2023 GEHA Medical Benefits Guide

2023 GEHA Medical Plans

Choose from five unique medical plans designed to meet you where you are in life.

geha.com | 800.262.4342

What’s inside 03 Welcome 04 Choose from five unique medical plans 06 Elevate 08 HDHP 10 Standard 12 Elevate Plus 14 High 16 Get help choosing the right plan 17 Extras if you choose Elevate

18 Earn Wellness Pays rewards—Elevate and Elevate Plus plans 19 Earn Health Rewards—HDHP, Standard and High plans 20 Vision discounts and benefits for GEHA plans 21 Benefits included in all five plans 22 GEHA works with Medicare A and B 24 Compare premiums 25 Compare deductibles and out-of-pocket maximum

26 Compare prescription costs 28 Compare medical benefits 30 It pays to stay in-network 31 Definitions and terms

2023 GEHA medical plans

Welcome Whatever stage of life you’re in, GEHA has a plan to fit your needs. We believe health care isn’t one size fits all, and our plans are designed with that in mind. For more than 85 years, GEHA (Government Employees Health Association, Inc.) has provided medical plans designed exclusively for federal employees.

GEHA is a non-profit association and one of the largest national medical plan carriers for federal employees.

Choose from five medical plans:

Elevate

HDHP

Standard

Elevate Plus

High

Choose from the following enrollment types:

Open Season begins on Monday, November 14, and concludes on Monday, December 12. NOV DEC

Self Only Self Only covers only the enrollee and no one else.

Self Plus One Self Plus One covers the enrollee and one eligible family member.

All five GEHA medical plans cover pre-existing conditions.

Self and Family Self and Family covers the enrollee and eligible family including children up to age 26.

2023 GEHA medical plans

Choose from five unique medical plans

Elevate

HDHP

Standard

• One of the lowest national premiums and low doctor visit copays • Uniquely designed plan with a complete wellness focus • Earn up to $1,000 per household with a

• No-cost preventive care paired with a low premium. • GEHA puts money in your HSA every month geha.com/HSA • Earn up to $500 per household to pay for qualified expenses

• Comprehensive medical coverage for all stages of life • Affordable premiums and low copays for common services • Earn up to $500 per household to pay for qualified expenses

generous rewards program geha.com/WellnessPays

geha.com/HealthRewards

How often you use your plan:

Low

Average

High

Low

Average

High

Low

Average

High

Prescription medication need:

Low

Average

High

Low

Average

High

Low

Average

High

Life-stage: early career Health care style : wellness-focused, cost-conscious

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

Life-stage: mid-career Health care style: traditional care and coverage

geha.com/Standard

geha.com/Elevate

geha.com/HDHP

This is a brief description of the features of GEHA’s medical plans. Please read the Plan’s Federal brochure (RI 71-018, RI 71-014 and RI 71-006), available at geha.com/PlanBrochure . All benefits are subject to the definitions, limitations and exclusions set forth in the Federal brochure.

2023 GEHA medical plans

We believe health care isn’t one size fits all, and our plans are designed with that in mind. Whatever stage of life you’re in, GEHA has a plan designed to fit your needs.

Elevate Plus

High

All plans include:

• NEW $150 deductible for Self Only and $300 deductible for Self Plus One and Self and Family • NEW 15% coinsurance for some services • Earn up to $1,000 per household with a generous rewards program geha.com/WellnessPays

• Low copays for

primary and specialist doctor visits

Nationwide coverage

• Get more care with GEHA and Medicare geha.com/Medicare • Earn up to $500 per household to pay for qualified expenses

Telehealth visits with MDLIVE

geha.com/HealthRewards

24/7 Health Advice Line

How often you use your plan:

Low

Average

High

Low

Average

High

Preventive care

Prescription medication need:

Incentives and discounts

Low

Average

High

Low

Average

High

Life-stage: mid-career Health care style: proactive, values generous rewards

Life-stage: late-career Health care style: maximum coverage, dependable support

No referrals necessary

geha.com/ElevatePlus

geha.com/High

Rewards programs

2023 GEHA medical plans

Elevate Learn all about this plan at geha.com/Elevate • GEHA’s lowest premium plan • Low copays for non-traditional care, like chiropractic and acupuncture • Engaging digital wellness hub powered by Rally ® Health Premium and enrollment code Employed – biweekly Retired – monthly 254 Self Only $50.69 $109.83 256 Self Plus One $118.83 $257.47 255 Self and Family $144.67 $313.46 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 which maintains your health benefits enrollment.

Health care style: a wellness-focused and cost-conscious plan for those without an extensive prescription need.

How often you use your plan:

Prescription benefit need:

Low

Average

High

Low

Average

High

How this plan pays you back: • Earn Wellness Pays rewards up to $500 (Self Only) or $1,000 (Self Plus One or Self and Family) annually. Rewards dollars can be used for qualified medical expenses such as copays, and medical, dental and vision expenses. geha.com/WellnessPays • Subscribers can select an annual plan perk. Options include a Fitbit wearable device including 12-month Fitbit Premium Membership, a $125 gift card for DICK’S Sporting Goods or REI, or a 12-month Daily Burn virtual fitness subscription. 4 geha.com/PlanPerk

Yearly deductible in-network 1

You pay

$500

Self Only

$1,000

Self Plus One or Self and Family

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.

Out-of-pocket maximum in-network 1,2

You pay

$8,500

Self Only

$17,000

Self Plus One or Self and Family

2023 GEHA medical plans

Medical benefits in-network 1

You pay

Unlimited telehealth visits, including mental health, with MDLIVE Preventive care; adult routine screenings Well-child visit; up to age 22 Maternity; routine care Vision coverage; eye exams 2

Primary physician office visit Mental health office visit MinuteClinic ® where available Chiropractic care (manipulative therapy), including X-rays; up to 12 visits per year Acupuncture; up to 20 treatments per year

$10

$30

Specialist care office visit

$50

Urgent care facility

ER visit Maternity; inpatient care Hospital care; inpatient and outpatient Lab services X-ray and other diagnostic services Outpatient professional surgical services

25% 3

$250

Inpatient professional surgical services

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 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. 3 Calendar year deductible applies. 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.

Prescription benefits in-network 1,2,3

You pay

30-day retail generic

50% ( $500 max)

30-day retail preferred brand-name

100%

30-day retail non-preferred brand-name

50% ( $500 max)

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

100%

30-day specialty CVS exclusive non-preferred brand-name

2023 GEHA medical plans

HDHP Learn all about this plan at geha.com/HDHP

• Low premiums with a lower net deductible than many traditional plans • Reduce out-of-pocket expenses and enjoy a triple tax advantage with a health savings account (HSA) geha.com/HSA • GEHA contributes to your HSA. Use your HSA money to reduce your net deductible or save it and let it grow tax-free in your account. Premium and enrollment code Employed – biweekly Retired – monthly 341 Self Only $69.37 $150.30 343 Self Plus One $149.15 $323.15 342 Self and Family $183.28 $397.11

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 which maintains your health benefits enrollment.

How often you use your plan:

Prescription benefit need:

Health care style: for the analytical health care consumer, focused on savings

Low

Average

High

Low

Average

High

How this plan pays you back: • Up to two adults ages 18 and over can earn up to $250 (maximum $500 per household) per year in Health Rewards geha.com/HealthRewards • GEHA contributes $900 (Self Only) or $1,800 (Self Plus One or Self and Family) to your HSA

GEHA HSA contribution

Yearly deductible in-network 1

Annual deductible

You pay 2

$1,500

$900

$600

Self Only

$3,000

$1,800

$1,200

Self Plus One or Self and Family

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 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. Out-of-pocket maximum in-network 1,2 You pay Self Only $5,000 Self Plus One or Self and Family $10,000 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 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.

2023 GEHA medical plans

Medical benefits in-network 1

You pay

$0 2, 3

Unlimited telehealth visits, including mental health, with MDLIVE

Maternity; routine care Maternity; inpatient care

$0 2

Preventive care; adult routine screenings Well-child visit; up to age 22 Preventive dental care, twice yearly

Vision coverage; eye exam and additional benefits

Primary physician office visit Mental health office visit Specialist care office visit Urgent care facility ER visit Hospital care; inpatient and outpatient MinuteClinic ® where available Lab services X-ray and other diagnostic services Professional surgical services Chiropractic care (manipulative therapy), including X-rays; up to 20 visits per year Acupuncture; up to 20 treatments per year

5% 2

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 Calendar year deductible applies. 3 HDHP members who have met their deductible will be charged by MDLIVE, but GEHA will reimburse the member 100% of the plan allowance. 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.

Prescription benefits in-network 1,2,3

You pay

25%

30-day retail generic

25% 4

30-day retail preferred brand-name

40% 4

30-day retail non-preferred brand-name

25%

90-day mail service generic

25% 4

90-day mail service preferred brand-name

40% 4

90-day mail service non-preferred brand-name

25% 4

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

30-day specialty CVS exclusive non-preferred brand-name 40% 4 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 Calendar year deductible applies. 4 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.

2023 GEHA medical plans

Standard Learn all about this plan at geha.com/Standard

• Dependable, traditional coverage • Affordable premiums • Some of the FEHB’s lowest copays for in-network primary care and specialist visits Premium and enrollment code Employed – biweekly Retired – monthly 314 Self Only $68.77 $149.01 316 Self Plus One $147.87 $320.39 315 Self and Family $180.92 $392.00 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 which maintains your health benefits enrollment .

How often you use your plan:

Prescription benefit need:

Health care style: traditional care and coverage to stay on a healthy path

Low

Average

High

Low

Average

High

How this plan pays you back: • Up to two adults ages 18 and over can earn up to $250 (maximum $500 per household) per year in Health Rewards geha.com/HealthRewards

Yearly deductible in-network 1

You pay

$350

Self Only

$700

Self Plus One or Self and Family

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.

Out-of-pocket maximum in-network 1,2

You pay

$6,500

Self Only

$13,000

Self Plus One or Self and Family

2023 GEHA medical plans

Medical benefits in-network 1

You pay

Unlimited telehealth visits, including mental health, with MDLIVE Preventive care; adult routine screenings Well-child visit; up to age 22

Maternity; routine care Maternity; inpatient care QuestSelect TM Lab Benefit (formerly Lab Card ® )

Vision coverage; eye exams 2

$10

MinuteClinic ® where available Primary physician office visit Mental health office visit

$20

Specialist care office visit Urgent care facility Chiropractic care (manipulative therapy), including X-rays; up to 20 visits per year

$35

15%

Lab services (other than QuestSelect)

ER visit Hospital care; inpatient and outpatient Professional surgical services X-ray and other diagnostic services Acupuncture; up to 20 treatments per year

15% 3

50%

Preventive dental care, twice yearly

$100

Outpatient professional High Tech Imaging (MRI, CT, PET, etc.)

$150

Outpatient facility High Tech Imaging (MRI, CT, PET, etc.)

Prescription benefits in-network 1,2

You pay

$10

30-day retail generic

50% ( $200 max 3 )

30-day retail preferred brand-name

50% ( $300 max 3 )

30-day retail non-preferred brand-name

$20

90-day mail service generic

50% ( $500 max 3 )

90-day mail service preferred brand-name

50% ( $600 max 3 )

90-day mail service non-preferred brand-name

50% ( $250 max 3 )

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

50% ( $400 max 3 )

30-day specialty CVS exclusive non-preferred brand-name

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 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.

2023 GEHA medical plans

Elevate Plus Learn all about this plan at geha.com/ElevatePlus • $150 deductible for Self Only. $300 for Self Plus One and Self and Family. 15% coinsurance for some services. • Low copays for non-traditional care, like chiropractic and acupuncture • Engaging digital wellness hub powered by Rally Health Premium and enrollment code Employed – biweekly Retired – monthly 251 Self Only $85.77 $185.84 253 Self Plus One $187.64 $406.55 252 Self and Family $209.83 $454.64 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 which maintains your health benefits enrollment.

How often you use your plan:

Prescription benefit need:

Health care style: health-focused and proactive

Low

Average

High

Low

Average

High

Yearly deductible in-network 1,2

You pay

$150

Self Only

$300

Self Plus One or Self and Family

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 This plan has no out-of-network coverage.

Out-of-pocket maximum in-network 1,2

You pay

$6,000

Self Only

$12,000

Self Plus One or Self and Family

2023 GEHA medical plans

Medical benefits in-network 1,2

You pay

Unlimited telehealth visits, including mental health, with MDLIVE Preventive care; adult routine screenings Well-child visit; up to age 22 Lab services Maternity; routine care Vision coverage; eye exams 3

$10

MinuteClinic ® where available

Primary physician office visit Mental health office visit Chiropractic care (manipulative therapy), including X-rays; up to 15 visits per year Acupuncture; up to 20 treatments per year

$30

$45

Specialist care office visit

$50

Urgent care facility

$50 4

X-ray and other diagnostic services

ER visit Outpatient and inpatient professional surgery services Maternity; inpatient care Hospital care; inpatient and outpatient

15% 5

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 This plan has no out-of-network coverage. 3 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. 4 You pay $175 ($100 professional fee, $75 facility fee) for advanced outpatient High Tech Imaging such as MRI, CT, PET, etc. Refer to GEHA’s 2023 plan brochure RI 71-018 (Elevate and Elevate Plus) at geha.com/PlanBrochure 5 Calendar year deductible applies. 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. Prescription benefits in-network 1,2,3 You pay 30-day retail generic $10 30-day retail preferred brand-name $80 4 30-day retail non-preferred brand-name 50% 4 90-day mail service generic $20 90-day mail service preferred brand-name $200 4 90-day mail service non-preferred brand-name 50% 4 30-day specialty CVS exclusive generic and preferred brand-name 40% ( $500 max 4 ) 30-day specialty CVS exclusive non-preferred brand-name 50% 4 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 This plan has no out-of-network pharmacy coverage. 4 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.

2023 GEHA medical plans

High Learn all about this plan at geha.com/High

• Comprehensive brand-name and specialty prescription coverage • NEW! $1,000 Medicare Part B premium reimbursement. geha.com/MRA • Low copays for doctor visits • $2,500 hearing aid benefit and additional discount Premium and enrollment code Employed – biweekly Retired – monthly 311 Self Only $105.74 $229.10 313 Self Plus One $243.49 $527.56 312 Self and Family $304.39 $659.52 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 which maintains your health benefits enrollment.

How often you use your plan:

Prescription benefit need:

Health care style: maximum coverage and dependable support

Low

Average

High

Low

Average

High

Low

Average

High

Low

Average

High

How this plan pays you back: • NEW! $1,000 Medicare Part B premium reimbursement • Adults ages 18 and over can earn up to $250 (maximum $500 per household) per year in Health Rewards. geha.com/HealthRewards

Yearly deductible in-network 1

You pay

$350

Self Only

$700

Self Plus One or Self and Family

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.

Out-of-pocket maximum in-network 1,2

You pay

$5,000

Self Only

$10,000

Self Plus One or Self and Family

2023 GEHA medical plans

Medical benefits in-network 1

You pay

Unlimited telehealth visits, including mental health, with MDLIVE Preventive care; adult routine screenings Well-child visit; up to age 22 Maternity; routine care Maternity; inpatient care Outpatient accidental injury, including ER (within 72 hours) Lab services

Vision coverage; eye exams 2

$10

MinuteClinic ® where available

Primary physician office visit Mental health office visit Specialist care office visit Chiropractic care (manipulative therapy), including X-rays; up to 20 visits per year

$20

$35

Urgent care facility

ER visit; medical emergency Hospital care; outpatient Professional surgical services X-ray and other diagnostic services Acupuncture; up to 20 treatments per year

10% 3

$100 per admission plus 10%

Hospital care; inpatient

Balance after GEHA pays $22 per visit

Preventive dental; twice yearly

Prescription benefits in-network 1,2

You pay

$10 3

30-day retail generic

25% ( $150 max 3 ,4 ) 40% ( $200 max 3 ,4 )

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

$20

90-day mail service generic

25% ( $350 max 4 ) 40% ( $500 max 4 ) 25% ( $150 max 4 ) 40% ( $200 max 4 )

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

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 Costs for initial prescription and first refill. You pay 50% for third and additional refills at retail for 30-day supply. For long-term prescriptions, use mail order or your local retail CVS Pharmacy store (90-day supply) for greater cost savings. 4 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.

2023 GEHA medical plans

Get help choosing the right plan GEHA has a plan for every stage of your life. We are here to help you discover which plan is the right fit for you.

Call us Talk to a GEHA Benefits Adviser Monday –Friday, 7 a.m. –7 p.m. Central time. 800.262.4342

Book an appointment Meet one-on-one with a GEHA Benefits Adviser to help answer your questions. geha.com/Meet

Watch on-demand webinars Learn how to find a plan that’s right for you

Chat online Chat or text with a GEHA Benefits Adviser in real time Monday –Friday, 7 a.m. –7 p.m. Central time. geha.com

with an on-demand webinar. geha.com/BenefitsWebinars

Compare plans Easily compare GEHA’s five medical plans. geha.com/CompareMedical

Plan recommender tool Answer a few questions to see a plan that matches your individual or family needs. geha.com/Select-A-Plan

For more information about FEHB plans, visit the U.S. Office of Personnel Management at opm.gov/Healthcare-Insurance

2023 GEHA medical plans

Extras if you choose Elevate

Elevate subscribers can choose among three options annually to support a healthy lifestyle. It pays to be a GEHA Elevate plan member. This plan includes an exclusive plan perk option to support a healthy lifestyle. It’s quick and easy for Elevate subscribers to claim their plan perk. Sign up for a geha.com account (or log in to your existing account) and update your contact preferences.

Choice of one Fitbit device including a 12-month Fitbit Premium Membership.

12-month Daily Burn virtual fitness subscription.

GEHA’s unique position as a nonprofit member association allows us to offer this bonus plan perk exclusively for the Elevate plan. We don’t have stockholders, which means our priority is putting money back into supporting our members. For more information, visit geha.com/PlanPerk

$125 gift card for DICK’s Sporting Goods or REI.

These products and services are neither offered nor guaranteed under contract with the FEHB Program, but are made available to eligible Subscribers who become members of the GEHA Elevate medical plan. Only Subscribers in the 50 United States and the District of Columbia are eligible at this time.

2023 GEHA medical plans

Earn Wellness Pays rewards Elevate and Elevate Plus plans

Get rewarded for activities you’re probably already doing.

HOW IT WORKS • Earn rewards automatically for healthy activities you’re probably already doing • Register on our Rally ® platform to manage your health goals, enroll with a wellness coach and more • Complete your first rewardable activity and receive your Wellness Pays reloadable debit card in the mail • Redeem the rewards for qualified medical expenses such as copays

geha.com/WellnessPays

HOW MUCH YOU CAN EARN • $500 per individual, per year

• $1,000 per family per year

ACTIVITIES THAT EARN YOU WELLNESS PAYS REWARDS

$10 per month to hit your Stride step goal

$50 annual flu shot 1

$100 cervical, colorectal or breast cancer screening 1

$100 first trimester prenatal appointment 1

$50 one MDLIVE telehealth or mental health visit

$75 one time Rally health survey; $50 to do Rally missions/wellness quizzes

$100 annual physical or digital wellness coaching

$200 complete Real Appeal or Quit for Life

1 Activity must be reported online to earn rewards. 2 Restrictions may apply. This is a brief description of the features of the Elevate and Elevate Plus plans. Before making a final decision, please read the Plan’s Federal brochure (RI 71-018), available at geha.com/PlanBrochure . All benefits are subject to the definitions, limitations, and exclusions set forth in the Federal brochure.

2023 GEHA medical plans

Earn Health Rewards HDHP, Standard and High plans

The tools and incentives you need to help you live healthier.

HOW IT WORKS • Complete your first rewardable activity and receive your Health Rewards reloadable debit card in the mail automatically • Redeem the rewards for qualified medical expenses such as copays • Complete rewardable activities to add funds to your Health Rewards debit card

geha.com/HealthRewards

HOW MUCH YOU CAN EARN • $250 per individual, per year

• $500 per family per year

ACTIVITIES THAT EARN YOU HEALTH REWARDS

$10 per online wellness workshop

$25 annual flu shot 1

$50 cervical, colorectal or breast cancer screening 2

$50 first trimester prenatal appointment 1

$50 one MDLIVE telehealth or mental health visit

$75 health risk assessment

$50 participate in a targeted health program 3

1 Activity must be reported online to earn rewards. 2 Restrictions may apply. 3 By invitation only.

This is a brief description of the features of the HDHP, Standard and High plans. Before making a final decision, please read the Plan’s Federal brochure (RI 71-014 or RI 71-006), available at geha.com/PlanBrochure . All benefits are subject to the definitions, limitations, and exclusions set forth in the Federal brochure.

2023 GEHA medical plans

With all GEHA medical and dental plans, you get discounts on eye exams, frames and lenses through EyeMed. ® The EyeMed network includes Independent Provider Network, LensCrafters, Pearle Vision, Target Optical, contactsdirect.com , glasses.com and more. Members also save on LASIK at participating US Laser Network locations. Vision discounts and benefits for GEHA plans

Learn more at geha.com/Vision The HDHP plan includes additional vision benefits. Learn more at geha.com/HDHPVision

Elevate 1 you pay

HDHP you pay

Standard 1 you pay

Elevate Plus 1 you pay

High 1 you pay

Vision benefit

Eye exams retail price

$0 under $100 plus 80% over $100

60% of price

Frames retail price

Eyeglass lenses, standard plastic single vision retail price Eyeglass lenses, standard plastic bifocal retail price Eyeglass lenses, standard plastic progressive lens retail price Eyeglass lens options, UV treatment, tint (solid and gradient), standard plastic scratch coating Eyeglass lens options, standard anti-reflective coating

Up to $50 $10

Up to $50

Up to $70 $10

Up to $70

No more than $75

Up to $135

$15

$45

$10 under $110 plus 85% over $110

85% of price

Contact lens, conventional retail price

85% of price

1 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.

2023 GEHA medical plans

Benefits included in all five plans

24/7 Health Advice Line Talk to a nurse 24/7. geha.com/Healthline

Unlimited $0 MDLIVE 1 telehealth visits Get access to certified doctors, including pediatricians, mental health therapists and dermatologists.

Gym membership discount 2 Access 11,600+ Active&Fit Direct ™ locations nationwide with GEHA’s Connection Fitness ® program. geha.com/Fitness Teeth whitening discounts 2 Get a 20% discount on the lowest published price on all Smile Brilliant ® home teeth whitening and oral care products. geha.com/Whitening Hearing aid discounts 2 Get discounts through TruHearing ® on hearing aids. Save up to 30% to 60% off hearing aids. Some average more than $2,600 in savings per pair. geha.com/Hearing Medical alert system discount 2 Get free activation on Life Alert ® services, plus a 10% monthly discount, for you and your extended family. geha.com/LifeAlert

geha.com/MDLIVE

Electric toothbrush discount 2,3 Enjoy 70% off a cariPRO ® premium electric toothbrush.

geha.com/Toothbrush

1 HDHP members who have met their deductible will be charged by MDLIVE, but GEHA will reimburse the member 100% of the Plan Allowance. 2 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. 3 The cariPRO ® premium toothbrush removes seven times more plaque than a regular brush, is completely waterproof and comes with a two-year manufacturer’s warranty. Replacement brush heads with high-quality DuPont TM bristles are also available at this exclusive, member-only price.

2023 GEHA medical plans

GEHA works with Medicare A and B

GEHA offers five medical plans, each with coverage that coordinates with Medicare. For more information, including benefits and rates, visit geha.com/Medicare

Elevate and Medicare

HDHP and Medicare

Standard and Medicare

Elevate Plus and Medicare

High and Medicare

Plan service

NEW! $1,000 Medicare Part B premium reimbursement 100% medical coverage (copays and deductibles waived) with Medicare A & B primary

Yes

Hearing aid benefit 1

Coverage for in-network and out-of-network care 1 Coverage for care outside of the United States

Yes

Non-preferred drug coverage 2

Yes

Mail service pharmacy

Choice of plan perk 3

Yes

1 Though the Elevate Plus plan on its own does not provide out-of-network medical coverage, when it’s combined with Medicare and the provider accepts Medicare assignment, out-of-network cost shares are waived. There are no out-of-network pharmacy benefits for Elevate and Elevate Plus. 2 With High plan, when Medicare A & B is primary, you pay a lower coinsurance for preferred and non-preferred brand medications. 3 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 medical plan. This is a brief description of the features of Government Employees Health Association, Inc.’s medical plans. Before making a final decision, please read the GEHA Federal brochures which are available at geha.com/PlanBrochure. All benefits are subject to the definitions, limitations and exclusions set forth in the Federal brochures.

2023 GEHA medical plans

GEHA and Medicare EyeMed ® vision coverage

Elevate and Elevate Plus you pay

Standard and High you pay

Vision services in-network

HDHP you pay

Eye exams; retail price

$0 under $100 plus 80% over $100

60% of price

Frames; retail price

Eyeglass lenses, standard plastic, single vision; retail price Contact lens, conventional; retail price

Up to $50

$10

$10 under $110 plus 85% over $100

85% of price

GEHA’s HDHP plan includes a complete vision benefit in addition to vision discounts through EyeMed. Learn more at geha.com/HDHPVision

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.

2023 GEHA medical plans

Compare premiums

Self Only premium and enrollment code

Employed – biweekly

Retired – monthly

$50.69

$109.83

254 Elevate

$69.37

$150.30

341 HDHP

$68.77

$149.01

314 Standard

$85.77

$185.84

251 Elevate Plus

$105.74

$229.10

311 High

Self Plus One premium and enrollment code

Employed – biweekly

Retired – monthly

$118.83

$257.47

256 Elevate

$149.15

$323.15

343 HDHP

$147.87

$320.39

316 Standard

$187.64

$406.55

253 Elevate Plus

$243.49

$527.56

313 High

Self and Family premium and enrollment code

Employed – biweekly

Retired – monthly

$144.67

$313.46

255 Elevate

$183.28

$397.11

342 HDHP

$180.92

$392.00

315 Standard

$209.83

$454.64

252 Elevate Plus

$304.39

$659.52

312 High

2023 GEHA medical plans

Compare deductibles and out-of-pocket maximum

Compare deductibles What you pay each year before the plan begins to pay out benefits.

High You pay

Yearly deductible in-network 1

Elevate You pay

HDHP You pay

Standard You pay

Elevate Plus 2 You pay

$500

$600 3

$350

$150

$350

Self Only

Self Plus One or Self and Family

$1,000

$1,200 3

$700

$300

$700

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 This plan has no out-of-network coverage. 3 The net deductible is the remaining amount after you subtract the GEHA contribution from the annual deductible. This is your out-of-pocket cost before plan benefits begin.

Compare out-of-pocket maximum The maximum amount of coinsurance, copays and deductibles you pay for all family members before GEHA begins to pay 100% of covered services. This is a combined maximum of medical care and prescriptions.

Out-of-pocket maximum in-network 1

Elevate You pay

HDHP You pay

Standard You pay

Elevate Plus 2 You pay

High You pay

$8,500

$5,000

$6,500

$6,000

$5,000

Self Only

Self Plus One or Self and Family

$17,000

$10,000

$13,000

$12,000

$10,000

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 This plan has no out-of-network coverage.

2023 GEHA medical plans

Compare prescription costs

Elevate 4 You pay

HDHP 5 You pay

Standard You pay

Prescription benefits in-network 1,2,3

25%

$10

30-day retail generic

50% ( $500 max)

50% ( $200 max 6 ) 50% ( $300 max 6 )

25% 6

30-day retail preferred brand-name

100%

40% 6

30-day retail non-preferred brand-name

25%

$20

90-day mail service generic

No benefit

50% ( $500 max 6 ) 50% ( $600 max 6 ) 50% ( $250 max 6 ) 50% ( $400 max 6 )

25% 6

90-day mail service preferred brand-name No benefit

90-day mail service non-preferred brand-name

40% 6

No benefit

50% ( $500 max)

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

25% 6

30-day specialty CVS exclusive non-preferred brand-name

100%

40% 6

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 The out-of-pocket maximum is the maximum amount of coinsurance and copays 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. 3 Refer to geha.com/Prescriptions for formulary and specialty coverage for specific medications. 4 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 5 Calendar year deductible applies. 6 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.

You’ve got options with retail prescriptions Pay less for prescriptions filled at an in-network pharmacy location. Locations include any CVS Pharmacy location, but you don’t have to go to a CVS to pay in-network prices. Find an in-network pharmacy location at geha.com/Find-Care

2023 GEHA medical plans

Check drug costs at info.caremark.com/oe/geha

Elevate Plus 4 You pay

High You pay

Prescription benefits in-network 1,2,3

$10

$10 5

30-day retail generic

25% ( $150 max 5,6 ) 40% ( $200 max 5,6 )

$80 6

30-day retail preferred brand-name

50% 6

30-day retail non-preferred brand-name

$20

90-day mail service generic

25% ( $350 max 6 ) 40% ( $500 max 6 ) 25% ( $150 max 6 ) 40% ( $200 max 6 )

$200 6

90-day mail service preferred brand-name

50% 6

90-day mail service non-preferred brand-name

40% ( $500 max 6 )

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

30-day specialty CVS exclusive non-preferred brand-name

50% 6

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 The out-of-pocket maximum is the maximum amount of coinsurance and copays 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. 3 Refer to geha.com/Prescriptions for formulary and specialty coverage for specific medications. 4 This plan has no out-of-network coverage 5 Costs for initial prescription and first refill. You pay 50% for third and additional refills at retail for 30-day supply. For long-term prescriptions, use mail order or your local retail CVS Pharmacy store (90-day supply) for greater cost savings. 6 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.

Save more with mail order prescriptions With CVS Caremark’s Mail Service Pharmacy, you can save money and have your routine prescriptions delivered to your home, postage-paid, within about 14 days from the time you submit your prescription. Mail order is not available for the Elevate plan option.

2023 GEHA medical plans

Compare medical benefits

Elevate You pay

HDHP You pay

Standard You pay

Medical benefits in-network 1

Unlimited telehealth visits, including mental health, with MDLIVE Preventive care; adult routine screenings Well-child visit; up to age 22

$0 2, 3

Vision coverage; eye exams

$0 3

Maternity; routine care

$10

5% 3

$10

MinuteClinic ® where available

$10

5% 3

$20

Primary physician office visit

$10

5% 3

$20

Mental health office visit

$30

5% 3

$35

Specialist care office visit

$50

5% 3

$35

Urgent care facility

25% 3

5% 3

15% 3

ER visit; accidental

25% 3

5% 3

15% 3

ER visit; medical

25% 3

5% 3

15% 3

Hospital care; inpatient

25% 3

$0 3

Maternity; inpatient care

25% 3

5% 3

15% 3

Hospital care; outpatient

$250

5% 3

15% 3

Inpatient professional surgical services

25% 3

5% 3

15% 3

Outpatient professional services

25% 3

5% 3

15% (QuestSelect $0 )

Lab services

25% 3

5% 3

15% 3 ,4

X-rays and other diagnostic services

Chiropractic care visit (manipulative therapy), including X-rays. Limited per year. Acupuncture visit; up to 20 treatments per year

$10

5% 3

$35

$10

5% 3

15% 3

50%

Preventive dental care

No benefit

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 HDHP members who have met their deductible will be charged by MDLIVE, but GEHA will reimburse the member 100% of the plan allowance. 3 Calendar year deductible applies. 4 Standard, you pay $250 ($100 professional fee, $150 facility fee) for advanced outpatient High Tech Imaging such as MRI, CT, PET, etc. Refer to GEHA’s 2023 plan brochure RI 71-006 (High and Standard) at geha.com/PlanBrochure

2023 GEHA medical plans

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