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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