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
$0
$5
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
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 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.
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2023 GEHA medical plans
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