Compare medical benefits for all plans NOTE: The Elevate Plus medical plan does not offer out-of-network coverage.
Elevate What you pay
HDHP What you pay
Standard What you pay
Elevate Plus What you pay
High What you pay
Medical benefits in-network 1
Unlimited telehealth visits, including behavioral health, with MDLIVE • Preventive care; adult routine screenings • Well-child visit; up to age 22
$0
$0
$0
$0
$0
2,3
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0 2
Maternity; routine care
$10
5% 2
$10
$10
$10
MinuteClinic © (where available)
$15
$25
$20
$10
5% 2
Primary physician office visit
$30 $35
$40 $50
$20 $35
$25 $50
5% 2 5% 2
Specialist care; office visit
Urgent care
$0 (must be within 72 hours)
5% 2
15% 2
$200
25% 2
Emergency care; accidental
25% 2
5% 2
15% 2
$200
10% 2
Emergency care; medical
$250 per day up to $1,000 per admission $250 per day up to $1,000 per admission $250 per day per facility
$100 per admission plus 10%
25% 2
5% 2
15% 2
Hospital care; inpatient
$0 2
$0
$0
25% 2
Hospital care; inpatient maternity
5% 2
15% 2
10%
25% 2
Hospital care; outpatient
2
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 Calendar year deductible applies. 3 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.
26 2022 GEHA MEDICAL PLANS
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