2023 GEHA Medical Benefits Guide

Definitions and terms We know some terms can be confusing. As you work your way through this guide, these definitions may help.

Term

Definition

Calendar year deductible

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

The percentage you pay for a covered health care service, after you’ve met your deductible.

Coinsurance

Copay

A fixed amount you pay for a service or prescription.

Portion of monthly HDHP premium that GEHA contributes to a health savings account (HSA) or health reimbursement arrangement (HRA).

GEHA contribution

A health care provider who is a part of GEHA’s provider network. These providers agree to limit what they will charge you.

In-network provider

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.

Net deductible (HDHP)

The maximum amount you pay each year for coverage. Includes copays, deductibles and coinsurance, but not premiums. Once the limit is met, the plan pays the remainder of your covered health care expenses for the rest of the year.

Out-of-pocket max

Cost of health care goods and services after subtracting the insurance company’s negotiated discount. For complete details see the definition of “Plan allowance” in Section 10 of any GEHA plan brochure. geha.com/PlanBrochure

Plan allowance

PPO

A preferred provider organization.

Premium

What you pay monthly or biweekly for coverage.

Prescription benefits

What you pay as a copay or percentage of coinsurance for medication.

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.

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2023 GEHA medical plans

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