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
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