MEDICAL BENEFITS - GEHAWEB20 · that you can use to reduce your out-of-pocket expenses while...

MEDICAL BENEFITS

geha.com

http://www.geha.com

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What’s inside

Plans

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Help

20 COMPARE PLAN BENEFITS

21 COMPARE PLAN PRICING

22 COMPARE DEDUCTIBLES & OUT-OF-POCKET MAXIMUMS

23 COMPARE PRESCRIPTION BENEFITS

25 HELPFUL RESOURCES

26 DEFINITIONS

27 ENDNOTES

28 WHAT’S NEW IN 2020

04 ELEVATE NEW!This new plan rewards you for your commitment to healthy living while offering broad access to convenient online care with a low premium.

06 HIGH DEDUCTIBLE HEALTH PLAN (HDHP)Take advantage of a lower-than-expected deductible, comprehensive coverage and funds you can use to pay for future health care expenses.

10 STANDARD OPTIONFor those who want traditional coverage and affordable premiums.

12 ELEVATE PLUS NEW!This new plan has no deductible when you use in-network providers — and you have copays for most common medical expenses.

14 HIGH OPTIONA smart pick if you take brand-name prescription drugs. New for 2020: $600 Medicare Part B premium reimbursement.

16 INCLUDED BENEFITS & SAVINGSGEHA medical plan members receive additional benefits for things like vision coverage, online doctor visits and discounted gym memberships.

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GEHA’s medical plan portfolio

GEHA offers five medical plans that empower you to achieve the health you need to live the life you want. Each plan is designed to help you do your possible.

Whether you’re focused on wellness, saving for future health care needs, seeking a traditional benefit plan or looking for a complement to Medicare, GEHA has an option that is right for you.

All GEHA plans offer worldwide coverage and a mix of benefits. You can choose the plan that works for your budget and lifestyle.

Elevate

GEHA’s lowest premium. Broad access to care. This plan uses digital wellness tools to help you enjoy an active lifestyle and rewards you for your commitment to healthy living.

NEW!

High Deductible Health Plan (HDHP)

GEHA’s HDHP pairs a low premium and a lower-than-expected deductible. You pay only 5% of medical services after your deductible is met.

Standard OptionWith affordable premiums, GEHA’s Standard Option medical plan provides dependable benefits and coverage.

Elevate Plus

No deductible when you use in-network providers. Copays for most common medical expenses. This plan supports your healthy lifestyle with rewards for wellness and personalized concierge

NEW!

HighOptionGEHA’s High Option is a smart pick if you take brand-name prescription drugs and have Medicare as your primary coverage.

Questions? Call 800.262.4342 | Learn how to enroll at geha.com/Enroll

NEW! $600 Medicare Part B premium reimbursement.

http://www.geha.com/enroll

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Learn more at geha.com/Elevate | Questions? Call 800.262.4342 | Learn how to enroll at geha.com/Enroll

Elevate NEW!

Included benefits14 – explore more detail on pages 16-19.

Digital tools to simplify your health care experience.

Our digital platform is a fun way to help you self-manage your health goals.

$4 generic prescriptions.

Free 24/7 online doctor visits.Health care on your terms. Get

online access to doctors, including dermatologists, and licensed therapists

through MDLIVE.

GEHA’s lowest premium plan.

Rewards for healthy behavior.Up to $500 annually (or $1,000

annually for two family members).

Don’t want to think about health benefits? Don’t worry. We’ve done the thinking for you. This new plan is designed to be easy and affordable. Elevate offers you convenient care, when you need it, and then lets you get back to your busy life.

Earn rewards for your healthy behavior. Get a flu shot? That’s good for a $50 reward. Completed your routine physical? That’s a $100 reward. Completed an online coaching program? That’ll earn you a $150 reward.12

You should know ...This plan is designed to lower premiums by focusing on generic drugs over specialty and brand-name prescriptions.12 Prescriptions can only be picked up at an in-network pharmacy, and mail order is not available. If these are priorities to you, please consider Elevate Plus. You can evaluate the pharmacy drug list and use the pharmacy locator at info.caremark.com/GEHA

Get rewarded for your commitment to healthy living, while enjoying broad access to convenient online care.

Teethwhitening

Online doctor visits

Gym membership

Electric toothbrush

Vision discount

http://info.caremark.com/GEHA

http://www.geha.com/Elevate


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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 that maintains your health benefits enrollment.

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What you pay: PremiumsSelf OnlyENROLL CODE 254

Self Plus OneENROLL CODE 256

Self and FamilyENROLL CODE 255

Non-Postal biweekly $47.32 $108.84 $132.51

Postal biweekly – Category 1 APWU, IT/AS, NALC, NPMHU $45.43 $104.49 $127.21

Postal biweekly – Category 2 PPOA $39.28 $90.34 $109.98

Retirees monthly $102.53 $235.83 $287.10

Prescription medications What you pay in-network

Retail pharmacy; 30-day supply4,12

Generic $4

Preferred brand-name medication 50% ($500 max)

Non-preferred brand-name medication

100%

Specialty prescription CVS exclusive4,12; 30-day supply8

Generic and preferred brand-name medication 50% ($500 max)

Non-preferred brand-name medication 100%

What you pay in-network3 Self OnlySelf Plus

OneSelf and

Family

Calendar year deductible $500 $1,000 $1,000

Out-of-pocket maximum2 $7,000 $14,000 $14,000

Compare all plans on pages 20-23. 1-4,8,12,14 See full definitions and endnotes on pages 26-27.

Deductible & out-of-pocket maximum

Medical benefits What you pay in-network3,12

Online doctor visits with MDLIVE Nothing

Preventive care; adult routine screenings Nothing

Well-child visit; up to age 22 Nothing

MinuteClinic® (where available) $10

Primary physician office visit $10

Specialist care; office visit $25

Urgent care $50

Emergency care 25% of allowance1

Hospital care; inpatient including maternity 25% of allowance1

Hospital care; outpatient 25% of allowance1

Chiropractic care; up to 12 visits per year (spinal manipulation therapy)

$10

Acupuncture; up to 20 medically necessary treatments per year

$10

High Deductible Health Plan

Take advantage of a lower-than-expected deductible, comprehensive coverage and funds you can use to pay for future health care expenses.

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This plan pairs lower premiums with a health savings account (HSA) or a health reimbursement arrangement (HRA). GEHA‘s HDHP provides comprehensive coverage combined with funds you can use to pay for future medical expenses.12

X You pay only 5% of medical services after your deductible is met.

X With our premium pass-through, GEHA contributes to your HSA/HRA to lower your net deductible. GEHA contributes $900 for Self Only or $1,800 for Self Plus One or Self and Family.

X Vision benefits are included and you pay nothing for in-network preventive dental treatment, which includes two checkups and one X-ray annually.

X Your in-network, out-of-pocket maximum for 2020 is only $5,000 for Self Only, or $10,000 for Self Plus One or Self and Family.

The high deductible health plan that’s not high at all.GEHA contributes money to your HSA/HRA that you can use to reduce your out-of-pocket expenses while satisfying your deductible. Combine this benefit with a health savings account (HSA) or a health reimbursement arrangement (HRA) to get low-cost medical coverage with funds for future use.

GEHA CONTRIBUTION $900

YOUR NET DEDUCTIBLE $600

SELF ONLY DEDUCTIBLE $1,500

SELF PLUS ONE OR FAMILY DEDUCTIBLE $3,000

GEHA CONTRIBUTION $1,800

YOUR NET DEDUCTIBLE $1,200

Learn more at geha.com/HDHP | Questions? Call 800.262.4342 | Learn how to enroll at geha.com/Enroll


Medical alert system

Gym membership

Teethwhitening

Electric toothbrush


Health Advice Line

Vision discount

Biometric screening

Hearing aid discount

http://www.geha.com/HDHP


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Prescription medications What you pay in-network3


Generic 25% of allowance1

Preferred brand-name medication 25% of allowance1,5

Non-preferred brand-name medication

40% of allowance1,5

Mail service pharmacy; 90-day supply4,12

Generic 25% of allowance1

Preferred brand-name medication 25% of allowance1,5

Non-preferred brand-name medication 40% of allowance1,5


Generic and preferred brand-name medication 25% of allowance1

Non-preferred brand-name medication 40% of allowance1,5


OneSelf and

Family

Calendar year deductible

GEHA contributionYour net deductible

$1,500-$900$600

$3,000-$1,800$1,200

$3,000-$1,800$1,200


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Online doctor visits with MDLIVE Nothing1,6



Maternity; routine preventive care Nothing

Primary physician office visit 5% of allowance1

Specialist care; office visit 5% of allowance1

Urgent care 5% of allowance1

MinuteClinic® (where available) 5% of allowance1

Emergency care 5% of allowance1

Hospital care; inpatient, outpatient 5% of allowance1

Hospital care; inpatient maternity Nothing1


Balance after GEHA payment.

GEHA pays $20 per visit.1

Chiropractic X-raysBalance after GEHA payment.

GEHA pays $25 for X-rays.1

Preventive dental care; twice yearly Nothing

Preventive lab services Nothing

Learn more at geha.com/HDHP | Questions? Call 800.262.4342 | Learn how to enroll at geha.com/Enroll

HSA and HRA eligibility

Which one are you eligible for?Most people qualify for an HSA. Those who don’t are enrolled in an HRA; this group includes Medicare enrollees and those who have non-HDHP coverage elsewhere.

A quick look at HSA vs. HRA HSA HRA

You own the account and can take it with you when you change jobs or retire

You do not own the account Unused money rolls over year-over-year Money in your account can grow, tax-free, over time Accounts are provided by HSA Bank with access to investment services

You can make additional tax-deductible deposits No additional personal contributions are allowed Tax-free withdrawals for qualified medical expenses GEHA pays your account setup fee and monthly maintenance fee

No account fees

HSA – For most active federal employees who enroll during Open Season, the first monthly HSA deposit will be available as early as February 15, 2020. After that date, a portion of your plan premium will be deposited into your HSA each month.

HRA – For those who don’t qualify for an HSA and who enroll during Open Season, the full annual HRA deposit is available for qualified medical expenses incurred on or after your effective date in January.

How and when will my HSA or HRA be funded?

Learn more about HDHP HSA and HRA accounts at geha.com/HDHP

geha.com/IRS969

Find out which one you‘re eligible for at:

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http://www.geha.com/irs969




Every year, Evan saves and invests all of his annual GEHA contribution of $900 and invests an additional contribution of $2,650, which brings him to the $3,550 maximum allowed for individual coverage for the plan year.

INVESTED EVAN TOTAL SAVED PER YEAR $3,550

$205,008.40

$86,032.90

$20,640.07

$3,5501 year

5 years

15 years

25 years

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Grow with a High Deductible Health Plan

The plan that pays you back. Watch your money grow with an HSA.Unused HSA funds roll over from year to year, from job to job, and on into retirement. Because there is no need to “use it or lose it,” you can keep your money in an interest-bearing savings account, or invest in stocks, bonds and mutual funds to grow your savings.12

Growth projections given as example only. No guarantee on returns. Examples given based on 6% annual rate of return.

Reduce your taxable income while you save for your future.Investing your HSA money not only helps you save for future financial security, it offers some major tax advantages, too. All HSA contributions are pre-tax and are not taxed when you withdraw them for qualified medical expenses.13

Tax-free contributions lower your yearly federal taxable income.

1Tax-free interest is earned in your account, growing your investment over time.

2Tax-free withdrawals for qualified medical expenses.3

CONTRIBUTING KIM TOTAL SAVED PER YEAR $1,800

Every year, Kim saves and invests all of her $900 annual GEHA contribution, plus she puts an additional $900 in her HSA.

$103,949.09

$43,622.81

$10,465.50

$1,8001 year

5 years

15 years

25 years

SAVINGS STEVE TOTAL SAVED PER YEAR $900

Every year, Steve saves and invests all of his $900 annual GEHA contribution.

1 year

5 years

15 years

25 years $51,974.55

$21,811.40

$5,232.75

$900

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12,13 See full definitions and endnotes on pages 26-27.Investment products are not FDIC insured, are not a deposit or other obligation of or guaranteed by HSA Bank, and are subject to investment risks. The information provided is for informational purposes only. It should not be considered legal or financial advice. You should consult with a professional to determine what may be best for your individual needs.

Standard Option

For those who want traditional coverage and affordable premiums.

Get the dependable health and wellness coverage you want at the price you can afford. With comprehensive care, you get what you expect, because it’s the plan you know and trust, with familiar benefits and coverage.12

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Learn more at geha.com/StandardOption | Questions? Call 800.262.4342 | Learn how to enroll at geha.com/Enroll


Gym membership

Teethwhitening

Lab services

Electric toothbrush


Health Advice Line

Vision discount

Biometric screening

Hearing aid benefit

X Pay nothing for online doctor visits with access to certified doctors, including dermatologists, and licensed therapists through MDLIVE.

X Pay nothing for routine, in-network maternity care.

X Get a complete range of prescription services.

X Receive straightforward, dependable coverage at a modest cost.

When you enroll in GEHA’s Standard Option, you:

X A 30-day supply of generic medication costs just $10.

X You can visit any in-network primary care doctor for only a $15 copay each visit.

X This plan covers 100% of preventive care costs when you see an in-network provider.

Other Standard Option highlights include:

You should know ...You can earn rewards up to a total of $250 for completing healthy activities like a yearly heath assessment, a biometric screening, and online classes such as weight management, stress management or smoking cessation.

http://www.geha.com/StandardOption


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OneSelf and

Family

Calendar year deductible $350 $700 $700












Generic $10

Preferred brand-name medication 50% ($200 max5)

Non-preferred brand-name medication 50% ($300 max5)


Generic $20



Specialty prescription CVS exclusive; 30-day supply4,8,12

Generic and preferred brand-name medication 50% ($250 max5)










Urgent care $35


Emergency care; accidental Nothing if services within 72 hours

Emergency care; medical 15% of allowance1

Hospital care; inpatient, outpatient 15% of allowance1

Hospital care; inpatient maternity Nothing


Balance after GEHA payment. GEHA pays $20 per visit.

Chiropractic X-rays Balance after GEHA payment. GEHA pays $25 for X-rays.

Preventive dental care; twice yearly 50% of allowance


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Learn more at geha.com/ElevatePlus | Questions? Call 800.262.4342 | Learn how to enroll at geha.com/Enroll

Elevate Plus NEW!

No deductible when you use in-network providers. Copays for most common medical expenses.


Out-of-network coverage.

Fixed costs. No in-network deductible.

Know what you’re paying upfront for many common services. Simple and straightforward,

so you can focus on care.

Digital tools to navigate your health care experience.

Our personalized programs help you get the most out of your plan.

Free 24/7 online doctor visits.Health care on your terms. Get online access to doctors, including dermatologists, and licensed

therapists through MDLIVE.

Rewards for healthy behavior.Up to $500 annually (or $1,000 annually for

two family members).

If you expect the unexpected, GEHA’s Elevate Plus plan is designed for you.

Elevate Plus offers a balance of predictable costs for in-network services — you pay only copays for most services — along with personalized concierge support to help you get the most value out of your plan.14

Surgical concierge. Get the highest quality of care for a wide range of surgical services, all at $0 out-of-pocket cost. With our concierge service, BridgeHealth, your dedicated Care Coordinator will schedule appointments, set up the surgery and manage all post-surgical services.12,15

You should know ...This plan includes a comprehensive drug list and mail order service. Retail prescriptions can only be picked up at an in-network pharmacy location. If your pharmacy location is a priority, you can evaluate available pharmacy locations and your prescription costs at info.caremark.com/GEHA

Teethwhitening


Gym membership

Electric toothbrush

Vision discount

Hearing aid benefit


http://www.geha.com/ElevatePlus


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Prescription medications What you pay in-network


Generic $5

Preferred brand-name medication $80 copay5

Non-preferred brand-name medication 40% of allowance5


Generic $12

Preferred brand-name medication $200 copay5






OneSelf and

Family



Compare all plans on pages 20-23. 2-5,8,12,14,15 See full definitions and endnotes on pages 26-27.
















Urgent care $50

Emergency care $150

Hospital care; inpatient including maternity $200 copay / day, up to $1,000 / admission

Hospital care; outpatient $200 copay / day per facility

Chiropractic care; up to 15 visits per year (spinal manipulation therapy) $20

Acupuncture; up to 20 medically necessary treatments per year $20

High Option

You work hard to maintain your health and live a healthy lifestyle. In 2020, count on GEHA’s High Option plan to support you on your wellness journey.

Maybe you depend on brand-name prescription medications. Maybe you’re a Medicare A & B enrollee looking for a $600 reimbursement to help with your Medicare Part B premium payments. Maybe you’ve simply reached that point in life where you’re willing to spend a little more for a premium plan that gives you the confidence to live life to its fullest. High Option was designed with you in mind.12

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Learn more at geha.com/HighOption | Questions? Call 800.262.4342 | Learn how to enroll at geha.com/Enroll



Gym membership

Teethwhitening

Lab services

Electric toothbrush


Health Advice Line

Vision discount

Biometric screening

Hearing aid benefit

Are you eligible for Medicare?To see how GEHA’s medical plans work together with your coverage, visit geha.com/Medicare

X Comprehensive prescription coverage that works with Medicare.

X Get a $2,500 hearing aid benefit.

When you enroll in GEHA’s High Option, you’ll get:

X Combines a $600 reimbursement for Medicare Part B premiums with a cost-share waiver, making High Option the plan of choice for Medicare enrollees.

X Low out-of-pocket costs when you need care.

X Similar to other plans, you get worldwide coverage that lets you travel abroad worry-free.

Other High Option highlights include:

A smart pick if you take brand-name prescription drugs. New for 2020: $600 Medicare Part B premium reimbursement.

http://www.geha.com/HighOption

http://www.geha.com/Medicare


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Compare all plans on pages 20-23. 1-5,7,8,12,14 See full definitions and endnotes on pages 26-27.



Generic $10 copay7

Preferred brand-name medication 25% ($150 max5,7)

Non-preferred brand-name medication 40% ($200 max5,7)


Generic $20







OneSelf and

Family


















Urgent care $35


Emergency care; accidental Nothingif services within 72 hours

Emergency care; medical 10% of allowance1

Hospital care; inpatient $100 per admission copay plus 10% of allowance

Hospital care; inpatient maternity Nothing

Hospital care; outpatient 10% of allowance1

Chiropractic care; up to 20 visits per year(spinal manipulation therapy)

Balance after GEHA payment. GEHA pays $20 per visit.

Chiropractic X-rays Balance after GEHA payment. GEHA pays $25 for X-rays.

Preventive dental care Balance after GEHA pays $22 / visit, 2 times / year


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Questions? Call 800.262.4342 | Learn how to enroll at geha.com/Enroll | Find provider at geha.com/Find-Care

Included benefits & savings Learn more at geha.com/Vision

Vision coverage & discounts

X $0 copay for Elevate and Elevate Plus — and a $5 copay for Standard, High and HDHP — for annual eye exams at qualified EyeMed providers.

X Up to $45 in reimbursements from EyeMed™, per covered member, per year, for out-of-network exams.

X No limit on the number of discount glasses or contact lenses purchased each year.

X Savings on LASIK and PRK.

X EyeMed providers include LensCrafters, Target, independent eye doctors and top optical retailers.

GEHA‘s High Deductible Health Plan (HDHP) is the only plan that also includes generous vision benefits for eye exams, frames and lenses, especially if you stay in-network. To learn more, download plan brochure RI 71-014 at geha.com/PlanBrochure

Discounts What you pay in-network10

Eye exam; with dilation as necessary $0 for Elevate and Elevate Plus

Eye exam; with dilation as necessary $5 for High, Standard and HDHP

Eyeglass frames 60% of the retail price

10 See full definitions and endnotes on pages 26-27.

Additional pairs

Eyeglasses (complete pair) Up to 60% of the retail price

Contacts (conventional lenses) Up to 85% of the retail price

Eyeglass lenses

Standard plastic, single vision Up to $50

Standard plastic bifocal Up to $70

Standard plastic trifocal Up to $105

Standard progressive lens Up to $135

Premium progressive lens 80% of the retail price

Eyeglass lens options

UV treatment $15

Tint (solid and gradient) $15

Standard plastic scratch coating $15

Standard polycarbonate $40

Standard anti-reflective coating $45

Photochromatic/transitions plastic 80% of the retail price

Premium anti-reflective 80% of the retail price

Other add-ons 80% of the retail price

Contact lenses

Conventional 85% of the retail price

Disposable No discount

These benefits are neither offered nor guaranteed under contract with the FEHB, but are made available to all enrollees and family members who become members of a GEHA medical plan.

http://www.geha.com/Vision

http://www.geha.com/PlanBrochure


http://www.geha.com/Find-care

Examples of common hearing aid product ranges

Products given as examples onlyAverage retail price

TruHearing price

Standard / High Option benefit

Standard / High Option: What you pay

Elevate Plus benefit

Elevate Plus: What you pay

Starkey Muse iQ i1000 $3,410 $1,950 $2,500 Nothing $1,500 $450

TruHearing Advanced 19 $4,890 $2,500 $2,500 Nothing $1,500 $1,000

Widex Beyond 220 $4,260 $2,500 $2,500 Nothing $1,500 $1,000

Oticon Opn 3 $4,830 $2,790 $2,500 $290 $1,500 $1,290

ReSound LiNX 3D 5 $4,950 $3,190 $2,500 $690 $1,500 $1,690

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Hearing aid savings X Three of our plans include a hearing aid benefit: $2,500 with no deductible for the Standard and High Option plans, and

$1,500 with no deductible for the Elevate Plus plan.

X This hearing aid benefit is per person, every three years for adults — and annually for dependents up to age 22.

X This benefit can be combined with our TruHearing™ hearing aid discounts, which apply to all GEHA plans. Even extended family members get access to exclusive prices. Most members see savings of 30% to 60%, averaging more than $2,100 per pair.

Learn more at geha.com/Hearing

http://www.geha.com/Hearing

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Questions? Call 800.262.4342 | Learn how to enroll at geha.com/Enroll | Find a provider at geha.com/Find-Care

Elevate HDHP Standard Option

Elevate Plus

High Option

Vision coverage & discounts$0 copay for Elevate and Elevate Plus — and a $5 copay for Standard, High and HDHP — routine eye exams at qualified EyeMed™ providers. For out-of-network exams, EyeMed reimburses you up to $45 per covered member per year. No limit on the number of discount glasses or contact lenses purchased each year. EyeMed providers include LensCrafters, Target, independent eye doctors and top optical retailers.geha.com/Vision

Hearing aid savingsThree GEHA plans include a hearing aid benefit: $2,500 for High and Standard Option plans, and $1,500 for Elevate Plus. Get exclusive pricing on TruHearing™ hearing aids with all GEHA medical plans. Most members see savings of 30% to 60%, averaging more than $2,100 per pair.geha.com/Hearing

Online doctor visitsGEHA offers 24/7 virtual access to certified doctors, including pediatricians, therapists and dermatologists, through MDLIVE.geha.com/MDLIVE

24-hour Health Advice LineFree for all GEHA medical members: You can talk with a nurse 24/7.geha.com/Healthline

Biometric screeningSpot the early warning signs of serious conditions such as heart disease and diabetes with this easy test. You can have a free confidential screening at home, at work or at one of 2,300 Quest Diagnostics locations nationwide.geha.com/Screenings

Included benefits & savings

http://www.geha.com/Vision

http://www.geha.com/Hearing

http://www.geha.com/MDLIVE

http://www.geha.com/Healthline'

http://www.geha.com/Screenings


http://www.geha.com/Find-Care

Elevate HDHP Standard Option

Elevate Plus

High Option

Gym discountWith GEHA’s Connection Fitness® program, all GEHA medical plan members can access more than 10,000 Active&Fit Direct™ participating fitness centers nationwide for $25 a month (plus a $25 enrollment fee and applicable taxes). geha.com/Fitness

Lab CardIf you do not have Medicare and you sign up for GEHA’s Standard or High Option medical plan, you will receive a Quest Diagnostics Lab Card after enrolling. When you use your Lab Card, GEHA pays outpatient lab testing at 100%. Lab Card coverage does not apply to in-hospital testing.geha.com/LabCard

Electric toothbrush9

GEHA members can save more than 70% off a premium electric toothbrush by cariPRO™.geha.com/Toothbrush

Teeth whiteningReceive a 20% discount on the lowest published price on all Smile Brilliant home teeth whitening products. This includes custom-fitted trays, whitening gel and desensitizing gel.smilebrilliant.com/GEHA

Medical alert systemGEHA members and extended family are eligible for discounted services from Life Alert®, the industry leader in responsive emergency care. Members receive free activation, plus a 10% monthly discount.geha.com/LifeAlert

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The included benefits listed are neither offered nor guaranteed under contract with the FEHB program, but are made available to all enrollees who become members of GEHA and their eligible family members.


http://www.geha.com/Fitness

http://www.geha.com/LabCard

http://www.geha.com/Toothbrush

http://www.smilebrilliant.com/GEHA

http://www.geha.com/LifeAlert

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What you pay: Medical benefits in-network3,12

Elevate HDHP Standard Option Elevate Plus High Option

Preventive care; adult routine screenings

Nothing Nothing Nothing Nothing Nothing

Well-child care; up to age 22 Nothing Nothing Nothing Nothing Nothing

Primary care physician; office visit

$10 5% of allowance1 $15 $20 $20

Specialist care; office visit $25 5% of allowance1 $30 $35 $20

Online doctor visits with MDLIVE Nothing Nothing1,6 Nothing Nothing Nothing

Maternity; routine preventive care

Nothing Nothing Nothing Nothing Nothing

Urgent care $50 5% of allowance1 $35 $50 $35

MinuteClinic® (where available) $10 5% of allowance1 $10 $10 $10

Emergency care; accidental 25% of allowance1 5% of allowance1 Nothing, if services within 72 hours

$150 Nothing, if services within 72 hours

Emergency care; medical 25% of allowance1 5% of allowance1 15% of allowance1 $150 10% of allowance1

Hospital care; inpatient 25% of allowance1 5% of allowance1 15% of allowance1 $200 copay / day$100 per admission copay plus 10% of allowance

Hospital care; inpatient maternity 25% of allowance1 Nothing1 Nothing $200 copay / day, up to $1,000 / admission

Nothing

Hospital care; outpatient 25% of allowance1 5% of allowance1 15% of allowance1 $200 copay / day per facility

10% of allowance1

Chiropractic (spinal manipulation therapy)

$10 copay, up to 12 visits per year

Balance after GEHA payment. GEHA pays $20 per visit,

20 times / year.1

Balance after GEHA payment. GEHA pays $20 per visit, 20 times / year.

$20 copay, up to 15 visits per year

Balance after GEHA payment. GEHA pays $20 per visit, 20 times / year.

Chiropractic X-rays 25% of allowance1Balance after GEHA payment. GEHA pays $25 for X-rays.

Balance after GEHA payment. GEHA pays $25 for X-rays.

$50Balance after GEHA payment. GEHA pays $25 for X-rays.

Preventive dental care N/A Nothing, twice yearly50% of allowance, twice yearly

N/ABalance after GEHA pays $22 / visit, twice yearly

Acupuncture; up to 15-20 medically necessary treatments per year

$10 5% of allowance1 15% of allowance1 $20 10% of allowance1

Compare plan benefits

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Self OnlyWhat you pay

ElevateENROLL CODE 254

HDHPENROLL CODE 341

Standard OptionENROLL CODE 314

Elevate PlusENROLL CODE 251

High OptionENROLL CODE 311

Non-Postal biweekly $47.32 $59.29 $60.54 $72.67 $105.42

Postal biweekly – Category 1 APWU, IT/AS, NALC, NPMHU

$45.43 $56.92 $58.12 $69.77 $102.14

Postal biweekly – Category 2 PPOA

$39.28 $49.21 $50.25 $60.32 $92.32

Retirees monthly $102.53 $128.46 $131.18 $157.46 $228.41

1,3,6,12 See full definitions and endnotes on pages 26-27.

Compare plan pricing

Self Plus OneWhat you pay


HDHPENROLL CODE 343






$104.49 $122.38 $124.97 $163.27 $239.51


$90.34 $105.81 $108.05 $142.26 $218.50


Self and Family What you pay


HDHPENROLL CODE 342






$127.21 $144.04 $149.30 $173.02 $296.80


$109.98 $124.53 $129.08 $149.59 $274.04




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Check drug costs in advanceDon‘t be surprised at the pickup counter. Check drug costs to estimate what you‘ll pay based on your GEHA medical plan and prescription dosage at info.caremark.com/GEHA

There’s a good chance your doctor is in-network.All plans come with an extensive nationwide network of up to 4 million provider locations (depending on the plan you pick) and the freedom to choose any doctor — with extra savings when you see an in-network provider.

Eligible for Medicare? To see how GEHA‘s medical plans work together with your coverage, visit geha.com/Medicare

Compare deductibles & out-of-pocket maximums

What you pay in-network:Calendar year deductible12


Self Only $500 $1,500 DEDUCTIBLE

-$ 900 GEHA CONTRIBUTION

$ 600 YOUR NET DEDUCTIBLE

$350 $0 $350

Self Plus One $1,000 $3,000 DEDUCTIBLE

-$1,800 GEHA CONTRIBUTION

$1,200 YOUR NET DEDUCTIBLE

$700 $0 $700

Self and Family $1,000 -$3,000 DEDUCTIBLE

-$1,800 GEHA CONTRIBUTION

$1,200 YOUR NET DEDUCTIBLE

$700 $0 $700

What you pay:Out-of-pocket maximum2,12


Self Only $7,000 $5,000 $6,500 $6,000 $5,000

Self Plus One $14,000 $10,000 $13,000 $12,000 $10,000

Self and Family $14,000 $10,000 $13,000 $12,000 $10,000





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Retail pharmacy; in-network3,4,12


What you pay: 30-day supply

Generic $4 25% of allowance1 $10 $5 $10 copay7

Preferred brand-name medication 50% ($500 max) 25% of allowance1,5 50% ($200 max5) $80 copay5 25% ($150 max5,7)

Non-preferred brand-name medication 100% 40% of allowance1,5 50% ($300 max5) 40% of allowance5 40% ($200 max5,7)

Understanding your pharmacy benefits

Retail: You‘ve got optionsTo pay less, all prescriptions must be filled at an in-network pharmacy location. Your options include any CVS Pharmacy location, but you don‘t have to go to a CVS to pay in-network prices. Visit geha.com/Find-Care to find in-network locations.

Save more with mail orderWith CVS Caremark’s Mail Service Pharmacy, you can save money and have your routine prescriptions delivered to your home, postage-paid, within about 14 days from the time you submit your prescription.*

Learn more4 at geha.com/PrescriptionsCompare prescription benefits

Mail service pharmacy; in-network3,4,12


What you pay: 90-day supply

Generic N/A 25% of allowance1 $20 $12 $20

Preferred brand-name medication N/A 25% of allowance1,5 50% ($500 max5) $200 copay5 25% ($350 max5)

Non-preferred brand-name medication N/A 40% of allowance1,5 50% ($600 max5) 40% of allowance5 40% ($500 max5)

Specialty prescription; in-network3,4,12


What you pay: 30-day supply; CVS exclusive8

Generic and preferred brand-name medication

50% ($500 max) 25% of allowance1 50% ($250 max5) 40% ($500 max5) 25% ($150 max5)

Non-preferred brand-name medication 100% 40% of allowance1,5 50% ($400 max5) 40% of allowance5 40% ($200 max5)

1-5,7,8,12 See full definitions and endnotes on pages 26-27. *Not available for the Elevate plan option.

http://www.geha.com/Prescriptions


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Helpful tools Description Learn more

Find a provider Search our nationwide network for a doctor or medical facility near you. geha.com/Find-Care

Online decision support Take our quiz to see which GEHA medical plan might be the best fit for your lifestyle.

geha.com/Select-A-Plan

Urgent care Get the care you need, anytime, at any in-network urgent care facility near you.

geha.com/Find-Care

Pharmacy program Verify drug costs based on your benefit plan and prescription dosage. info.caremark.com/GEHA

MinuteClinic®11 Basic care in many CVS Pharmacies, no appointment needed. cvs.com/MinuteClinic/Clinic-Locator

Plan resources Description Learn more

Customer Care Contact GEHA with questions about your plan benefits or coverage. 800.262.4342

Medical plans Get details on GEHA‘s medical plans and supplemental benefits. geha.com/Rates

Medicare plans Discover how GEHA plans offer extra coverage with your Medicare plan. geha.com/Medicare

Overseas information Get information about medical coverage when you‘re outside of the United States.

geha.com/OutsideUSA

Enrollment help Tips for new enrollees or members who are changing plans. geha.com/Enroll

The National Active and Retired Federal Employees Association

Dedicated to helping federal employees and retirees manage their benefits.

narfe.org

U.S. Office of Personnel Management

Official information for federal employees eligible for FEHB plans. opm.gov/Healthcare-Insurance

If you have questions after reviewing this benefits guide, the online tools, phone numbers and websites below are great places to find helpful answers. If you’re stuck or overwhelmed, call 800.262.4342 and talk to one of our helpful Customer Care advisers.

Helpful resources


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http://www.geha.com/Select-A-Plan



http://www.cvs.com/MinuteClinic/Clinic-Locator

http://www.geha.com/Rates

http://www.geha.com/OutsideUSA



http://www.narfe.org

http://www.opm.gov/Healthcare-Insurance


We hope these definitions help cut through the confusion of shopping for a medical plan.

Definitions

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Term Definition

Allowance (negotiated rate or allowed charges)

The cost of health care goods and services after applying the insurance company‘s negotiated discount. This amount is often lower than providers‘ initial billed rates.

Calendar year deductible The amount you must pay out-of-pocket each year before the plan begins to pay benefits. Not all services are subject to the deductible.

Coinsurance The percentage of costs you pay for a covered health care service, after you‘ve met your deductible.

Copay The amount you pay for a specific service or prescription. A fixed dollar amount.

In-network provider A health care provider who is a part of GEHA‘s provider network.

Net deductible The remaining amount after you subtract the annual premium pass-through from the annual deductible for a High Deductible Health Plan (HDHP). This is your out-of-pocket cost before plan benefits begin.

Out-of-pocket maximum The maximum amount you will pay each year for coverage. It includes copays, deductibles and coinsurance, but not premiums. Once you have reached this limit, the plan pays the remainder of your covered health care expenses for the rest of the year.

PPO A preferred provider organization. PPOs offer maximum benefits when you visit an in-network provider, but still provide some coverage for out-of-network providers. Additionally, you can usually visit any provider without a referral from your primary physician.

Premium The total amount paid to an insurance company for coverage, typically paid monthly or biweekly. For federal employees, the premium is paid in part by the government, with the remainder deducted from your paycheck.

Premium pass-through A portion of your monthly High Deductible Health Plan (HDHP) premium that is used to fund your health savings account (HSA) or health reimbursement account (HRA).

Prescription benefits Depending on the medication, you will pay a set amount as a copay or percentage of coinsurance.

PRK Photorefractive keratectomy is a type of refractive surgery to correct myopia (nearsightedness), hyperopia (farsightedness) and astigmatism.


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Endnotes

1 Calendar year deductible applies.

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 your care. This is a combined maximum for both medical care and prescriptions.

3 For out-of-network benefits, see one of GEHA‘s 2020 plan brochures: RI 71-006 (High and Standard), RI 71-014 (HDHP) or RI 71-018 (Elevate and Elevate Plus).

4 Refer to geha.com/Prescriptions for formulary and specialty coverage for specific medications.

5 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.

6 If deductible is met, HDHP member will be charged by MDLIVE but GEHA will then reimburse the member 100% of the billed charge.

7 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.

8 Over 30-day specialty copay based on days of therapy. The drug cost share is two times for drugs that provide 60 days‘ worth of therapy and three times the copay for drugs that provide 90 days‘ worth of therapy.

9 The cariPRO™ premium electric toothbrush removes seven times more plaque than a regular brush, is completely waterproof and comes with a two-year manufacturer‘s warranty. Replacement brush heads with high-quality DuPont™ bristles are also available at this exclusive, members-only price.

10 Elevate, Standard Option, Elevate Plus and High Option only when you visit an EyeMed provider.

11 For HDHP members, these benefits are subject to the deductible and applicable coinsurance.

12 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 available at geha.com/PlanBrochure. All benefits are subject to the definitions, limitations and exclusions set forth in the federal brochure.

13 See IRS Publications 502 and 969 for more information regarding qualified medical expenses, health savings accounts and health reimbursement arrangements.

14 These benefits are neither offered nor guaranteed under contract with the FEHB, but are made available to all enrollees and family members who become members of a GEHA medical plan.

15 Subject to any eligibility limitations. For more information, see info.bridgehealth.com/GEHA

Notice of Summary of Benefits and Coverage (SBC): Availability of Summary Health Information: The Federal Employees Health Benefit (FEHB) Program offers numerous health benefits plans and coverage options. Choosing a health plan and coverage option is an important decision. To help you make an informed choice, each FEHB plan makes available a Summary of Benefits and Coverage (SBC) about each of its health coverage options, online and in paper. The SBC summarizes important information in a standard format to help you compare plans and options.

This plan‘s SBC is available on the internet at geha.com/SBC A paper copy is also available, free of charge, by calling 800.821.6136.

To find out more information about plans available under the FEHB Program, including SBCs for other FEHB plans, please visit opm.gov/insure

http://www.geha.com/prescriptions


http://info.bridgehealth.com/GEHA

http://www.geha.com/SBC

http://www.opm.gov/insure

WHAT'S NEW

X Up to $600 in reimbursements per calendar year. This amount may be used on Medicare Part B premium payments, for High Option plan members enrolled in Medicare Parts A & B.

X No preauthorization required for physical, occupational or speech therapy, on all GEHA medical plans.

X Expanded online doctor visits now includes coverage for dermatology care in addition to previously available coverage for non-emergency medical and behavioral health consultations.

X 100% contraceptive coverage now limited to generics under the preventive benefit on all GEHA medical plans.

X Increased cost share for non-preferred brand medications for HDHP option, from 25% to 40% of the plan allowance.

X Increased coinsurance maximums for Standard Option, from $200 to $250 for generic and preferred brand specialty drugs, and from $300 to $400 for non-preferred brand specialty drugs.

For information and changes on GEHA‘s medical plans, see our three plan brochures — RI 71-006 (High and Standard Options), RI 71-014 (HDHP) and RI 71-018 (Elevate and Elevate Plus) — which are available at geha.com/PlanBrochure

OS-BKT-0819-001

/gehahealth

/company/gehahealth

gehapossible.comQuestions? Call 800.262.4342

© 2019 Government Employees Health Association, Inc. All rights reserved. Please recycle.

GEHA has two new medical plans for 2020: Elevate and Elevate PlusSee if one might be the right plan for you on page 4 and page 12.

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