2023 GEHA Medical Benefits Guide

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

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

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

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.

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2023 GEHA medical plans

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