2022 GEHA Medical Benefits Guide

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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