2023 GEHA Medical Plans - Choose from five unique medical plans designed to meet you where you are in life.
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2023 GEHA Medical Plans Choose from five unique medical plans designed to meet you where you are in life. geha.com | 800.262.4342
What’s inside
03 Welcome
04 Choose from five unique medical plans
06 Elevate
08 HDHP
10 Standard
12 Elevate Plus
14 High
16 Get help choosing the right plan
17 Extras if you choose Elevate
18 Earn Wellness Pays rewards—Elevate and Elevate Plus plans
19 Earn Health Rewards—HDHP, Standard and High plans
20 Vision discounts and benefits for GEHA plans
21 Benefits included in all five plans
22 GEHA works with Medicare A and B
24 Compare premiums
25 Compare deductibles and out-of-pocket maximum
26 Compare prescription costs
28 Compare medical benefits
30 It pays to stay in-network
31 Definitions and terms
02 2023 GEHA medical plans
Welcome
Whatever stage of life you’re in, GEHA has a plan to fit your needs.
We believe health care isn’t one size fits all, and our plans are designed with that in mind. For
more than 85 years, GEHA (Government Employees Health Association, Inc.) has provided
medical plans designed exclusively for federal employees.
GEHA is a non-profit association and one of the largest national medical plan carriers for
federal employees.
Choose from five medical plans:
Elevate HDHP Standard Elevate Plus High
Choose from the following
enrollment types:
NOV DEC
Self Only
Self Only covers only the enrollee and no
one else.
Open Season
begins on Monday, November 14,
and concludes on
Monday, December 12.
Self Plus One
Self Plus One covers the enrollee and
one eligible family member.
All five GEHA
medical plans cover
Self and Family pre-existing conditions.
Self and Family covers the enrollee and
eligible family including children up to
age 26.
2023 GEHA medical plans 03
Choose from five unique
medical plans
Elevate HDHP Standard
• One of the lowest national • No-cost preventive • Comprehensive medical
premiums and low doctor care paired with a coverage for all stages
visit copays low premium. of life
• Uniquely designed • GEHA puts money in • Affordable premiums
plan with a complete your HSA every month and low copays for
wellness focus geha.com/HSA common services
• Earn up to $1,000 • Earn up to $500 per • Earn up to $500 per
per household with a household to pay for household to pay for
generous rewards program qualified expenses qualified expenses
geha.com/WellnessPays geha.com/HealthRewards geha.com/HealthRewards
How often you use your plan: How often you use your plan: How often you use your plan:
Low Average High Low Average High Low Average High
Prescription Prescription Prescription
medication need: medication need: medication need:
Low Average High Low Average High Low Average High
Life-stage: early career Life-stage: all career stages Life-stage: mid-career
Health care style: Health care style: Health care style: traditional
wellness-focused, non-traditional, focused on care and coverage
cost-conscious saving for future needs
geha.com/Elevate geha.com/HDHP geha.com/Standard
This is a brief description of the features of GEHA’s medical plans. Please read the Plan’s Federal brochure (RI 71-018, RI 71-014 and RI 71-006), available at
geha.com/PlanBrochure. All benefits are subject to the definitions, limitations and exclusions set forth in the Federal brochure.
04 2023 GEHA medical plans
We believe health care isn’t one size fits all, and our plans are designed with
that in mind. Whatever stage of life you’re in, GEHA has a plan designed to
fit your needs.
Elevate Plus High All plans include:
• NEW $150 deductible • Low copays for
for Self Only and $300 primary and specialist
deductible for Self Plus doctor visits
One and Self and Family Nationwide coverage
• Get more care with
• NEW 15% coinsurance for GEHA and Medicare
some services geha.com/Medicare
• Earn up to $1,000 • Earn up to $500 per
Telehealth visits with MDLIVE
per household with a household to pay for
generous rewards program qualified expenses
geha.com/WellnessPays geha.com/HealthRewards
24/7 Health Advice Line
How often you use your plan: How often you use your plan:
Low Average High Low Average High
Preventive care
Prescription Prescription
medication need: medication need:
Low Average High Low Average High Incentives and discounts
Life-stage: mid-career Life-stage: late-career
Health care style: proactive, Health care style: maximum No referrals necessary
values generous rewards coverage, dependable support
geha.com/ElevatePlus geha.com/High
Rewards programs
This is a brief description of the features of GEHA’s medical plans. Please read the Plan’s Federal brochure (RI 71-018, RI 71-014 and RI 71-006), available at
geha.com/PlanBrochure. All benefits are subject to the definitions, limitations and exclusions set forth in the Federal brochure.
2023 GEHA medical plans 05
Elevate
Learn all about this plan at geha.com/Elevate
• GEHA’s lowest premium plan
• 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
254 Self Only $50.69 $109.83
256 Self Plus One $118.83 $257.47
255 Self and Family $144.67 $313.46
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.
Health care style: How often you use your plan: Prescription benefit need:
a wellness-focused and
cost-conscious plan for
those without an extensive
Low Average High Low Average High
prescription need.
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
• Subscribers can select an annual plan perk. Options include a Fitbit wearable device including 12-month
Fitbit Premium Membership, a $125 gift card for DICK’S Sporting Goods or REI, or a 12-month Daily Burn
virtual fitness subscription.4geha.com/PlanPerk
Yearly deductible in-network1 You pay
Self Only $500
Self Plus One or Self and Family $1,000
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.
Out-of-pocket maximum in-network1,2 You pay
Self Only $8,500
Self Plus One or Self and Family $17,000
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.
06 2023 GEHA medical plansMedical benefits in-network1 You pay
Unlimited telehealth visits, including mental health, with MDLIVE
Preventive care; adult routine screenings
Well-child visit; up to age 22 $0
Maternity; routine care
Vision coverage; eye exams2
Primary physician office visit
Mental health office visit
MinuteClinic® where available $10
Chiropractic care (manipulative therapy), including X-rays; up to 12 visits per year
Acupuncture; up to 20 treatments per year
Specialist care office visit $30
Urgent care facility $50
ER visit
Maternity; inpatient care
Hospital care; inpatient and outpatient
25%3
Lab services
X-ray and other diagnostic services
Outpatient professional surgical services
Inpatient professional surgical services $250
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.
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.
Prescription benefits in-network1,2,3 You pay
30-day retail generic $4
30-day retail preferred brand-name 50% ($500 max)
30-day retail non-preferred brand-name 100%
30-day specialty CVS exclusive generic and preferred brand-name 50% ($500 max)
30-day specialty CVS exclusive non-preferred brand-name 100%
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 To provide a low premium, this plan does not include mail-order prescriptions or out-of-network pharmacy coverage, and it has a limited pharmacy network. Find a
pharmacy at geha.com/Find-Care
2023 GEHA medical plans 07HDHP
Learn all about this plan at geha.com/HDHP
• Low premiums with a lower net deductible than many traditional plans
• Reduce out-of-pocket expenses and enjoy a triple tax advantage with a
health savings account (HSA) geha.com/HSA
• GEHA contributes to your HSA. Use your HSA money to reduce your net
deductible or save it and let it grow tax-free in your account.
Premium and enrollment code Employed – biweekly Retired – monthly
341 Self Only $69.37 $150.30
343 Self Plus One $149.15 $323.15
342 Self and Family $183.28 $397.11
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.
Health care style: How often you use your plan: Prescription benefit need:
for the analytical health
care consumer, focused
on savings Low Average High Low Average High
How this plan pays you back:
• Up to two adults ages 18 and over can earn up to $250 (maximum $500 per household) per year in Health
Rewards geha.com/HealthRewards
• GEHA contributes $900 (Self Only) or $1,800 (Self Plus One or Self and Family) to your HSA
GEHA HSA
Yearly deductible in-network1 Annual deductible contribution You pay2
Self Only $1,500 $900 $600
Self Plus One or Self and Family $3,000 $1,800 $1,200
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 net deductible is 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.
Out-of-pocket maximum in-network1,2 You pay
Self Only $5,000
Self Plus One or Self and Family $10,000
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.
08 2023 GEHA medical plansMedical benefits in-network1 You pay
Unlimited telehealth visits, including mental health, with MDLIVE $02,3
Maternity; routine care
$02
Maternity; inpatient care
Preventive care; adult routine screenings
Well-child visit; up to age 22 $0
Preventive dental care, twice yearly
Vision coverage; eye exam and additional benefits $5
Primary physician office visit
Mental health office visit
Specialist care office visit
Urgent care facility
ER visit
Hospital care; inpatient and outpatient
5%2
MinuteClinic® where available
Lab services
X-ray and other diagnostic services
Professional surgical services
Chiropractic care (manipulative therapy), including X-rays; up to 20 visits per year
Acupuncture; up to 20 treatments per year
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 Calendar year deductible applies.
3 HDHP members who have met their deductible will be charged by MDLIVE, but GEHA will reimburse the member 100% of the plan allowance.
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.
Prescription benefits in-network1,2,3 You pay
30-day retail generic 25%
30-day retail preferred brand-name 25%4
30-day retail non-preferred brand-name 40%4
90-day mail service generic 25%
90-day mail service preferred brand-name 25%4
90-day mail service non-preferred brand-name 40%4
30-day specialty CVS exclusive generic and preferred brand-name 25%4
30-day specialty CVS exclusive non-preferred brand-name 40%4
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 Calendar year deductible applies.
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.
2023 GEHA medical plans 09Standard
Learn all about this plan at geha.com/Standard
• Dependable, traditional coverage
• Affordable premiums
• Some of the FEHB’s lowest copays for in-network primary care and
specialist visits
Premium and enrollment code Employed – biweekly Retired – monthly
314 Self Only $68.77 $149.01
316 Self Plus One $147.87 $320.39
315 Self and Family $180.92 $392.00
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.
Health care style: How often you use your plan: Prescription benefit need:
traditional care and
coverage to stay on a
healthy path Low Average High Low Average High
How this plan pays you back:
• Up to two adults ages 18 and over can earn up to $250 (maximum $500 per household) per year
in Health Rewards geha.com/HealthRewards
Yearly deductible in-network1 You pay
Self Only $350
Self Plus One or Self and Family $700
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.
Out-of-pocket maximum in-network1,2 You pay
Self Only $6,500
Self Plus One or Self and Family $13,000
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.
10 2023 GEHA medical plansMedical benefits in-network1 You pay
Unlimited telehealth visits, including mental health, with MDLIVE
Preventive care; adult routine screenings
Well-child visit; up to age 22
$0
Maternity; routine care
Maternity; inpatient care
QuestSelectTM Lab Benefit (formerly Lab Card®)
Vision coverage; eye exams2 $5
MinuteClinic® where available $10
Primary physician office visit
$20
Mental health office visit
Specialist care office visit
Urgent care facility $35
Chiropractic care (manipulative therapy), including X-rays; up to 20 visits per year
Lab services (other than QuestSelect) 15%
ER visit
Hospital care; inpatient and outpatient
Professional surgical services 15%3
X-ray and other diagnostic services
Acupuncture; up to 20 treatments per year
Preventive dental care, twice yearly 50%
Outpatient professional High Tech Imaging (MRI, CT, PET, etc.) $100
Outpatient facility High Tech Imaging (MRI, CT, PET, etc.) $150
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-network1,2 You pay
30-day retail generic $10
30-day retail preferred brand-name 50% ($200 max3)
30-day retail non-preferred brand-name 50% ($300 max3)
90-day mail service generic $20
90-day mail service preferred brand-name 50% ($500 max3)
90-day mail service non-preferred brand-name 50% ($600 max3)
30-day specialty CVS exclusive generic and preferred brand-name 50% ($250 max3)
30-day specialty CVS exclusive non-preferred brand-name 50% ($400 max3)
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 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.
2023 GEHA medical plans 11Elevate 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-network1,2 You pay
Self Only $150
Self Plus One or Self and Family $300
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-network1,2 You pay
Self Only $6,000
Self Plus One or Self and Family $12,000
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.
12 2023 GEHA medical plansMedical benefits in-network1,2 You pay
Unlimited telehealth visits, including mental health, with MDLIVE
Preventive care; adult routine screenings
Well-child visit; up to age 22
$0
Lab services
Maternity; routine care
Vision coverage; eye exams3
MinuteClinic® where available $10
Primary physician office visit
Mental health office visit
Chiropractic care (manipulative therapy), including X-rays; $30
up to 15 visits per year
Acupuncture; up to 20 treatments per year
Specialist care office visit $45
Urgent care facility $50
X-ray and other diagnostic services $504
ER visit
Outpatient and inpatient professional surgery services
15%5
Maternity; inpatient care
Hospital care; inpatient and outpatient
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 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.
4 You pay $175 ($100 professional fee, $75 facility fee) for advanced outpatient High Tech Imaging such as MRI, CT, PET, etc. Refer to GEHA’s 2023 plan brochure
RI 71-018 (Elevate and Elevate Plus) at geha.com/PlanBrochure
5 Calendar year deductible applies.
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.
Prescription benefits in-network1,2,3 You pay
30-day retail generic $10
30-day retail preferred brand-name $804
30-day retail non-preferred brand-name 50%4
90-day mail service generic $20
90-day mail service preferred brand-name $2004
90-day mail service non-preferred brand-name 50%4
30-day specialty CVS exclusive generic and preferred brand-name 40% ($500 max4)
30-day specialty CVS exclusive non-preferred brand-name 50%4
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 This plan has no out-of-network pharmacy coverage.
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.
2023 GEHA medical plans 13High
Learn all about this plan at geha.com/High
• Comprehensive brand-name and specialty prescription coverage
• NEW! $1,000 Medicare Part B premium reimbursement. geha.com/MRA
• Low copays for doctor visits
• $2,500 hearing aid benefit and additional discount
Premium and enrollment code Employed – biweekly Retired – monthly
311 Self Only $105.74 $229.10
313 Self Plus One $243.49 $527.56
312 Self and Family $304.39 $659.52
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:
maximum coverage and
Low Average High Low Average High
dependable support
Low Average High Low Average High
How this plan pays you back:
• NEW! $1,000 Medicare Part B premium reimbursement
• Adults ages 18 and over can earn up to $250 (maximum $500 per household) per year in
Health Rewards. geha.com/HealthRewards
Yearly deductible in-network1 You pay
Self Only $350
Self Plus One or Self and Family $700
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.
Out-of-pocket maximum in-network1,2 You pay
Self Only $5,000
Self Plus One or Self and Family $10,000
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.
14 2023 GEHA medical plansMedical benefits in-network1 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 $0
Maternity; inpatient care
Outpatient accidental injury, including ER (within 72 hours)
Lab services
Vision coverage; eye exams2 $5
MinuteClinic® where available $10
Primary physician office visit
Mental health office visit
$20
Specialist care office visit
Chiropractic care (manipulative therapy), including X-rays; up to 20 visits per year
Urgent care facility $35
ER visit; medical emergency
Hospital care; outpatient
Professional surgical services 10%3
X-ray and other diagnostic services
Acupuncture; up to 20 treatments per year
$100 per admission
Hospital care; inpatient
plus 10%
Balance after
Preventive dental; twice yearly GEHA pays
$22 per visit
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-network1,2 You pay
30-day retail generic $103
30-day retail preferred brand-name 25% ($150 max3,4)
30-day retail non-preferred brand-name 40% ($200 max3,4)
90-day mail service generic $20
90-day mail service preferred brand-name 25% ($350 max4)
90-day mail service non-preferred brand-name 40% ($500 max4)
30-day specialty CVS exclusive generic and preferred brand-name 25% ($150 max4)
30-day specialty CVS exclusive non-preferred brand-name 40% ($200 max4)
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.
2023 GEHA medical plans 15Get help choosing
the right plan
GEHA has a plan for every stage of your
life. We are here to help you discover
which plan is the right fit for you.
Book an appointment Call us
Meet one-on-one with a GEHA Benefits Talk to a GEHA Benefits Adviser
Adviser to help answer your questions. Monday – Friday, 7 a.m. – 7 p.m. Central time.
geha.com/Meet 800.262.4342
Chat online Watch on-demand webinars
Chat or text with a GEHA Benefits Adviser Learn how to find a plan that’s right for you
in real time Monday – Friday, 7 a.m. – 7 p.m. with an on-demand webinar.
Central time.
geha.com/BenefitsWebinars
geha.com
Plan recommender tool Compare plans
Answer a few questions to see a plan that Easily compare GEHA’s five medical plans.
matches your individual or family needs.
geha.com/CompareMedical
geha.com/Select-A-Plan
For more information about FEHB plans, visit the U.S. Office of Personnel Management at opm.gov/Healthcare-Insurance
16 2023 GEHA medical plansExtras if you choose Elevate
Elevate subscribers can choose
among three options annually
to support a healthy lifestyle.
It pays to be a GEHA Elevate plan member.
This plan includes an exclusive plan perk
option to support a healthy lifestyle.
It’s quick and easy for Elevate
subscribers to claim their plan perk.
Sign up for a geha.com account (or
log in to your existing account) and
update your contact preferences.
Choice of one Fitbit device including a
12-month Fitbit Premium Membership.
12-month Daily Burn virtual
fitness subscription.
GEHA’s unique position as a nonprofit member
association allows us to offer this bonus plan
perk exclusively for the Elevate plan. We
$125 gift card for DICK’s Sporting Goods
don’t have stockholders, which means our
or REI.
priority is putting money back into supporting
our members.
These products and services are neither offered nor guaranteed under
For more information, visit contract with the FEHB Program, but are made available to eligible
Subscribers who become members of the GEHA Elevate medical plan.
geha.com/PlanPerk Only Subscribers in the 50 United States and the District of Columbia are
eligible at this time.
2023 GEHA medical plans 17Earn Wellness Pays rewards
Elevate and Elevate Plus plans
Get rewarded for activities you’re probably already doing.
HOW IT WORKS
• Earn rewards automatically for healthy activities
you’re probably already doing
• Register on our Rally® platform to manage your
health goals, enroll with a wellness coach and more
• Complete your first rewardable activity and receive
your Wellness Pays reloadable debit card in the mail
• Redeem the rewards for qualified medical expenses
such as copays
geha.com/WellnessPays
HOW MUCH YOU CAN EARN
• $500 per individual, per year • $1,000 per family per year
ACTIVITIES THAT EARN YOU WELLNESS PAYS REWARDS
$10 $50 $100 $100
per month to annual flu shot1 cervical, colorectal first trimester prenatal
hit your Stride or breast cancer appointment1
step goal screening1
$50 $75 $100 $200
one MDLIVE one time Rally health annual physical or complete Real Appeal
telehealth or mental survey; $50 to do Rally digital wellness or Quit for Life
health visit missions/wellness quizzes coaching
1 Activity must be reported online to earn rewards.
2 Restrictions may apply.
This is a brief description of the features of the Elevate and Elevate Plus plans. Before making a final decision, please read the Plan’s Federal brochure (RI 71-018), available at
geha.com/PlanBrochure. All benefits are subject to the definitions, limitations, and exclusions set forth in the Federal brochure.
18 2023 GEHA medical plansEarn Health Rewards
HDHP, Standard and High plans
The tools and incentives you need to help you live healthier.
HOW IT WORKS
• Complete your first rewardable activity and receive
your Health Rewards reloadable debit card in the
mail automatically
• Redeem the rewards for qualified medical expenses such
as copays
• Complete rewardable activities to add funds to your
Health Rewards debit card
geha.com/HealthRewards
HOW MUCH YOU CAN EARN
• $250 per individual, per year • $500 per family per year
ACTIVITIES THAT EARN YOU HEALTH REWARDS
$10 $25 $50 $50
per online wellness annual flu shot1 cervical, colorectal first trimester prenatal
workshop or breast cancer appointment1
screening2
$50 $75 $50
one MDLIVE health risk participate in a
telehealth or mental assessment targeted health
health visit program3
1 Activity must be reported online to earn rewards.
2 Restrictions may apply.
3 By invitation only.
This is a brief description of the features of the HDHP, Standard and High plans. Before making a final decision, please read the Plan’s Federal brochure (RI 71-014 or
RI 71-006), available at geha.com/PlanBrochure. All benefits are subject to the definitions, limitations, and exclusions set forth in the Federal brochure.
2023 GEHA medical plans 19Vision discounts and benefits
for GEHA plans
With all GEHA medical and dental plans, you get discounts on eye exams, frames and lenses through
EyeMed.® The EyeMed network includes Independent Provider Network, LensCrafters, Pearle Vision, Target
Optical, contactsdirect.com, glasses.com and more. Members also save on LASIK at participating US Laser
Network locations.
Learn more at geha.com/Vision
The HDHP plan includes additional vision benefits. Learn more at geha.com/HDHPVision
Elevate1 HDHP Standard1 Elevate Plus1 High1
Vision benefit you pay you pay you pay you pay you pay
Eye exams retail price $0 $5 $5 $0 $5
$0 under $100 60%
Frames retail price 60% of price plus 80% 60% of price 60% of price
of price
over $100
Eyeglass lenses,
standard plastic single Up to $50 $10 Up to $50 Up to $50 Up to $50
vision retail price
Eyeglass lenses, standard
Up to $70 $10 Up to $70 Up to $70 Up to $70
plastic bifocal retail price
Eyeglass lenses, standard
No more
plastic progressive lens Up to $135 Up to $135 Up to $135 Up to $135
than $75
retail price
Eyeglass lens options,
UV treatment, tint (solid
$15 $15 $15 $15 $15
and gradient), standard
plastic scratch coating
Eyeglass lens
options, standard $45 $45 $45 $45 $45
anti-reflective coating
$10 under
Contact lens, 85%
85% of price $110 plus 85% 85% of price 85% of price
conventional retail price of price
over $110
1 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.
20 2023 GEHA medical plansBenefits included in all five plans
24/7 Health Advice Line
Talk to a nurse 24/7.
Unlimited $0 MDLIVE 1 geha.com/Healthline
telehealth visits
Get access to certified doctors, Gym membership discount2
including pediatricians, mental health
therapists and dermatologists. Access 11,600+ Active&Fit Direct™
locations nationwide with GEHA’s
Connection Fitness® program.
geha.com/MDLIVE
geha.com/Fitness
Teeth whitening discounts2
Get a 20% discount on the lowest
published price on all Smile Brilliant®
home teeth whitening and oral
care products.
geha.com/Whitening
Electric
toothbrush discount2,3 Hearing aid discounts2
Enjoy 70% off a cariPRO premium ®
Get discounts through TruHearing® on
electric toothbrush.
hearing aids. Save up to 30% to 60%
off hearing aids. Some average more
geha.com/Toothbrush than $2,600 in savings per pair.
geha.com/Hearing
Medical alert system
discount2
Get free activation on Life Alert®
services, plus a 10% monthly discount,
for you and your extended family.
geha.com/LifeAlert
1 HDHP members who have met their deductible will be charged by MDLIVE, but GEHA will reimburse the member 100% of the Plan Allowance.
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 The cariPRO® premium 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 DuPontTM bristles are also available at this exclusive, member-only price.
2023 GEHA medical plans 21GEHA works with
Medicare A and B
GEHA offers five medical plans, each with coverage that coordinates with Medicare.
For more information, including benefits and rates, visit geha.com/Medicare
Elevate HDHP Standard Elevate High
and and and Plus and and
Plan service Medicare Medicare Medicare Medicare Medicare
NEW! $1,000 Medicare Part
No No No No Yes
B premium reimbursement
100% medical coverage
(copays and deductibles
No No Yes Yes Yes
waived) with Medicare
A & B primary
Hearing aid benefit1 No No Yes Yes Yes
Coverage for in-network and
Yes Yes Yes Yes Yes
out-of-network care1
Coverage for care outside of
Yes Yes Yes Yes Yes
the United States
Non-preferred
No Yes Yes Yes Yes
drug coverage2
Mail service pharmacy No Yes Yes Yes Yes
Choice of plan perk3 Yes No No No No
1 Though the Elevate Plus plan on its own does not provide out-of-network medical coverage, when it’s combined with Medicare and the provider accepts Medicare
assignment, out-of-network cost shares are waived. There are no out-of-network pharmacy benefits for Elevate and Elevate Plus.
2 With High plan, when Medicare A & B is primary, you pay a lower coinsurance for preferred and non-preferred brand medications.
3 These benefits are neither offered nor guaranteed under contract with the FEHB Program, but are made available to subscribers who become a member of GEHA’s
Elevate medical plan.
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.
22 2023 GEHA medical plansGEHA and Medicare EyeMed® vision coverage
Elevate and Elevate Standard and High
Vision services in-network Plus you pay you pay HDHP you pay
Eye exams; retail price $0 $5 $5
$0 under $100 plus
Frames; retail price 60% of price 60% of price
80% over $100
Eyeglass lenses, standard
plastic, single vision; Up to $50 Up to $50 $10
retail price
Contact lens, conventional; $10 under $110 plus
85% of price 85% of price
retail price 85% over $100
GEHA’s HDHP plan includes a complete vision benefit in addition to vision discounts through
EyeMed. Learn more at geha.com/HDHPVision
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.
2023 GEHA medical plans 23Compare premiums Self Only premium and enrollment code Employed – biweekly Retired – monthly 254 Elevate $50.69 $109.83 341 HDHP $69.37 $150.30 314 Standard $68.77 $149.01 251 Elevate Plus $85.77 $185.84 311 High $105.74 $229.10 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. Self Plus One premium and enrollment code Employed – biweekly Retired – monthly 256 Elevate $118.83 $257.47 343 HDHP $149.15 $323.15 316 Standard $147.87 $320.39 253 Elevate Plus $187.64 $406.55 313 High $243.49 $527.56 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. Self and Family premium and enrollment code Employed – biweekly Retired – monthly 255 Elevate $144.67 $313.46 342 HDHP $183.28 $397.11 315 Standard $180.92 $392.00 252 Elevate Plus $209.83 $454.64 312 High $304.39 $659.52 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. 24 2023 GEHA medical plans
Compare deductibles and
out-of-pocket maximum
Compare deductibles
What you pay each year before the plan begins to pay out benefits.
Yearly deductible Elevate HDHP Standard Elevate Plus2 High
in-network1 You pay You pay You pay You pay You pay
Self Only $500 $6003 $350 $150 $350
Self Plus One or
$1,000 $1,2003 $700 $300 $700
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.
3 The net deductible is the remaining amount after you subtract the GEHA contribution from the annual deductible. This is your out-of-pocket cost before plan
benefits begin.
Compare out-of-pocket maximum
The maximum amount of coinsurance, copays and deductibles you pay for all family members
before GEHA begins to pay 100% of covered services. This is a combined maximum of medical care
and prescriptions.
Out-of-pocket
maximum Elevate HDHP Standard Elevate Plus2 High
in-network1 You pay You pay You pay You pay You pay
Self Only $8,500 $5,000 $6,500 $6,000 $5,000
Self Plus One or
$17,000 $10,000 $13,000 $12,000 $10,000
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.
2023 GEHA medical plans 25Compare prescription costs
Elevate4 HDHP5 Standard
Prescription benefits in-network1,2,3 You pay You pay You pay
30-day retail generic $4 25% $10
50% 50%
30-day retail preferred brand-name 25%6
($500 max) ($200 max6)
50%
30-day retail non-preferred brand-name 100% 40%6
($300 max6)
90-day mail service generic No benefit 25% $20
50%
90-day mail service preferred brand-name No benefit 25%6
($500 max6)
90-day mail service non-preferred 50%
No benefit 40%6
brand-name ($600 max6)
30-day specialty CVS exclusive generic 50% 50%
25%6
and preferred brand-name ($500 max) ($250 max6)
30-day specialty CVS exclusive 50%
100% 40%6
non-preferred brand-name ($400 max6)
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 and copays 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.
3 Refer to geha.com/Prescriptions for formulary and specialty coverage for specific medications.
4 To provide a low premium, this plan does not include mail-order prescriptions or out-of-network pharmacy coverage, and it has a limited pharmacy network. Find a
pharmacy at geha.com/Find-Care
5 Calendar year deductible applies.
6 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.
You’ve got options with retail prescriptions
Pay less for prescriptions filled at an in-network pharmacy location. Locations include any CVS
Pharmacy location, but you don’t have to go to a CVS to pay in-network prices.
Find an in-network pharmacy location at geha.com/Find-Care
26 2023 GEHA medical plansCheck drug costs at info.caremark.com/oe/geha
Elevate Plus4 High
Prescription benefits in-network 1,2,3
You pay You pay
30-day retail generic $10 $105
25%
30-day retail preferred brand-name $806
($150 max5,6)
40%
30-day retail non-preferred brand-name 50%6
($200 max5,6)
90-day mail service generic $20 $20
25%
90-day mail service preferred brand-name $2006
($350 max6)
40%
90-day mail service non-preferred brand-name 50%6
($500 max6)
30-day specialty CVS exclusive generic and preferred 40% 25%
brand-name ($500 max6) ($150 max6)
30-day specialty CVS exclusive 40%
50%6
non-preferred brand-name ($200 max6)
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 and copays 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.
3 Refer to geha.com/Prescriptions for formulary and specialty coverage for specific medications.
4 This plan has no out-of-network coverage
5 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.
6 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.
Save more with mail order prescriptions
With 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.
Mail order is not available for the Elevate plan option.
2023 GEHA medical plans 27Compare medical benefits
Elevate HDHP Standard
Medical benefits in-network 1
You pay You pay You pay
Unlimited telehealth visits, including mental
$0 $02,3 $0
health, with MDLIVE
Preventive care; adult routine screenings
$0 $0 $0
Well-child visit; up to age 22
Vision coverage; eye exams $0 $5 $5
Maternity; routine care $0 $03 $0
MinuteClinic® where available $10 5%3 $10
Primary physician office visit $10 5%3 $20
Mental health office visit $10 5%3 $20
Specialist care office visit $30 5%3 $35
Urgent care facility $50 5%3 $35
ER visit; accidental 25%3 5%3 15%3
ER visit; medical 25%3 5%3 15%3
Hospital care; inpatient 25%3 5%3 15%3
Maternity; inpatient care 25%3 $03 $0
Hospital care; outpatient 25%3 5%3 15%3
Inpatient professional surgical services $250 5%3 15%3
Outpatient professional services 25%3 5%3 15%3
Lab services 25%3 5%3 15% (QuestSelect $0)
X-rays and other diagnostic services 25%3 5%3 15%3,4
Chiropractic care visit (manipulative therapy),
$10 5%3 $35
including X-rays. Limited per year.
Acupuncture visit; up to 20 treatments
$10 5%3 15%3
per year
Preventive dental care No benefit $0 50%
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 HDHP members who have met their deductible will be charged by MDLIVE, but GEHA will reimburse the member 100% of the plan allowance.
3 Calendar year deductible applies.
4 Standard, you pay $250 ($100 professional fee, $150 facility fee) for advanced outpatient High Tech Imaging such as MRI, CT, PET, etc. Refer to GEHA’s 2023 plan
brochure RI 71-006 (High and Standard) at geha.com/PlanBrochure
28 2023 GEHA medical plansElevate Plus2 High
Medical benefits in-network 1
You pay You pay
Unlimited telehealth visits, including mental
$0 $0
health, with MDLIVE
Preventive care; adult routine screenings
$0 $0
Well-child visit; up to age 22
Vision coverage; eye exams $0 $5
Maternity; routine care $0 $0
MinuteClinic® where available $10 $10
Primary physician office visit $30 $20
Mental health office visit $30 $20
Specialist care office visit $45 $20
Urgent care facility $50 $35
ER visit; accidental 15%3 $0
ER visit; medical 15%3 10%3
Hospital care; inpatient 15%3 $100 per admission plus 10%
Maternity; inpatient care 15%3 $0
Hospital care; outpatient 15%3 10%3
Inpatient professional surgical services 15%3 10%3
Outpatient professional services 15%3 10%3
Lab services $0 $0
X-rays and other diagnostic services $504 10%3
Chiropractic care visit (manipulative therapy),
$30 $20
including X-rays. Limited per year.
Acupuncture visit; up to 20 treatments
$30 10%3
per year
Balance after GEHA pays $22
Preventive dental care No benefit
per visit
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
2023 GEHA medical plans 29It pays to stay in-network
Whether it’s a fixed dollar amount, or a percentage, we want you to understand what you pay for in-network
or out-of-network services. We’ve included an example below for a plan with a 10% coinsurance1 for
services in-network and 25% coinsurance for services out-of-network.
The Elevate Plus medical plan does
not offer out-of-network coverage. Out-of-network In-network
Provider’s billed rate $150 $150
• In-network provider’s contracted rate
with GEHA
$100 $100
• GEHA’s plan allowance for
out-of-network providers
$75 $90
What GEHA pays
75% of $100 90% of $100
What you pay (coinsurance) $25 $10
25% of $100 10% of $100
You also pay the difference between the
out-of-network provider’s billed rate and $50 $0
GEHA’s plan allowance
What you pay total for this service $75 $10
1 See page 31 for definition.
30 2023 GEHA medical plansDefinitions 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
Coinsurance
your deductible.
Copay A fixed amount you pay for a service or prescription.
Portion of monthly HDHP premium that GEHA contributes to a health savings
GEHA contribution
account (HSA) or health reimbursement arrangement (HRA).
A health care provider who is a part of GEHA’s provider network. These providers
In-network provider
agree to limit what they will charge you.
The remaining amount after you subtract the annual GEHA contribution from the
Net deductible (HDHP)
annual deductible. This is your out-of-pocket cost before plan benefits begin.
The maximum amount you pay each year for coverage. Includes copays,
Out-of-pocket max 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.
Cost of health care goods and services after subtracting the insurance company’s
Plan allowance negotiated discount. For complete details see the definition of “Plan allowance” in
Section 10 of any GEHA plan brochure. geha.com/PlanBrochure
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.
2023 GEHA medical plans 31STANDARD
US POSTAGE
PAID
GEHA
PO Box 21542 | Eagan, MN 55121-9930
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Ready to enroll?
If you’ve found a plan that aligns with your
needs, learn how to enroll in a plan today.
geha.com/Enroll
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 brochure.
Download the plan brochure
For information and changes to GEHA’s medical plans, see our three plan brochures – RI 71-006 (High and Standard), RI 71-014 (HDHP) and RI 71-018 (Elevate and Elevate Plus) – which are
available at geha.com/PlanBrochure
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. GEHA’s
SBCs are available on the internet at geha.com/SBC Paper copies are 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
geha.com | 800.262.4342
©2022-2023 Government Employees Health Association, Inc. All rights reserved. Please recycle.
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