2022 GEHA Medical Benefits Guide

HDHP geha.com/HDHP • Low premiums with a low net-deductible • Reduce out-of-pocket expenses and enjoy a triple tax advantage with a health savings account (HSA) 6 geha.com/HSA • Use your HSA money to reduce your net deductible or save it and let it grow tax-free in your account 6 How this plan pays you back • GEHA contributes $900 (Self Only) or $1,800 (Self Plus One or Self and Family) to your HSA • Earn up to $250 (maximum $500 per household) in Health Rewards annually geha.com/HealthRewards

Self Only What you pay

Self Plus One What you pay

Self and Family What you pay

Premiums

342

Enrollment codes

341

343

$63.21 $136.95

$135.90 $294.44

$167.00

Biweekly – employed

Monthly – retired $361.83 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 you pay after GEHA contribution to your HSA 2

Plan type

Yearly deductible in-network 1

$600

$1,500

Self Only

Self Plus One and Self and Family

$1,200

$3,000

Prescription benefits in-network 1,3,4

What you pay

25% 25% 5 40% 5 25% 25% 5 40% 5 25% 5 40% 5

• 30-day retail generic

• 30-day retail preferred brand-name • 30-day retail non-preferred brand-name

• 90-day mail service generic

• 90-day mail service preferred brand-name • 90-day mail service non-preferred brand-name

Life stage: all career stages Health care style: non-traditional, focused on saving for future needs

• 30-day specialty CVS exclusive generic and preferred brand-name • 30-day specialty CVS exclusive non-preferred brand-name

Check prescription costs at geha.com/Prescriptions

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. For out-of-network benefits, refer to GEHA’s 2022 plan brochure RI 71-014 (HDHP) at geha.com/PlanBrochure 2 The net deductible is the remaining amount after you subtract the annual GEHA contribution from the annual deductible. This is your out-of-pocket cost before plan benefits begin. 3 Calendar year deductible applies. 4 Refer to geha.com/Prescriptions for formulary and specialty coverage for specific medications. 5 If you choose a brand-name medication when a generic is available, you will be charged the generic copay plus the difference in cost between the brand-name and the generic. 6 The information provided is for informational purposes only. It should not be considered legal or financial advice. You should consult with a professional to determine what may be best for your individual needs.

Low

Average

High

06 2022 GEHA MEDICAL PLANS

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