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
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