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
$0
Maternity; routine care Maternity; inpatient care QuestSelect TM Lab Benefit (formerly Lab Card ® )
$5
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.)
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.
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.
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2023 GEHA medical plans
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