupuncture; up to 20 treatments per year

5% 2

geha.com/LifeAlert For a complete list of included benefits visit geha.com/Savings

Out-of-pocket maximum in-network 1,4

What you pay

$5,000 $10,000

Self Only

Self Plus One and Self and Family

5 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.

Additional vision benefit with HDHP . GEHA’s HDHP plan includes a complete vision benefit in addition to vision discounts through EyeMed. 5 Learn more at geha.com/HDHPVision

Ready to enroll? opm.gov | 800.332.9798

1 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 2022 plan brochure RI 71-014 (HDHP) at geha.com/PlanBrochure 2 Calendar year deductible applies. 3 If the deductible is met, high deductible health plan (HDHP) member will be charged by MDLIVE but GEHA will then reimburse the member 100% of the billed charges. 4 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.

09 2022 GEHA MEDICARE BENEFITS

Standard + Medicare geha.com/Standard 800.262.4342

Self Only What you pay

Self Plus One What you pay

Self and Family What you pay

Premiums

314

316

315

Enrollment codes Monthly – retired

$135.77 $357.17 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. $291.92

• Good choice for Medicare A & B primary members who take generic prescriptions • $0 for deductibles, copays and coinsurance whether your provider is in- or out-of-network, even outside the United States • $0 for inpatient and outpatient hospital services, surgeries and office visits • $2,500 hearing aid benefit and additional discount How this plan pays you back • Earn up to $250 (maximum $500 per household) per year in Health Rewards geha.com/HealthRewards

Yearly deductible with Medicare A & B primary

What you pay

$0 $0

Self Only

Self Plus One and Self and Family

Prescription benefits in-network 1,2

What you pay

• 30-day retail generic

$10

• 30-day retail preferred brand-name • 30-day retail non-preferred brand-name

50% ($200 max 3 ) 50% ($300 max 3 )

• 90-day mail service generic

$20

• 90-day mail service preferred brand-name • 90-day mail service non-preferred brand-name

50% ($500 max 3 ) 50% ($600 max 3 ) 50% ($250 max 3 ) 50% ($400 max 3 )

• 30-day specialty CVS exclusive generic and preferred brand-name • 30-day specialty CVS exclusive non-preferred brand-name

Health care style: traditional coverage to stay on a healthy path

Check prescription costs at geha.com/Prescriptions

How often you use your plan

Low

Average

High

Prescription medication need

Low

Average

High

1 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 2022 plan brochure RI 71-006 (High and Standard) at geha.com/PlanBrochure 2 Refer to geha.com/Prescriptions for formulary and specialty coverage for specific medications. 3 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.

10

2022 GEHA MEDICARE BENEFITS

Included with Standard

With Medicare A & B primary, go to any provider that accepts Medicare assignment 1 • Unlimited telehealth visits, including behavioral health with MDLIVE geha.com/MDLIVE • Preventive care; adult routine screenings • Lab, X-ray and diagnostic test services • MinuteClinic © (where available) geha.com/MinuteClinic • Primary physician office visit • Specialist care; office visit • Urgent care • Emergency care • Hospital care; inpatient and outpatient • Professional surgical services; inpatient and outpatient • Outpatient professional and facility High Tech Imaging (MRI, CT, PET, etc.) • Chiropractic care (manipulative therapy), including X-rays; up to 20 visits per year

What you pay

Telehealth visits, including behavioral health and dermatology geha.com/MDLIVE Vision discount 3 (see page 4) geha.com/Vision Hearing aid benefit and discount 3 geha.com/Hearing Gym membership discount 3 geha.com/Fitness Electric toothbrush discount 3 geha.com/Toothbrush Teeth whitening discount 3 geha.com/Whitening Medical alert system discount 3

$0

• Preventive dental care; twice yearly

50%

geha.com/LifeAlert For a complete list of included benefits visit geha.com/Savings

Out-of-pocket maximum in-network 1 ,2

What you pay

$6,500 $13,000

Self Only

Self Plus One and Self and Family

3 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.

Ready to enroll? opm.gov | 800.332.9798

1 Refer to GEHA’s 2022 plan brochure RI 71-006 (High and Standard) at geha.com/PlanBrochure 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.

11

2022 GEHA MEDICARE BENEFITS

Elevate Plus + Medicare geha.com/ElevatePlus 800.262.4342 • You pay $0 for medical deductibles, copays and coinsurance • Engaging digital wellness portal powered by Rally ® • $1,500 hearing aid benefit and added discounts How this plan pays you back • NEW! Subscribers can select an annual plan perk. See page 5. geha.com/PlanPerk • Earn Wellness Pays rewards up to $500 (Self Only) or $1,000 (Self Plus One or Self and Family) annually geha.com/WellnessPays

Self Only What you pay

Self Plus One What you pay

Self and Family What you pay

Premiums

251

253

252

Enrollment codes Monthly – retired

$171.44 $413.04 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. $395.44

Yearly deductible with Medicare A & B primary

What you pay

$0 $0

Self Only

Self Plus One and Self and Family

Prescription benefits in-network 1,2,3

What you pay

• 30-day retail generic

$10 $80 4 50% 4

• 30-day retail preferred brand-name • 30-day retail non-preferred brand-name

• 90-day mail service generic

$20

• 90-day mail service preferred brand-name • 90-day mail service non-preferred brand-name

$200 4 50% 4

• 30-day specialty CVS exclusive generic and preferred brand-name • 30-day specialty CVS exclusive non-preferred brand-name

40% ($500 max 4 )

50% 4

Health care style: health-focused, proactive and values predictable pricing

Check prescription costs at geha.com/Prescriptions

How often you use your plan

No out-of-network pharmacy and a limited pharmacy network. Find a provider or a pharmacy at geha.com/Find-Care

Low

Average

High

Prescription medication need

1 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. Refer to GEHA’s 2022 plan brochure RI 71-018 (Elevate and Elevate Plus) at geha.com/PlanBrochure 2 Refer to geha.com/Prescriptions for formulary and specialty coverage for specific medications. 3 This plan has no out-of-network pharmacy coverage and a limited pharmacy network. Find a pharmacy at geha.com/Find-Care 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.

Low

Average

High

12

2022 GEHA MEDICARE BENEFITS

Included with Elevate Plus

With Medicare A & B primary, go to any provider that accepts Medicare assignment 1 • Unlimited telehealth visits, including behavioral health with MDLIVE geha.com/MDLIVE

What you pay

Telehealth visits, including behavioral health and dermatology geha.com/MDLIVE Vision discount 4 (see page 4) geha.com/Vision Hearing aid benefit and discount 4 geha.com/Hearing Gym membership discount 4 geha.com/Fitness Electric toothbrush discount 4 geha.com/Toothbrush Teeth whitening discount 4 geha.com/Whitening Medical alert system discount 4

• Preventive care; adult routine screenings • Lab, X-ray and diagnostic test services • MinuteClinic © (where available) geha.com/MinuteClinic • Primary physician office visit • Specialist care; office visit • Urgent care • Emergency care • Hospital care; inpatient and outpatient • Chiropractic care (manipulative therapy), including X-rays; up to 15 visits per year • Acupuncture; up to 20 treatments per year • Professional surgical services; inpatient and outpatient $0

Out-of-pocket maximum in-network 1 ,2

What you pay

geha.com/LifeAlert For a complete list of included benefits visit geha.com/Savings

$6,000 $12,000

Self Only

Self Plus One and Self and Family

NEW! Subscribers can select an annual plan perk. Options include a SilverSneakers fitness benefit, a Fitbit wearable device including monthly Fitbit Premium Membership, a $125 gift card for DICK’S Sporting Goods or REI, or a Daily Burn virtual fitness subscription. 3 See page 5. geha.com/PlanPerk

4 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.

Ready to enroll? opm.gov | 800.332.9798

1 Refer to GEHA’s 2022 plan brochure RI 71-018 (Elevate and Elevate Plus) at geha.com/PlanBrochure 2 The out-of-pocket maximum is the maximum amount of coinsurance and copays 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 These benefits are neither offered nor guaranteed under contract with the FEHB program, but are made available to subscribers who become a member of GEHA’s Elevate and Elevate Plus medical plans.

13

2022 GEHA MEDICARE BENEFITS

High + Medicare geha.com/High 800.262.4342 • Comprehensive brand-name and specialty prescription coverage • You pay $0 for deductibles, copays and coinsurance whether your provider is in- or out-of-network, even outside the United States • You pay $0 for inpatient and outpatient hospital services, surgeries and office visits • $2,500 hearing aid benefit and added discount How this plan pays you back • NEW! $800 Medicare Part B reimbursement geha.com/MRA • Earn up to $250 (maximum $500 per household) per year in Health Rewards geha.com/HealthRewards

Self Only What you pay

Self Plus One What you pay

Self and Family What you pay

Premiums

311

313

312

Enrollment codes Monthly – retired

$227.20 $654.87 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. $530.31

Yearly deductible with Medicare A & B primary

What you pay

$0 $0

Self Only

Self Plus One and Self and Family

Prescription benefits in-network 1,2

What you pay

• 30-day retail generic

$10 3

• 30-day retail preferred brand-name • 30-day retail non-preferred brand-name

20% ($150 max 3,4 ) 35% ($200 max 3,4 )

• 90-day mail service generic

$15

• 90-day mail service preferred brand-name • 90-day mail service non-preferred brand-name

15% ($350 max 4 ) 30% ($500 max 4 )

• 30-day specialty CVS exclusive generic and preferred brand-name • 30-day specialty CVS exclusive non-preferred brand-name

15% ($150 max 4 )

Health care style: maximum coverage and dependable support

30% ($200 max 4 )

How often you use your plan

Check prescription costs at geha.com/Prescriptions

Low

Average

High

Prescription medication need

1 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 2022 plan brochure RI 71-006 (High and Standard) at geha.com/PlanBrochure 2 Refer to geha.com/Prescriptions for formulary and specialty coverage for specific medications. 3 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. 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.

Low

Average

High

14

2022 GEHA MEDICARE BENEFITS

Included with High

With Medicare A & B primary, go to any provider that accepts Medicare assignment 1 • Unlimited telehealth visits, including behavioral health with MDLIVE geha.com/MDLIVE • Preventive care; adult routine screenings • Lab, X-ray and diagnostic test services • MinuteClinic © (where available) geha.com/MinuteClinic • Primary physician office visit • Specialist care; office visit • Urgent care • Emergency care • Hospital care; inpatient and outpatient • Professional surgical services; inpatient and outpatient • Chiropractic care (manipulative therapy), including X-rays; up to 20 visits per year

What you pay

Telehealth visits, including behavioral health and dermatology geha.com/MDLIVE Vision discount 3 (see page 4) geha.com/Vision Hearing aid benefit and discount 3 geha.com/Hearing Gym membership discount 3 geha.com/Fitness Electric toothbrush discount 3 geha.com/Toothbrush Teeth whitening discount 3 geha.com/Whitening Medical alert system discount 3

$0

Balance after GEHA pays $22 per visit

• Preventive dental care

geha.com/LifeAlert For a complete list of included benefits visit geha.com/Savings

Out-of-pocket maximum in-network 1 ,2

What you pay

$5,000 $10,000

Self Only

Self Plus One and Self and Family

3 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.

Ready to enroll? opm.gov | 800.332.9798

1 Refer to GEHA’s 2022 plan brochure RI 71-006 (High and Standard) at geha.com/PlanBrochure 2 The out-of-pocket maximum is the maximum amount of coinsurance and copays 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.

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2022 GEHA MEDICARE BENEFITS

GEHA has a medical plan for your needs Choose from five unique medical plans designed to meet you where you are in life.

Talk to a Benefits Adviser 800.262.4342

Ready to enroll? If you are a retired federal employee, you can sign up for a GEHA medical plan by completing OPM form 2809, available through the Office of Personnel Management. opm.gov | 800.332.9798

OPM Open Season online system retireefehb.opm.gov/Annuitant Explore how GEHA medical plans work with Medicare geha.com/Medicare Search our extensive nationwide network geha.com/Find-Care Check prescription costs geha.com/Prescriptions Learn about coverage outside the United States geha.com/OutsideUSA

This is a brief description of the features of Government Employees Health Association, Inc.‘s medical plans. Before making a final decision, please read the GEHA Federal brochures which are available at geha.com/PlanBrochure . All benefits are subject to the definitions, limitations and exclusions set forth in the Federal brochure. For information and changes to GEHA’s medical plans, see our three plan brochures – RI 71-006 (High and Standard Options), RI 71-014 (HDHP) and RI 71- 018 (Elevate and Elevate Plus) – which are available at geha.com/PlanBrochure Notice of Summary of Benefits and Coverage (SBC): Availability of Summary Health Information: The Federal Employees Health Benefit (FEHB) program offers numerous health benefits plans and coverage options. Choosing a health plan and coverage option is an important decision. To help you make an informed choice, each FEHB plan makes available a Summary of Benefits and Coverage (SBC) about each of its health coverage options, online and in paper. The SBC summarizes important information in a standard format to help you compare plans and options. GEHA’s SBCs are available on the internet at geha.com/SBC . Paper copies are also available, free of charge, by calling 800.821.6136 . To find out more information about plans available under the FEHB program, including SBCs for other FEHB plans, please visit opm.gov/Insure ©2021-2022 Government Employees Health Association, Inc. All rights reserved. Please recycle.

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