Elevate geha.com/Elevate • GEHA’s lowest premium plan
Self Only What you pay
Self Plus One What you pay
Self and Family What you pay
Premiums
255
Enrollment codes
254
256
$48.74 $105.61
$112.11 $272.90
$136.48
Biweekly – employed
• Low copays for doctor visits, and chiropractic and acupuncture visits • Engaging digital wellness portal powered by Rally Health How this plan pays you back • NEW! Subscribers can select an annual plan perk. Options include a Fitbit wearable device including monthly Fitbit Premium Membership, a $125 gift card for DICK’S Sporting Goods or REI, or a Daily Burn virtual fitness subscription. 4 geha.com/PlanPerk • Earn up to $500 (maximum $1,000 per household) in Wellness Pays annually geha.com/WellnessPays
Monthly – retired $295.71 Footnote: These rates do not apply to all enrollees. If you are in a special enrollment category, please refer to the FEHB program website or contact the agency or Tribal Employer that maintains your health benefits enrollment.
Yearly deductible in-network 1
What you pay
$500
Self Only
$1,000
Self Plus One and Self and Family
Prescription benefits in-network 1,2,3
What you pay
$4
• 30-day retail generic
50% ($500 max)
• 30-day retail preferred brand-name • 30-day retail non-preferred brand-name
100%
50% ($500 max)
• 30-day specialty CVS exclusive generic and preferred brand-name • 30-day specialty CVS exclusive non-preferred brand-name
100%
Check prescription costs at geha.com/Prescriptions To provide a low premium, this plan does not include mail-order prescriptions or out-of- network pharmacy coverage, and it has a limited pharmacy network. Find a pharmacy at geha.com/Find-Care
Life stage: early career Health care style: wellness-focused, cost-conscious
How often you use your plan
Low
Average
High
Prescription medication need
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. 2 Refer to geha.com/Prescriptions for formulary and specialty coverage for specific medications. 3 To provide a low premium, this plan does not include mail-order prescriptions or out-of-network pharmacy coverage, and it has a limited pharmacy network. Find a pharmacy at geha.com/Find-Care 4 These benefits are neither offered nor guaranteed under contract with the FEHB program, but are made available to subscribers who become a member of GEHA’s Elevate and Elevate Plus medical plans.
Low
Average
High
04 2022 GEHA MEDICAL PLANS
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