2022 GEHA Medical Benefits Guide

2022 GEHA MEDICAL PLANS

Choose from five unique medical plans designed to meet you where you are in life.

geha.com | 800.262.4342

Choose from five medical plans

Contents

02

Choose from five medical plans

04

Elevate

06

HDHP

Elevate geha.com/Elevate • Our lowest premium plan • Low copays for doctor, chiropractic and acupuncture visits • Digital wellness portal How this plan pays you back • NEW! Features an annual plan perk. See page 14. geha.com/PlanPerk • Earn rewards up to $500 to $1,000 annually geha.com/WellnessPays

HDHP geha.com/HDHP • Low premiums with a low net-deductible • Tax-advantaged health savings account (HSA) • GEHA contributes money to your HSA geha.com/HSA How this plan pays you back • Earn rewards up to $250 to $500 annually geha.com/HealthRewards • GEHA contributes $900 (Self Only) or $1,800 (Self Plus One or Self and Family) to your HSA

08

Standard

10

Elevate Plus

12

High

14 NEW! Exclusive plan perk for Elevate and Elevate Plus subscribers

15

Get help choosing the right plan

16

It pays to stay in-network

17

Definitions and terms

18

Wellness Pays

19

Health Rewards

20

Vision benefits and discounts for all plans

21

Included in all five plans

22

Compare deductibles for all plans

Life-stage: early career Health care style: wellness-focused, cost-conscious

Life-stage: all career stages Health care style: non-traditional, focused on saving for future needs

22

Compare out-of-pocket max for all plans

23

Compare premiums for all plans

How often you use your plan

How often you use your plan

24

Compare prescription coverage for all plans

Low

Average

High

Low

Average

High

25

GEHA works with Medicare A & B

Prescription medication need

Prescription medication need

26

Compare medical benefits for all plans

28

GEHA has a medical plan for your needs

Low

Average

High

Low

Average

High

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.

02 2022 GEHA MEDICAL PLANS

We believe health care isn’t one size fits all, and our plans are designed with that in mind. Whatever stage of life you’re in, GEHA has a plan designed to fit your needs.

Get help choosing the right plan for your needs Meet one-on-one Schedule an appointment with a GEHA Benefits Adviser. geha.com/Meet Talk to us Speak to a GEHA Benefits Adviser Monday – Friday, 7 a.m. – 7 p.m. Central time. 800.262.4342 Chat online During Open Season, you can chat with a GEHA Benefits Adviser online. geha.com Watch a webinar Tune in at a time that is convenient for you. geha.com/2022Webinars Plan recommender tool Answer a few questions to see a plan that matches your individual or family needs. geha.com/Select-A-Plan

Elevate Plus geha.com/ElevatePlus • Easy to determine costs. No deductible. • Digital wellness portal • NOTE: No out-of-network medical coverage How this plan pays you back • NEW! Features an annual plan perk. See page 14. geha.com/PlanPerk • Earn rewards up to $500 to $1,000 annually geha.com/WellnessPays

Standard geha.com/Standard • Dependable, traditional coverage • Affordable premiums

High geha.com/High • Comprehensive prescription coverage • Low copays for doctor visits • $2,500 hearing aid benefit and additional discount How this plan pays you back • NEW! $800 Medicare Part B premium reimbursement geha.com/Medicare • Earn rewards up to $250 to $500 annually geha.com/HealthRewards

• Some of the lowest copays for in-network primary care and specialist visits

How this plan pays you back • Earn rewards up to $250 to $500 annually geha.com/HealthRewards

Life-stage: mid-career Health care style: proactive, values predictable pricing

Life-stage: late-career Health care style: maximum coverage, dependable support

Life-stage: mid-career Health care style: traditional care and coverage

How often you use your plan

How often you use your plan

How often you use your plan

Low

Average

High

Low

Average

High

Low

Average

High

Prescription medication need

Prescription medication need

Prescription medication need

Low

Average

High

Low

Average

High

Low

Average

High

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.

03 2022 GEHA MEDICAL PLANS

Elevate geha.com/Elevate • GEHA’s lowest premium plan

Self Only What you pay

Self Plus One What you pay

Self and Family What you pay

Premiums

255

Enrollment codes

254

256

$48.74 $105.61

$112.11 $272.90

$136.48

Biweekly – employed

• Low copays for doctor visits, and chiropractic and acupuncture visits • Engaging digital wellness portal powered by Rally Health How this plan pays you back • NEW! Subscribers can select an annual plan perk. Options include 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. 4 geha.com/PlanPerk • Earn up to $500 (maximum $1,000 per household) in Wellness Pays annually geha.com/WellnessPays

Monthly – retired $295.71 Footnote: 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.

Yearly deductible in-network 1

What you pay

$500

Self Only

$1,000

Self Plus One and Self and Family

Prescription benefits in-network 1,2,3

What you pay

$4

• 30-day retail generic

50% ($500 max)

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

100%

50% ($500 max)

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

100%

Check prescription costs at geha.com/Prescriptions 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

Life stage: early career Health care style: wellness-focused, cost-conscious

How often you use your plan

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. 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 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.

Low

Average

High

04 2022 GEHA MEDICAL PLANS

Included with Elevate

Medical benefits in-network 1

What you pay

Telehealth visits, including behavioral health geha.com/MDLIVE Vision discount 4 (see page 20) geha.com/Vision Gym membership discount 4 geha.com/Fitness Electric toothbrush discount 4 geha.com/Toothbrush Teeth whitening discount 4 geha.com/Whitening Surgical concierge 5 $0 out-of-pocket surgery costs and care coordination geha.com/BridgeHealth For a complete list visit geha.com/Savings

• Unlimited telehealth visits, including behavioral health, with MDLIVE geha.com/MDLIVE • Preventive care; adult routine screenings • Well-child visit; up to age 22 • Maternity; routine care • 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

$25 $50

• Specialist care; office visit

• Urgent care

• Emergency care • Hospital care; inpatient including maternity • Hospital care; outpatient • Lab services • Other diagnostic services • Outpatient professional surgical services • Inpatient professional surgical services

25% 2

$250

Medicare A & B primary? See page 25 or visit geha.com/Medicare

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. 5 Subject to any eligibility limitations. See info.bridgehealth.com/GEHA for more information.

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

What you pay

$7,000 $14,000

Self Only

Self Plus One and Self and Family

Learn how to enroll at geha.com/Enroll

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.

05 2022 GEHA MEDICAL PLANS

HDHP geha.com/HDHP • Low premiums with a low net-deductible • Reduce out-of-pocket expenses and enjoy a triple tax advantage with a health savings account (HSA) 6 geha.com/HSA • Use your HSA money to reduce your net deductible or save it and let it grow tax-free in your account 6 How this plan pays you back • GEHA contributes $900 (Self Only) or $1,800 (Self Plus One or Self and Family) to your HSA • Earn up to $250 (maximum $500 per household) in Health Rewards annually geha.com/HealthRewards

Self Only What you pay

Self Plus One What you pay

Self and Family What you pay

Premiums

342

Enrollment codes

341

343

$63.21 $136.95

$135.90 $294.44

$167.00

Biweekly – employed

Monthly – retired $361.83 Footnote: 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.

Yearly deductible you pay after GEHA contribution to your HSA 2

Plan type

Yearly deductible in-network 1

$600

$1,500

Self Only

Self Plus One and Self and Family

$1,200

$3,000

Prescription benefits in-network 1,3,4

What you pay

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

• 30-day retail generic

• 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

Life stage: all career stages Health care style: non-traditional, focused on saving for future needs

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

Check prescription costs at geha.com/Prescriptions

How often you use your plan

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. 6 The information provided is for informational purposes only. It should not be considered legal or financial advice. You should consult with a professional to determine what may be best for your individual needs.

Low

Average

High

06 2022 GEHA MEDICAL PLANS

Included with HDHP

Medical benefits in-network 1

What you pay

Telehealth visits, including behavioral health 3 geha.com/MDLIVE Vision benefit and discount 5 (see page 20) geha.com/HDHPVision Gym membership discount 5 geha.com/Fitness Electric toothbrush discount 5 geha.com/Toothbrush Teeth whitening discount 5 geha.com/Whitening For a complete list visit geha.com/Savings Learn about health savings accounts geha.com/HSA

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

$0

2,3

• Maternity; routine care • Hospital care; inpatient maternity

$0 2

• Preventive care; adult routine screenings • Well-child visit; up to age 22 • 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

Medicare A & B primary? See page 25 or visit geha.com/Medicare

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.

Learn how to enroll at geha.com/Enroll

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 cha r ges. 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.

07 2022 GEHA MEDICAL PLANS

Standard geha.com/Standard • Dependable, traditional coverage • Affordable premiums • Some of the lowest copays for in-network primary care and specialist visits How this plan pays you back • Earn up to $250 (maximum $500 per household) in Health Rewards annually geha.com/HealthRewards

Self Only What you pay

Self Plus One What you pay

Self and Family What you pay

Premiums

315

Enrollment codes

314

316

$62.66 $135.77

$134.73 $291.92

$164.85

Biweekly – employed

Monthly – retired $357.17 Footnote: 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.

Yearly deductible in-network 1

What you pay

$350 $700

Self Only

Self Plus One and Self and Family

Prescription benefits in-network 1,2

What you pay

$10

• 30-day retail generic

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

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

$20

• 90-day mail service generic

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

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

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

Life stage: mid-career 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

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.

Low

Average

High

08 2022 GEHA MEDICAL PLANS

Included with Standard

Medical benefits in-network 1

What you pay

Telehealth visits, including behavioral health geha.com/MDLIVE Vision discount 4 (see page 20) geha.com/Vision Hearing aid 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 geha.com/LifeAlert Lab Card service geha.com/LabCard For a complete list visit geha.com/Savings

• Unlimited telehealth visits, including behavioral health, with MDLIVE geha.com/MDLIVE • Preventive care; adult routine screenings • Well-child visit; up to age 22 • Maternity; routine care • Hospital care; inpatient maternity • Lab Card services geha.com/LabCard

$0

• MinuteClinic © (where available) geha.com/MinuteClinic

$10 $15 $30 $35 15%

• Primary physician office visit • Specialist care; office visit

• Urgent care

• Lab services (other than Lab Card)

• Emergency care • Hospital care; inpatient and outpatient • Professional surgical services • X-ray and other diagnostic services • Acupuncture; up to 20 treatments per year

15% 2

50%

• Preventive dental care; twice yearly

• Chiropractic care (manipulative therapy), including X-rays; up to 20 visits per year • Outpatient professional High Tech Imaging (MRI, CT, PET, etc.)

$30

$100 $150

• Outpatient facility High Tech Imaging (MRI, CT, PET, etc.)

Medicare A & B primary? See page 25 or visit geha.com/Medicare

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.

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

What you pay

$6,500 $13,000

Self Only

Self Plus One and Self and Family

Learn how to enroll at geha.com/Enroll

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 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.

09 2022 GEHA MEDICAL PLANS

Elevate Plus geha.com/ElevatePlus • Easy to determine costs. No deductible. Copays for most common services. • Low copays for non-traditional care, like chiropractic and acupuncture • Engaging digital wellness portal • NOTE: This plan has no out-of-network coverage How this plan pays you back • 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. 6 geha.com/PlanPerk • Earn up to $500 (maximum $1,000 per household) in Wellness Pays annually geha.com/WellnessPays

Self Only What you pay

Self Plus One What you pay

Self and Family What you pay

Premiums

252

Enrollment codes

251

253

$79.13 $171.44

$182.51 $395.44

$190.63

Biweekly – employed

Monthly – retired $413.04 Footnote: 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.

Yearly deductible in-network. 1,2 No out-of-network coverage.

What you pay

$0

Self Only, Self Plus One and Self and Family

Prescription benefits in-network. 1,3,4 No out-of-network coverage.

What you pay

$10 $80 5 50% 5

• 30-day retail generic

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

$20

• 90-day mail service generic

$200 5 50% 5

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

40% ($500 max 5 )

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

50% 5

Life stage: mid-career Health care style: health-focused and proactive, values predictable pricing

Check prescription costs at geha.com/Prescriptions

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

How often you use your plan

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 This plan has no out-of-network coverage. 3 Refer to geha.com/Prescriptions for formulary and specialty coverage for specific medications. 4 This plan has no out-of-network pharmacy coverage and a limited pharmacy network. Find a pharmacy at geha.com/Find-Care 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 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.

Low

Average

High

10

2022 GEHA MEDICAL PLANS

Included with Elevate Plus

Medical benefits in-network. 1,2 No out-of-network coverage.

What you pay

• Unlimited telehealth visits, including behavioral health, with MDLIVE geha.com/MDLIVE • Preventive care; adult routine screenings • Well-child visit; up to age 22 • Lab services • Maternity; routine care

Telehealth visits, including behavioral health geha.com/MDLIVE Vision discount 5 (see page 20) 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 geha.com/Whitening Surgical concierge 6 $0 out-of-pocket surgery costs and care coordination geha.com/BridgeHealth For a complete list visit geha.com/Savings

$0

• MinuteClinic © (where available) geha.com/MinuteClinic

$10

• Primary physician office visit • Chiropractic care (manipulative therapy), including X-rays; up to 15 visits per year • Acupuncture; up to 20 treatments per year $25 • Specialist care; office visit $40 • Urgent care $50 • Other diagnostic services $50 3 • In-office professional surgical services $75 • Emergency care $200 • Outpatient and inpatient professional surgical services $200

$250 per day up to $1,000 per admission $250 per day per facility

• Hospital care; inpatient including maternity

• Hospital care; outpatient

Medicare A & B primary? See page 25 or visit geha.com/Medicare

Out-of-pocket maximum in-network. 1,4 No out-of-network coverage.

What you pay

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. 6 Subject to any eligibility limitations. For more information, see info.bridgehealth.com/GEHA

$6,000 $12,000

Self Only

Self Plus One and Self and Family

This plan has no out-of-network medical coverage. Find a provider or check if your provider is in-network at geha.com/Find-Care

Learn how to enroll at geha.com/Enroll

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. Elevate Plus has no out of network benefits. Refer to GEHA’s 2022 plan brochure RI 71-018 (Elevate and Elevate Plus) at geha.com/PlanBrochure 2 This plan has no out-of-network coverage. 3 You pay $175 ($100 professional fee, $75 facility fee) for advanced outpatient High Tech Imaging such as MRI, CT, PET, etc. Refer to GEHA’s 2022 plan brochure RI 71-018 (Elevate and Elevate Plus) at geha.com/PlanBrochure 4 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.

11

2022 GEHA MEDICAL PLANS

High geha.com/High • Comprehensive brand-name and specialty prescription coverage

Self Only What you pay

Self Plus One What you pay

Self and Family What you pay

Premiums

312

Enrollment codes

311

313

$104.86 $227.20

$244.76 $530.31

$302.25

Biweekly – employed

Monthly – retired $654.87 Footnote: 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.

• Low copays for doctor visits • $2,500 hearing aid benefit and additional discount

Yearly deductible in-network 1

What you pay

How this plan pays you back • NEW! $800 part B Medicare premium reimbursement geha.com/Medicare • Earn up to $250 (maximum $500 per household) in Health Rewards annually geha.com/HealthRewards

$350 $700

Self Only

Self Plus One and Self and Family

Prescription benefits in-network 1,2

What you pay

$10 3

• 30-day retail generic

25% ($150 max 3,4 ) 40% ($200 max 3,4 )

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

$20

• 90-day mail service generic

25% ($350 max 4 ) 40% ($500 max 4 ) 25% ($150 max 4 ) 40% ($200 max 4 )

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

Life stage: late-career Health care style: maximum coverage and dependable support

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

Check prescription costs at geha.com/Prescriptions

How often you use your plan

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

12

2022 GEHA MEDICAL PLANS

Included with High

Medical benefits in-network 1

What you pay

Telehealth visits, including behavioral health geha.com/MDLIVE Vision discount 4 (see page 20) geha.com/Vision Hearing aid 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 geha.com/LifeAlert Lab Card service geha.com/LabCard For a complete list visit geha.com/Savings

• Unlimited telehealth visits, including behavioral health, with MDLIVE geha.com/MDLIVE • Preventive care; adult routine screenings • Well-child visit; up to age 22 • Maternity; routine care • Emergency care; accidental (must be within 72 hours) • Hospital care; inpatient maternity • Lab Card services geha.com/LabCard

$0

• MinuteClinic © (where available) geha.com/MinuteClinic

$10

• Primary physician office visit • Specialist care; office visit • Chiropractic care (manipulative therapy), including X-rays; up to 20 visits per year $20 • Urgent care $35 • Lab services (other than Lab Card) 10%

• Emergency care; medical • Hospital care; outpatient • Professional surgical services • X-ray services • Other diagnostic services • Acupuncture; up to 20 treatments per year

10% 2

$100 per admission plus 10% Balance after GEHA pays $22 per visit

• Hospital care; inpatient

• Preventive dental care, twice yearly

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.

Medicare A & B primary? See page 25 or visit geha.com/Medicare

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

What you pay

$5,000 $10,000

Self Only

Self Plus One and Self and Family

Learn how to enroll at geha.com/Enroll

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 Calendar year deductible applies. 3 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.

13

2022 GEHA MEDICAL PLANS

It pays to be a GEHA subscriber 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

Fitbit wearable device including monthly Fitbit Premium Membership

NEW! Exclusive plan perk for Elevate and Elevate Plus subscribers

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

Daily Burn virtual fitness subscription

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

geha.com/PlanPerk

Activation is easy It’s quick and easy for Elevate and Elevate Plus subscribers to claim their plan perk after January 1, 2022. Just sign up for a geha.com account (or log into your existing account) and update your contact preferences.

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.

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2022 GEHA MEDICAL PLANS

Get help choosing the right plan For more information about FEHB plans, visit opm.gov/Healthcare-Insurance

Call us Talk to a GEHA Benefits Adviser Monday – Friday, 7 a.m. – 7 p.m. Central time. 800.262.4342

Book an appointment Meet one-on-one with a GEHA Benefits Adviser to help answer

your questions. geha.com/Meet

Chat online at Open Season Chat with a GEHA Benefits Adviser in real time during Open Season. geha.com

Watch on-demand webinars Learn how to find a plan that’s right for you with an on-demand webinar. geha.com/2022Webinars

Compare plans Compare GEHA’s five medical plans to easily find the right plan for you. geha.com/CompareMedical

Plan recommender tool Answer a few questions to see a plan that matches your

individual or family needs. geha.com/Select-A-Plan

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2022 GEHA MEDICAL PLANS

It pays to stay in-network Whether it’s a fixed dollar amount, or a percentage, we want you to understand what you pay for in- or out-of-network services. We’ve included an example below for a plan with a 10% coinsurance 1 for services in-network and 25% coinsurance for services out-of-network .

The Elevate Plus medical plan does not offer out-of-network coverage.

Service example

Out-of-network price In-network price

$150

$150

Provider’s billed rate

In-network provider’s contracted rate with GEHA and GEHA’s plan allowance for out-of-network providers

$100

$100

$75 75% of $100 $25 25% of $100

$90 90% of $100 $10 10% of $100

What GEHA pays

What you pay (coinsurance)

You also pay the difference between the out-of-network provider’s billed rate and GEHA’s plan allowance

$50

$0

What you pay total for this service

$75

$10

1 See page 17 for definition.

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2022 GEHA MEDICAL PLANS

Definitions and terms We know some terms can be confusing. As you work your way through this guide, these definitions may help.

Term

Definition

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).

GEHA contribution

A health care provider who is a part of GEHA’s provider network. These providers agree to limit what they will charge you.

In-network provider

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.

Net deductible (HDHP)

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.

Out-of-pocket max

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

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.

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 brochures.

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2022 GEHA MEDICAL PLANS

Wellness Pays

Wellness Pays rewards you for activities you’re probably already doing • When you complete your first rewardable activity, you will receive a Wellness Pays prepaid debit card in the mail. • The card can be used for qualified medical expenses such as copays, medical, dental and vision expenses at many major retailers. • As you continue completing rewardable activities, funds will be loaded onto your Wellness Pays prepaid debit card.

Elevate and Elevate Plus plans

Rewardable activity

Wellness Pays plan reward

$500 PER PERSON The maximum amount of Wellness Pays rewards that an individual can earn per year.

$10 per month

• Achieve your Stride step goal

$10 per month, $30 max

• Use of the medical cost estimate tool • Biometric screening • Rally Missions • Wellness quizzes • Flu shot • MDLIVE telehealth visit • MDLIVE behavioral health visit

$50

$1,000 PER HOUSEHOLD

$75

• Rally health survey

• Annual physical • Breast cancer screening (mammogram) 1 • Cervical cancer screening (Pap) 1 • Colorectal cancer screening (colonoscopy or in-home kit) 1 • Digital wellness coaching • First trimester prenatal appointment

The maximum amount of Wellness Pays rewards a household can earn per year.

$100

geha.com/WellnessPays

$200

• Complete Real Appeal or Quit for Life

Earn rewards on GEHA’s digital platform powered by Rally Register on our Rally ® platform to self-manage your health goals, enroll with a wellness coach and more. Earn rewards automatically You’ll receive a rewards card deposit about 10 business days after GEHA receives notification that you completed a rewardable activity. geha.com/ElevateLearn

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2022 GEHA MEDICAL PLANS

1 Restrictions may apply

Health Rewards

Health Rewards empowers you with tools and incentives to help you live healthier • Complete healthy activities like a health risk assessment, preventive screenings, and online wellness workshops such as weight management, stress management or smoking cessation. • As you continue completing rewardable activities, the money you earn can be used for qualified medical expenses 1 with your Health Rewards prepaid debit card.

HDHP, Standard and High plans

Rewardable activity

Health Rewards plan reward

$250 PER PERSON The maximum amount of Health Rewards that an individual can earn per year.

$10 per workshop

• Online wellness workshops

$25

• Flu shot

• Cervical cancer screening (Pap) 2 • Colorectal cancer screening (colonoscopy or in-home kit) 2 • Breast cancer screening (mammogram) 2 • First trimester prenatal appointment • MDLIVE telehealth visit

$50

$75

• Health risk assessment

$500 PER HOUSEHOLD The maximum amount of Health Rewards a household can earn per year.

$50 – $250

• Participation in a targeted health program (by invitation)

1 HDHP + HSA members can use their rewards on qualified dental and vision care expenses until they meet their deductible. Then, all eligible medical and pharmacy expenses qualify, too. 2 Restrictions may apply.

geha.com/HealthRewards

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2022 GEHA MEDICAL PLANS

Vision benefits and discounts for all plans

What you pay for an annual eye exam at a qualified EyeMed provider $0 COPAY Elevate and Elevate Plus $5 COPAY HDHP , Standard and High

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.

Elevate, Standard, Elevate Plus and High What you pay

HDHP What you pay

Vision discounts in-network 1,2

60% of price Up to $50 Up to $70 Up to $135

$0 under $100 plus 80% over $100

Frames (retail price)

$10 $10

Eyeglass lenses, standard plastic single vision (retail price) Eyeglass lenses, standard plastic bifocal lens (retail price) Eyeglass lenses, standard plastic progressive lens (retail price)

No more than $75

Eyeglass lens options, UV treatment, tint (solid and gradient), standard plastic scratch coating

$15

$15

$45

$45

Eyeglass lens options, standard anti-reflective coating

85% of price

$10 under $110 plus 85% over $110

Contact lens, conventional (retail price)

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

1 Elevate, Standard, Elevate Plus and High plans only when you visit an EyeMed provider. 2 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.

20 2022 GEHA MEDICAL PLANS

Included in all five plans

Free 24/7 Health Advice Line Talk to a nurse 24/7. geha.com/Healthline

Gym membership discount 2 Access 11,000+ Active&Fit Direct ™ locations nationwide with GEHA’s Connection Fitness ® program. geha.com/Fitness Teeth whitening discounts 2 Get a 20% discount on the lowest published price on all Smile Brilliant home teeth whitening and oral care products. geha.com/Whitening

Unlimited $0 MDLIVE 1 telehealth visits Get access to certified doctors, including pediatricians, behavioral health therapists and dermatologists. geha.com/MDLIVE

Hearing aid discounts 2 Get discounts through TruHearing on hearing aids. Save up to 30% to 60% off hearing aids. Some average more than $2,500

in savings per pair. geha.com/Hearing

Electric toothbrush discount 2,3 Enjoy 70% off a cariPRO TM premium electric toothbrush. geha.com/Toothbrush

Medical alert system discount 2 Get free activation on LifeAlert ® services, plus a 10% monthly discount, for you and your extended family. geha.com/LifeAlert

1 If 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 charge. 2 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. 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.

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2022 GEHA MEDICAL PLANS

Compare deductibles for all plans Yearly deductible in-network. 1 The Elevate Plus medical plan does not offer out-of-network coverage. What you pay each year before the plan begins to pay out benefits. For HDHP, the net deductible is the remaining amount after you subtract the GEHA contribution from the annual deductible. This is your out-of-pocket cost before plan benefits begin.

Elevate What you pay

HDHP What you pay

Standard What you pay

Elevate Plus What you pay

High What you pay

Plan type

$1,500 yearly deductible −$900 GEHA contribution 2 = $600 your net deductible $3,000 yearly deductible −$1,800 GEHA contribution 2 = $1,200 your net deductible

$350

$0

$350

$500

Self Only

Self Plus One and Self and Family

$700

$0

$700

$1,000

Compare out-of-pocket max for all plans Out-of-pocket max in-network. 1 The Elevate Plus medical plan does not offer out-of-network coverage. The maximum amount of coinsurance, copays and deductibles you pay for all family members before GEHA begins to pay 100% of covered services. This is a combined maximum of medical care and prescriptions.

Elevate What you pay

HDHP What you pay

Standard What you pay

Elevate Plus What you pay

High What you pay

Plan type

$7,000

$5,000

$6,500

$6,000

$5,000

Self Only

Self Plus One and Self and Family

$14,000

$10,000

$13,000

$12,000

$10,000

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 one of GEHA’s 2022 plan brochures: RI 71-006 (High and Standard), RI 71-014 (HDHP) or RI 71-018 (Elevate and Elevate Plus) at geha.com/PlanBrochure 2 GEHA’s contribution will go into a health savings account (HSA) or a health reimbursement arrangement (HRA). Most people qualify for an HSA. Those who don’t are enrolled in an HRA; this group includes Medicare enrollees and those who have non-HDHP coverage elsewhere. Find out which one you’re eligible for at geha.com/IRS969 22 2022 GEHA MEDICAL PLANS

Compare premiums for all plans What you pay monthly or biweekly for coverage.

Elevate What you pay

HDHP What you pay

Standard What you pay

Elevate Plus What you pay

High What you pay

Self Only premium

Enrollment code

254

341

314

251

311

$48.74

$63.21

$62.66

$79.13

$104.86

Biweekly – employed

$105.61

$136.95

$135.77

$171.44

$227.20

Monthly – retired

Elevate What you pay

HDHP What you pay

Standard What you pay

Elevate Plus What you pay

High What you pay

Self Plus One premium

Enrollment code

256

343

316

253

313

$112.11

$135.90

$134.73

$182.51

$244.76

Biweekly – employed

$242.90

$294.44

$291.92

$395.44

$530.31

Monthly – retired

Elevate What you pay

HDHP What you pay

Standard What you pay

Elevate Plus What you pay

High What you pay

Self and Family premium

Enrollment code

255

342

315

252

312

$136.48

$167.00

$164.85

$190.63

$302.25

Biweekly – employed

$295.71

$361.83

$357.17

$413.04

$654.87

Monthly – retired

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 benefit enrollment.

23 2022 GEHA MEDICAL PLANS

Compare prescription coverage for all plans What you pay in-network. 1,2

Elevate What you pay

HDHP What you pay

Standard What you pay

Elevate Plus What you pay

High What you pay

Prescription type

$4

25% 3

$10

$10

$10 4

• 30-day retail generic

50% ($500 max)

25% 3,5

50% ($200 max 5 )

$80 5

25% ($150 max 4,5 )

• 30-day preferred brand-name

100%

40% 3,5

50% ($300 max 5 )

50% 5

40% ($200 max 4,5 )

• 30-day non-preferred brand-name

25% 3

$20

$20

$20

• 90-day mail order service generic

No benefit

• 90-day mail order service preferred brand-name

25%

50% ($500 max 5 )

$200 5

25% ($350 max 5 )

No benefit

3,5

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

40%

50% ($600 max 5 )

50% 5

40% ($500 max 5 )

No benefit

3,5

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

50% ($500 max)

25%

50% ($250 max 5 )

40% ($500 max 5 )

25% ($150 max 5 )

3,5

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

100%

40%

50% ($400 max 5 )

50% 5

40% ($200 max 5 )

3,5

Elevate and Elevate Plus do not have out-of-network pharmacy coverage and have a limited pharmacy network. Learn more about prescription coverage at geha.com/Prescriptions

Check drug costs at info.caremark.com/GEHA

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 one of GEHA’s 2022 plan brochures: RI 71-006 (High and Standard), RI 71-014 (HDHP) or 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 Calendar year deductible applies. 4 Cost 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. 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.

24 2022 GEHA MEDICAL PLANS

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