Transparency in coverage
The Transparency in coverage Final Rule (for ease of reference, the "Rule") was published by the Department of Health and Human Services (HHS), the Department of Labor (DOL) and the Department of the Treasury (DOT) on November 12, 2020. This Rule is applicable to hospitals, health plans and insurance payers, and contains certain regulatory requirements that must be implemented.
The Rule is intended to provide access to information that can be used by health care consumers and others to better understand the cost of health care services and assist with making cost-conscious decisions. The information required to be made available will initially be in "machine-readable" files that will be updated monthly. The machine-readable files (MRFs) are displayed in JSON format as required by the Rule and may not be easily readable. GEHA has provided access to the MRFs through the links below, which contain the following information:
- In-network rates: These files contain a roster of all in-network providers and contracted items and services.
- Out-of-network rates: Historical payments to, and billed charges from, out-of-network providers.
Please note the following when reviewing these files: The in-network MRFs are reflective of all in-network providers and their prevailing contracts with our network partner. These files do not guarantee coverage of any or all services, and many services require the plan's authorization in advance based on the plan's criteria. Please refer to the GEHA plan brochures for the plan's coverage and benefit rules. All benefits are subject to the definitions, limitations and exclusions set forth in the GEHA plan brochures.
GEHA is committed to price and cost transparency, and as such, we believe that all members should understand their projected costs in advance. In addition to the MRFs, GEHA also offers user-friendly cost estimate tools that take into consideration plan design, deductibles and provider contract. For full access to these tools, including the member's specific cost share and accumulators, please sign in to your GEHA member portal.
- Members enrolled in a GEHA HDHP, Standard or High medical plan may access the cost estimate tool powered by Healthcare Bluebook.
- Members enrolled in a GEHA Elevate or Elevate Plus plan may access the cost estimate tool powered by Rally Health.
In-network MRFs
GEHA partners with UnitedHealthcare to provide access to medical networks.
Visit UnitedHealthcare to access the in-network MRFs for all GEHA plans
In-network MRFs: Ancillary networks
GEHA offers our members access to ancillary provider networks to augment our medical and mental health provider networks. The following table summarizes the ancillary networks and associated MRFs by plan.
| GEHA plan | Telehealth network | Transplant network | Dental network |
|---|---|---|---|
| HDHP, Standard, High | MDLIVE see below by plan |
Optum | GEHA Connection Dental see below by plan |
| Elevate, Elevate Plus | MDLIVE see below by plan |
Optum | n/a |
Out-of-network MRFs
The out-of-network MRFs are available below by plan.
- 2024-04-30 GEHA cdnetwork hdhp self and family in-network-rates 1
- 2024-04-30 GEHA cdnetwork hdhp self and family in-network-rates 2
- 2024-04-30 GEHA cdnetwork hdhp self only in-network-rates 1
- 2024-04-30 GEHA cdnetwork hdhp self only in-network-rates 2
- 2024-04-30 GEHA cdnetwork hdhp self plus one in-network-rates 1
- 2024-04-30 GEHA cdnetwork hdhp self plus one in-network-rates 2
- 2024-04-30 GEHA cdnetwork high self and family in-network-rates 1
- 2024-04-30 GEHA cdnetwork high self and family in-network-rates 2
- 2024-04-30 GEHA cdnetwork high self only in-network-rates 1
- 2024-04-30 GEHA cdnetwork high self only in-network-rates 2
- 2024-04-30 GEHA cdnetwork high self plus one in-network-rates 1
- 2024-04-30 GEHA cdnetwork high self plus one in-network-rates 2
- 2024-04-30 GEHA cdnetwork standard self and family in-network-rates 1
- 2024-04-30 GEHA cdnetwork standard self and family in-network-rates 2
- 2024-04-30 GEHA cdnetwork standard self only in-network-rates 1
- 2024-04-30 GEHA cdnetwork standard self only in-network-rates 2
- 2024-04-30 GEHA cdnetwork standard self plus one in-network-rates 1
- 2024-04-30 GEHA cdnetwork standard self plus one in-network-rates 2
- 2024-04-30 GEHA dental hdhp self and family allowed-amounts
- 2024-04-30 GEHA dental hdhp self only allowed-amounts
- 2024-04-30 GEHA dental hdhp self plus one allowed-amounts
- 2024-04-30 GEHA dental high self and family allowed-amounts
- 2024-04-30 GEHA dental high self only allowed-amounts
- 2024-04-30 GEHA dental high self plus one allowed-amounts
- 2024-04-30 GEHA dental standard self and family allowed-amounts
- 2024-04-30 GEHA dental standard self only allowed-amounts
- 2024-04-30 GEHA dental standard self plus one allowed-amounts
- 2024-04-30 GEHA elevate plus self and family allowed-amounts
- 2024-04-30 GEHA elevate plus self and family in-network-rates
- 2024-04-30 GEHA elevate plus self only allowed-amounts
- 2024-04-30 GEHA elevate plus self only in-network-rates
- 2024-04-30 GEHA elevate plus self plus one allowed-amounts
- 2024-04-30 GEHA elevate plus self plus one in-network-rates
- 2024-04-30 GEHA elevate self and family allowed-amounts
- 2024-04-30 GEHA elevate self and family in-network-rates
- 2024-04-30 GEHA elevate self only allowed-amounts
- 2024-04-30 GEHA elevate self only in-network-rates
- 2024-04-30 GEHA elevate self plus one allowed-amounts
- 2024-04-30 GEHA elevate self plus one in-network-rates
- 2024-04-30 GEHA hdhp self and family allowed-amounts
- 2024-04-30 GEHA hdhp self and family in-network-rates
- 2024-04-30 GEHA hdhp self only allowed-amounts
- 2024-04-30 GEHA hdhp self only in-network-rates
- 2024-04-30 GEHA hdhp self plus one allowed-amounts
- 2024-04-30 GEHA hdhp self plus one in-network-rates
- 2024-04-30 GEHA high self and family allowed-amounts
- 2024-04-30 GEHA high self and family in-network-rates
- 2024-04-30 GEHA high self only allowed-amounts
- 2024-04-30 GEHA high self only in-network-rates
- 2024-04-30 GEHA high self plus one allowed-amounts
- 2024-04-30 GEHA high self plus one in-network-rates
- 2024-04-30 GEHA standard self and family allowed-amounts
- 2024-04-30 GEHA standard self and family in-network-rates
- 2024-04-30 GEHA standard self only allowed-amounts
- 2024-04-30 GEHA standard self only in-network-rates
- 2024-04-30 GEHA standard self plus one allowed-amounts
- 2024-04-30 GEHA standard self plus one in-network-rates
- 2024-04-30 GEHA table-of-contents