2022 GEHA Medical Benefits Guide

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

15% 2 15% 2

$200 $200

10% 2 10% 2

$250 25% 2

5% 2 5% 2

Inpatient professional surgical services Outpatient professional surgical services

$0

$0

Lab Card services

No benefit

No benefit

No benefit

5% 2 5% 2

15%

$0

10% 10% 2

25% 2 25%

Lab services (other than Lab Card)

15% 2, 3

$50 4

Other diagnostic services

$10 up to 12 visits per year

5% 2 up to 20 visits per year

$30 up to 20 visits per year

$25 up to 15 visits per year

$20 up to 20 visits per year Balance after GEHA pays $22 per visit, twice yearly

Chiropractic care visit (manipulative therapy), including X-rays

$0 twice yearly; no deductible

50% twice yearly

Preventive dental care

No benefit

No benefit

Acupuncture visit; 20 treatments per year

15% 2

$25

10% 2

$10

5%

2

Still unsure? Try our plan recommender tool Answer a few simple questions and we’ll help you find a plan that might be right for your needs. geha.com/Select-A-Plan

Your doctor is probably in-network GEHA has an extensive nationwide network of up to 4 million provider locations. Check to see if your doctor is in-network. geha.com/Find-Care

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 Standard, you pay $175 ($100 professional fee, $75 facility fee) for advanced outpatient High Tech Imaging such as MRI, CT, PET, etc. You pay $175 ($100 professional fee, $75 facility fee) for High Tech Imaging such as MRI, CT, PET, etc. Refer to GEHA’s 2022 plan brochure RI 71-006 (High and Standard) at geha.com/PlanBrochure 4 Elevate Plus, you pay 25% for advanced outpatient diagnostic tests such as, High Tech Imaging such as MRI, CT, PET, etc. Refer to GEHA’s 2022 plan brochure RI 71-018 (Elevate and Elevate Plus) for a complete list at geha.com/PlanBrochure

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2022 GEHA MEDICAL PLANS

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