Standard geha.com/Standard • Dependable, traditional coverage • Affordable premiums • Some of the lowest copays for in-network primary care and specialist visits How this plan pays you back • 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
315
Enrollment codes
314
316
$62.66 $135.77
$134.73 $291.92
$164.85
Biweekly – employed
Monthly – retired $357.17 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
$350 $700
Self Only
Self Plus One and Self and Family
Prescription benefits in-network 1,2
What you pay
$10
• 30-day retail generic
50% ($200 max 3 ) 50% ($300 max 3 )
• 30-day retail preferred brand-name • 30-day retail non-preferred brand-name
$20
• 90-day mail service generic
50% ($500 max 3 ) 50% ($600 max 3 ) 50% ($250 max 3 ) 50% ($400 max 3 )
• 90-day mail service preferred brand-name • 90-day mail service non-preferred brand-name
• 30-day specialty CVS exclusive generic and preferred brand-name • 30-day specialty CVS exclusive non-preferred brand-name
Life stage: mid-career Health care style: traditional coverage to stay on a healthy path
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 71-006 (High and Standard) at geha.com/PlanBrochure 2 Refer to geha.com/Prescriptions for formulary and specialty coverage for specific medications. 3 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.
Low
Average
High
08 2022 GEHA MEDICAL PLANS
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