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.
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2022 GEHA MEDICAL PLANS
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