Elevate Plus 2 You pay
High 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
$0
$0
$0
$0
$5
Vision coverage; eye exams
$0
$0
Maternity; routine care
$10
$10
MinuteClinic ® where available
$30
$20
Primary physician office visit
$30
$20
Mental health office visit
$45
$20
Specialist care office visit
$50
$35
Urgent care facility
15% 3
$0
ER visit; accidental
15% 3
10% 3
ER visit; medical
15% 3
$100 per admission plus 10%
Hospital care; inpatient
15% 3
$0
Maternity; inpatient care
15% 3
10% 3
Hospital care; outpatient
15% 3
10% 3
Inpatient professional surgical services
15% 3
10% 3
Outpatient professional services
$0
$0
Lab services
$50 4
10% 3
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
$30
$20
$30
10% 3
Balance after GEHA pays $22 per visit
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 This plan has no out-of-network coverage. 3 Calendar year deductible applies. 4 Elevate Plus, you pay $100 copay for advanced outpatient diagnostic tests such as, High Tech Imaging such as MRI, CT, PET, etc. Refer to GEHA’s 2023 plan brochure RI 71-018 (Elevate and Elevate Plus) for a complete list at geha.com/PlanBrochure
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2023 GEHA medical plans
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