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
Powered by FlippingBook