Included with Elevate
Medical benefits in-network 1
What you pay
Telehealth visits, including behavioral health geha.com/MDLIVE Vision discount 4 (see page 20) geha.com/Vision Gym membership discount 4 geha.com/Fitness Electric toothbrush discount 4 geha.com/Toothbrush Teeth whitening discount 4 geha.com/Whitening Surgical concierge 5 $0 out-of-pocket surgery costs and care coordination geha.com/BridgeHealth For a complete list visit geha.com/Savings
• Unlimited telehealth visits, including behavioral health, with MDLIVE geha.com/MDLIVE • Preventive care; adult routine screenings • Well-child visit; up to age 22 • Maternity; routine care • Primary physician office visit • MinuteClinic © (where available) geha.com/MinuteClinic • Chiropractic care (manipulative therapy), including X-rays; up to 12 visits per year • Acupuncture; up to 20 treatments per year
$0
$10
$25 $50
• Specialist care; office visit
• Urgent care
• Emergency care • Hospital care; inpatient including maternity • Hospital care; outpatient • Lab services • Other diagnostic services • Outpatient professional surgical services • Inpatient professional surgical services
25% 2
$250
Medicare A & B primary? See page 25 or visit geha.com/Medicare
4 These benefits are neither offered nor guaranteed under contract with the FEHB program, but are made available to all enrollees who become members of a GEHA medical plan and their eligible family members. 5 Subject to any eligibility limitations. See info.bridgehealth.com/GEHA for more information.
Out-of-pocket maximum in-network 1,3
What you pay
$7,000 $14,000
Self Only
Self Plus One and Self and Family
Learn how to enroll at geha.com/Enroll
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 GEHA’s 2022 plan brochure RI 71-018 (Elevate and Elevate Plus) at geha.com/PlanBrochure 2 Calendar year deductible applies. 3 The out-of-pocket maximum is the maximum amount of coinsurance, copays and deductibles you pay for all family members before GEHA begins paying for 100% of covered services. This is a combined maximum for both medical care and prescriptions.
05 2022 GEHA MEDICAL PLANS
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