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
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