FAQs

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Welcome. Have a question about the GEHA Connection Dental Federal® FEDVIP dental plan? Click Get Dental Plan Answers.

Enrollment

  • Can I enroll in a GEHA health plan at any time other than Open Season?
    Enrollment is only available at Open Season or after a qualifying life event (QLE). For more on QLEs, visit OPM's "What is a Qualifying Life Event?" webpage.
  • How long after I get married can I add my spouse to my insurance?

    You can add a spouse to your health plan and change to Self + Family from a Self Only policy any time from 31 days before your wedding day to 60 days after the event. Contact your employing or retirement office to have a spouse added to your medical plan.

  • How do GEHA health plans work with Medicare?

    When you have Medicare A & B primary and GEHA health plan coverage, GEHA waives our deductible, coinsurance and copays. GEHA will pay the Medicare deductible and coinsurance for all of our covered services. If the service rendered is not covered by GEHA, then you are responsible for the Medicare coinsurance or deductible.

    If you are still actively employed, GEHA will pay as primary and regular GEHA plan benefits will apply. If you have Medicare Parts A and B primary, GEHA pays 100% of covered hospital and doctor expenses after Medicare. You pay no deductible or copays for surgical and medical benefits with GEHA Standard Option or High Option. You should present both your Medicare card and GEHA card to the provider at the time of service. The provider will bill Medicare, and in most cases once Medicare has processed the claim they will forward it on to GEHA.

    Additional prescription coverage through Medicare Part D is optional. OPM considers GEHA’s prescription coverage to be Creditable Coverage, which means it is expected to pay out as much as the standard Medicare prescription drug coverage will pay for all plan participants. If you decide to enroll in Medicare Part D later, you will not have to pay a penalty for late enrollment as long as you keep your FEHB coverage.

    Unfortunately, the list of providers that take Medicare changes regularly. Please check with your current physicians to ensure they are participating in Medicare.

  • How do I enroll in GEHA?

    If you are a new federal employee, you can sign up with GEHA by completing a health benefits registration form (SF 2809). Indicate the enrollment you want. Turn in your health benefits registration form according to your standard office procedures.

    • Standard Option 314-Self
    • Standard Option 315-Self and Family
    • Health Savings AdvantageSM 341-Self
    • Health Savings AdvantageSM 342-Self and Family
    • High Option 311-Self
    • High Option 312-Self and Family

    Many agencies also allow their employees to enroll online. These options include the following:

    • Employee Express. You might be able to enroll online with this site if your agency is on this list of participating agencies.
    • DoD automated systems. Available to Department of Defense employees.
    • MyPay. Health and Human Services employees and Environmental Protection Agency employees can enroll using this site.
    • Employee Personal Page. Available to most employees of agencies payrolled by the National Finance Center.
    • PostalEASE. A secure way for U.S. Postal Service employees to enroll, change enrollment or cancel enrollment in the FEHB program.
  • How do I use my GEHA card?

    You get two ID cards when you join the GEHA health plan. Each card is issued with the name of the member eligible for the health plan through FEHB. If you are the member, your spouse's card will have your name on it.

    1. Your health plan ID card.
      Use this card for:
      • Medical care at a doctor office or hospital
      • Prescriptions at an Express Scripts/Medco network pharmacy
      Important note: GEHA partners with a number of medical networks across the country. If you call your provider to confirm that he or she is in the GEHA network, please have your GEHA ID card handy. You'll want to ask the provider if he/she participates in the network indicated on your card. Network logos are placed on the front of the card. The back of the ID card tells the provider where to submit claims.
    2. LabCardYour Lab Card ID card (Not applicable if Medicare Part B is primary)
      Use this card for:
  • I am nine months pregnant. When can I enroll in a Self + Family plan?
    If you have a Self Only enrollment, you may change to Self + Family enrollment 31 days before to 60 days after you give birth. Self + Family enrollment begins on the first day of the pay period in which the child is born or becomes an eligible family member. If you give birth at an in-network facility, benefits are payable at 100% of the plan allowable for labor and delivery.
  • If a member with Self + Family coverage dies, do their family members retain coverage?
    If you are a survivor of a deceased federal or U.S. Postal Service employee or annuitant, and you are receiving an annuity, you may enroll with GEHA or continue the existing enrollment.
  • What is the age limit for dependents to receive coverage?

    Dependent children up to age 26 are eligible for FEHB coverage under your Self + family plan regardless of student status, residency or marriage. Coverage for dependent children ends at age 22 in the FEDVIP program.

  • When will I receive my GEHA ID card?

    If you enrolled at Open Season, your coverage is effective in January. You'll receive your ID card after we receive confirmation of your plan change from your payroll office.

    You can print a temporary member ID card by signing in your web account. Temporary cards show only the name of the GEHA member but may be used by a covered dependent. This temporary member ID card expires 30 days after printing.

    If you need a new permanent ID card, please email Customer Service or call (800) 821-6136.

  • Will I be able to keep my GEHA health insurance if the health care reform law stands?

    We expect the FEHB program and GEHA to remain intact. We also expect the FEDVIP program, which includes our Connection Dental Federal plan, to remain available to federal employees/retirees.

Benefits

  • Do I have some dental benefits under my FEHB plan – even if I don't have a FEDVIP dental plan?

    GEHA's health plans do include some basic dental benefits like diagnostic and preventive services; including examination, prophylaxis (cleaning), X-rays of all types and fluoride treatment.

    For the Standard Option health plan or the Health Savings Advantage high-deductible health plan (HDHP):

    GEHA will cover 50% up to the plan allowance for diagnostic and preventive services per year as follows:

    • Two examinations per person per year
    • Two prophylaxis (cleanings) per person per year
    • Two fluoride treatments per person per year
    • $150 in allowed X-ray charges per person per year (payable at 50%)

    For amalgam restorations, resin-based composite restorations, gold foil restorations and inlay/onlay restorations,  GEHA will cover $21 per tooth for a one-surface filling or $28 per tooth for two or more surface fillings. There is also a benefit of $21 per tooth for simple extractions. 

    For the High Option health plan:

    For diagnostic and preventive services, including examination, prophylaxis (cleaning), X-rays of all types and fluoride treatment, GEHA will pay $22 per visit (maximum two visits per year).

    For amalgam restorations, resin-based composite restorations, gold foil restorations and inlay/onlay restorations,  GEHA will cover $21 per tooth for a one-surface filling or $28 per tooth for two or more surface fillings. There is also a benefit of $21 per tooth for simple extractions. 

  • Do you require pre approval for medications?
    We do require pre-approval for some medications based on the patient’s diagnosis and the condition being treated.
  • Does GEHA have a hotline I can call if I have a health question but my doctor’s office is closed?

    Yes. You can call the GEHA Health Advice Line at (888) 257-4342. You can speak with a registered nurse 24 hours a day. Please have your member ID number available when you call.

    If you’re calling the Advice Line from outside the United States, call collect at (709) 835-8243.

    When you call the GEHA Health Advice Line, you can also choose to listen to recorded messages on more than 1,000 health topics.

  • Does GEHA offer vision coverage?
    All GEHA health plan and dental plan members receive vision coverage for no additional premium. Through Connection Vision powered by EyeMed, you and your covered family members each pay only a $5 copay for your annual eye exams when you use an EyeMed participating provider. If you use a non-participating provider, EyeMed will reimburse you up to $45 for your annual routine eye exam.

    To locate an EyeMed provider in your area, go to eyemedvisioncare.com and select the Insight network in the "Locate a Provider" box, or call (866) 804-0982.
  • Does GEHA provide coverage for hearing aids?
    Yes. Under our High Option plan, GEHA covers up to $500 per ear for hearings aids once every five years. Under our Standard Option plan, we cover up to $250 per ear once every five years.

    Also, all GEHA members are entitled to discounts on hearing aids through HearPO. Visit hearpo.com/geha or call (866) 211-6048 for locations and additional information.
  • Does GEHA use a mandatory formulary?

    No, GEHA does not use a mandatory formulary; however, our plan members may save money on their prescription copays by using the medications listed on Express Script’s preferred drug list.
  • How can I check my GEHA claims?
    For quick access, you'll want to register for a Member Web Account. GEHA web accounts give authorized users online access to GEHA claims and eligibility information. When you make a claims inquiry, you will see a list of your plan claims processed by GEHA. Click on an individual claim to view the online version of a GEHA explanation of benefits (EOB) form. The claim detail includes the date of service and the dollar amounts for charges and benefits.

    When you make an eligibility inquiry, you will see a list of your GEHA health and dental plans. Click on the plan description for a summary of benefits or to check amounts applied toward calendar-year deductibles and out-of-pocket maximums.
  • How do I get lab tests covered at 100%?
    When you use your Lab Card® at a participating provider location, GEHA pays outpatient laboratory testing at 100%. With Lab Card, you pay nothing – no deductible, no copay and no coinsurance.

    Each non-Medicare Standard Option and High Option member* will receive a Lab Card following enrollment in the health plan. You will need to show your card each time you receive lab services. Lab Card is an optional program. Members who choose not to use Lab Card will continue to pay deductibles and coinsurance/copayments for covered outpatient lab work.

    To find a listing of Lab Card provider locations in your area, click LabCard.com or call (800) 646-7788. Please note that the lab network is different than the GEHA provider network. If your doctor draws a specimen in his/her office, Lab Card must be called to pick up the specimen (toll-free number) for you to receive 100% coverage. For more information, see our Lab Card webpage.

    *GEHA Standard Option and High Option members with Medicare are not eligible for the Lab Card® program and will not receive Lab Cards. The Medicare program covers outpatient laboratory testing.

  • How do I request plan materials, including the benefit brochure?
    Visit the Form & Document Library to download materials or request materials by mail.
  • How is GEHA different from an HMO plan?

    GEHA is a Preferred Provider Organization (PPO) plan. With this plan, you pay a deductible and coinsurance or copayment for some care. We have a network of doctors and hospitals contracted with us to provide discounts for medical services. You may receive care from a doctor outside the GEHA provider network, but you will pay a higher amount for out-of-network care.
  • What is GEHA's catastrophic limit?

    The catastrophic limit is the maximum amount in coinsurance and deductibles you pay for all family members before GEHA begins paying for 100% of your care. In a single calendar year, your out-of-pocket expenses for coinsurance and deductibles are capped at this amount.

    The catastrophic limit varies by plan option.

    Plan Option Enrollment Code In-network Out-of-network
    Standard Option 314 – Self Only $5,000 $7,000
    315 – Self and Family $5,000 $7,000
    High Option 311 – Self Only $4,000 $6,000 
    312 – Self and Family $4,000 $6,000
    HDHP Option 341 – Self Only $5,000 $5,000
    342 – Self and Family $10,000 $10,000

  • What is my deductible and when do I pay it?

    A calendar year deductible is a fixed dollar amount that you pay for medical care before GEHA pays benefits. Copayments and coinsurance amounts do not count toward any deductible.

    If you have GEHA Standard Option or High Option plan, you pay a $350 deductible for Self Only coverage or $700 for Self + Family coverage for some types of medical care. After the $350 deductible is satisfied for an individual, covered services are payable for that individual. Under a Self + Family enrollment, all family members' individual deductibles are considered to be satisfied when the family members' deductibles are combined and reach $700.

    You pay the deductible for these types of medical care: surgery, hospitalization and emergency room visits.

    For other care, including in-network physician office visits, preventive care, chiropractic care, accidental injury and prescriptions, you do not have to meet the deductible before GEHA pays benefits.

    High Option plan members also pay a per hospital admission deductible of $100 for an in-network facility or $300 for an out-of-network facility.

  • What's the difference between coinsurance and a copayment?

    Coinsurance is a percentage of medical costs that you pay. If you have the GEHA Standard Option plan, you pay 15% of the plan allowance for hospital charges at an in-network provider and GEHA pays 85%, after you pay the calendar year deductible. If you have High Option, the split is 10%/90% at an in-network provider. You pay your deductible, then 10% of the allowable charge.

    A copayment is a fixed dollar amount that you pay for a covered service. For physician office visits and generic drugs, you pay a set dollar amount rather than a percentage of the cost. Low copays for these services help make your routine care more affordable. For example, with our Standard Option and High Option plans, you pay a low $10 copay in 2014 for a 30-day supply of a generic drug.

  • Where do I file a claim?

    Review the back of the patient’s ID card for GEHA’s mailing address or our electronic payor ID number for paperless claim filing.
  • Will Medco’s merger with Express Scripts change my prescription drug benefit coverage?

    Express Scripts, a pharmacy benefit manager, completed its merger with Medco Health Solutions on April 2, 2012. The combined company will be known as Express Scripts. There is no change to our members’ pharmacy benefits as a result of the merger. You are not required to do anything. Your prescription-drug benefits or home-delivery services will not be affected. You will continue to get the medications you need and the same high-quality service you expect. For the immediate future:

    • Your medication packaging/labels will remain the same.
    • You will continue to make your payments payable to the same company you always have.
    • You will not need to change retail pharmacies.
    • You will continue to send your prescription orders to the same home delivery pharmacy address.
    • You will continue to use the same phone number to contact us.
    • You will continue to use the same website and mobile app.

HDHP

  • Are GEHA’s contributions to my health savings account tax-deductible?
    Pass-through contributions made by GEHA to your health savings account are not tax-deductible.
  • Do I have to fund my account each year?
    No. You are not required to contribute to your account.
  • Do I have to see a network provider with GEHA's Health Savings Advantage HDHP plan?

    No. You can use any doctor, hospital or provider, but you will save money by seeing an in-network provider. Use our Provider Search to locate an in-network provider near you.
  • Do I have to use my HRA to pay for my annual physical or flu shot?
    No. For adults, preventive care from a qualified provider within GEHA’s network of providers is covered at 100 percent under GEHA’s Health Savings Advantage HDHP. Preventive care for children is covered at 100 percent. Preventive care includes annual physicals, routine adult immunizations, childhood immunizations and cancer screenings.
  • If I am a member of GEHA's Health Savings Advantage HDHP, do my prescription expenses apply to the catastrophic plan limit?

    Yes. The amount you pay for allowed prescription expenses is applied to the catastrophic limit that includes the deductible and the coinsurance.
  • If I am a member of GEHA's Health Savings Advantage HDHP, does it matter if I use a mail-order or retail pharmacy?

    You may use either. However, the advantage of using mail-order is that up to a 90-day supply can be obtained, as opposed to a 30-day supply at retail. Mail-order is recommended for medications you take on an ongoing basis.

    You may save money by using a mail-order pharmacy. To obtain a price quote, contact Express Scripts/Medco at (800) 551-7675.
  • How can an HRA plan save me money?
    An HRA plan may save you money through both lower premiums and tax-free medical reimbursements.
  • How do I find out how much of my deductible has been met?
    Since health plan deductibles aren’t a banking function, the bank statement will not tell you how much of your deductible has been met. You can find out how much of your deductible has been met by signing up for a Member Web Account. You can also call Customer Service at (800) 821-6136.
  • How do I find out my account balance? How can I verify GEHA contributions have been made?
    You will receive quarterly bank statements from HSA Bank. You may also enroll in free Internet Banking through the HSA Bank website. Internet banking allows you to check your account balance at any time. You can also use HSA Bank’s toll-free bank line at (800) 565-3512.
  • How do I make deposits to my account?
    If your HDHP coverage is effective after the first of the month, you may make direct voluntary contributions to your HSA the first day of the following month. You can mail deposits directly to HSA Bank or you set-up online contributions through HSA Bank’s Internet Banking system. For information, see your new HSA Bank account welcome kit or go to the HSA Bank website, hsabank.com.
  • How do I set up my HRA with GEHA?
    First, you must participate in our high-deductible health plan – GEHA Health Savings Advantage. Return the enrollment questionnaire mailed to you. GEHA will then set up and contribute to your HRA.
  • How do I use my HSA? How do I pay for services?

    When you have qualified medical expenses not paid by GEHA, you can pay with funds in your HSA. You are not required to use your HSA funds and may allow the funds to accumulate in your account. To withdraw HSA funds to pay your provider, use a debit card, write a check, make a withdrawal request or transfer funds into your personal account online using free Internet banking (I-banking). Go to Qualified Medical Expenses to see a partial list of expenses that qualify for reimbursement from your HSA.

    • Preventive care

    GEHA provides unlimited adult preventive care (paid at 100 percent, with no deductible) when you see a PPO doctor. Included are annual physicals, routine adult immunizations, mammograms and cancer screenings. Lab tests as part of your preventive care visit are also covered at 100 percent. GEHA covers well-child visits and immunizations (paid at 100 percent, with no deductible), regardless of provider. For details on covered preventive care, see your GEHA High-Deductible Health Plan Brochure.

    • Doctor or hospital

    You do not have to pay at the time of service when you see a doctor or go to a hospital. Your provider submits your claim to GEHA and GEHA then applies network discounts to the bill. You will receive an explanation of benefits (EOB) form listing “patient responsibility.” Pay that amount to the provider.

    • Prescriptions

    When you fill prescriptions at a pharmacy, you will pay at the time of purchase. Show your GEHA ID card to get the GEHA negotiated discount, and then pay for the prescription with your HSA debit card, cash, personal check or HSA check. If you pay for the prescription out of personal funds, you may reimburse yourself from your HSA, but be sure to save receipts of all medical expenses reimbursed from the HSA.

    • Dental/Vision
    Dental and vision services are not subject to the Health Savings Advantage plan deductible. Be sure to show your dental/vision ID card at the time of service to receive discounted services from participating Connection Dental® or EyeMed vision care providers. Many providers will submit claims to GEHA, but if yours does not, please submit an itemized statement from your provider to the address shown on your dental/vision ID card. You will receive an explanation of benefits (EOB) from GEHA or EyeMed. Pay the remaining balance to the provider.
  • How much can I contribute to my HRA?
    You can't make personal contributions to your HRA. Contributions are employer-only, made through GEHA premiums as a plan benefit. For the 2014 plan year, GEHA will make a contribution early in the year of $750 for each Self Only enrollment or $1,500 for each Self + Family enrollment in the HDHP. This entire annual amount will be credited to the HRA at the beginning of the plan year, allowing for immediate access to the funds. GEHA assumes the individual will be enrolled for the entire plan year. However, individuals who terminate employment or otherwise leave GEHA's HDHP will not be entitled to the entire contribution. The amount will be prorated for the months enrolled in the plan. If a member leaves during the plan year after using the entire plan year allotment, he or she will be responsible for returning the overpayment for the number of months remaining in the plan year.
  • How much can I contribute to my HSA?

    For 2014, the maximum contribution for an eligible individual with self-only coverage is $3,300 and the maximum contribution for an eligible individual with family coverage is $6,550. Individuals who are eligible individuals on the first day of the last month of the taxable year (December for most taxpayers) are allowed the full annual contribution (plus catch up contribution, if 55 or older by year end), regardless of the number of months the individual was an eligible individual in the year. For individuals who are no longer eligible individuals on that date, both the HSA contribution and catch up contribution apply pro rata based on the number of months of the year a taxpayer is an eligible individual.

    Here are some examples of total contributions:

    Plan Enrollment

     

    Statutory Contribution Limit**

     

    GEHA Contribution for 2014

     

    Under Age 55 – Max Voluntary Contribution

    Over Age 55 – Max Voluntary Contribution

     

    Self Only

     

    $3,300

     

    $750

     

    $2,550

     

    $3,550

     

    Self & Family

     

    $6,550

     

    $1,500

     

    $5,050

     

    $6,050

     


    *Catch-up contributions are allowed for those greater than 55 years of age ($1,000 in 2014). If you turn 55 at any point during the year, you are eligible for that year. 

    ** You may contribute the full HSA contribution regardless of the month you become eligible. However, if you do not stay in the HSA-eligible plan for 12 months following the last month of the year you first become eligible for an HSA, contributions to your HSA may be included in income and subject to 20 percent additional tax.

  • How much will GEHA contribute to my HSA?

    Once your account is set up, GEHA will deposit a portion of your regular health plan premiums for the month into your HSA. In 2014, GEHA will deposit:

    • $62.50 per month ($750 per year) for a Self Only enrollment or
    • $125 per month ($1,500 per year) for a Self and Family enrollment.
  • How will GEHA identify if I have other coverage and if the other coverage is or is not an HDHP?
    You will complete and submit a questionnaire, included in your enrollment kit, which will advise GEHA of other coverage. When submitting a health reimbursement (GE-HRA) form, you must certify that your medical expenses claimed under the HRA have not been reimbursed and will not be reimbursed under any other plan or arrangement covering that expense.
  • How will the HRA be paid out?
    You will be automatically reimbursed for your deductible or qualified out-of-pocket expenses up to the amount of your HRA balance when you or your provider submits a claim to Health Savings Advantage HDHP. For any items allowable as eligible medical expenses under the HRA, but not the HDHP, you may submit a GEHA health reimbursement form (GE-HRA). These forms are available online and were provided in your enrollment packet.
  • I am enrolled in GEHA’s HRA plan. How do I know what retail pharmacies are participating?
    The pharmacy network is the same as is currently used for the High Option and Standard Option plans. You may find a participating pharmacy by visiting geha.com or by calling the GEHA Prescription Drug Hotline toll-free at (800) 551-7675 to access the voice-activated, 24-hour Pharmacy Locator System.
  • I am very close to meeting my Self Only calendar year deductible for GEHA's Health Savings Advantage HDHP. Will the retail pharmacy know they should not charge the full price for the next prescription I have filled?

    Yes. When the retail pharmacy submits your next claim, you will be charged the remainder of your deductible and 25 percent of the balance of the prescription in 2014.

    Example: If you are $25 from meeting your deductible, and you have a $100 prescription filled, you will pay a total of $43.75 ($25 deductible plus $18.75, which is 25 percent of $75).

  • If I retire early, can I withdraw HSA funds for non-medical expenses?
    If you use your HSA for non-medical withdrawals prior to age 65, the amount will be included in your gross income and you will pay a 20 percent penalty.
  • If I’m still working and turn age 65 and qualify for Medicare, but do not elect to take it, will GEHA keep making deposits for me until Medicare is primary?
    Yes. You are eligible for an HSA after age 65 until you are enrolled in Medicare Part A, B, C or D (prescription drug program).
  • Is any dental care provided with GEHA's Health Savings Advantage HDHP plan?

    Yes. GEHA's health plans do include some basic dental benefits like diagnostic and preventive services, including examination, prophylaxis (cleaning), X-rays of all types and fluoride treatment.

    For the Standard Option health plan or the Health Savings Advantage high-deductible health plan (HDHP), GEHA will cover 50% up to the plan allowance for diagnostic and preventive services per year as follows:

    • Two examinations per person per year
    • Two prophylaxis (cleanings) per person per year
    • Two fluoride treatments per person per year
    • $150 in allowed X-ray charges per person per year (payable at 50%)

    For amalgam restorations, resin-based composite restorations, gold foil restorations and inlay/onlay restorations, GEHA will cover $21 per tooth for a one-surface filling or $28 per tooth for two or more surface fillings. There is also a benefit of $21 per tooth for simple extractions.

  • Is any vision care provided with GEHA's Health Savings Advantage HDHP plan?

    Yes. If you are a Health Savings Advantage high-deductible health plan member, Connection Vision® powered by EyeMed offers you and your covered family members professional vision care from qualified EyeMed providers. For more details, click Vision Benefits for HDHP Members.
  • Is my money safe in a health reimbursement arrangement (HRA) account?

    This isn’t a bank account. It is a credit from a premium pass-through that can reimburse you for qualified medical expenses for yourself and your enrolled dependents.
  • Is my pharmacy deductible separate from my medical deductible for GEHA's Health Savings Advantage HDHP?

    No. Pharmacy and medical expenses apply to the same deductible.
  • What are the tax benefits of an HRA?
    Contributions made to your HRA are 100 percent employer-funded, so they are free of federal, state and FICA taxes. The distributions for medical expenses are also tax-free.
  • What do I need to file my taxes?

    You must file IRS form 8889 to report contributions and distributions from your HSA. HSA Bank will send you IRS form 1099-SA, along with a year-end status report, for your use in completing IRS form 8889.

  • What does the IRS require me to report on my taxes concerning my HRA?
    Nothing. Your HRA is a health benefit.
  • What expenses qualify for payment?

    Expenses qualifying for reimbursement are determined by GEHA’s benefit design. GEHA’s HRA allows reimbursement for any qualified medical expense under Internal Revenue Code Section 213(d). See IRS Publication 502 for more details or a more complete list. Below is a partial list of items that qualify for reimbursement:

    - Deductibles
    - Coinsurance
    - Copayments
    - Prescriptions
    - Dental care, orthodontia
    - Doctor’s fees
    - Hearing aids
    - Chiropractic care
    - Long-term care services or insurance
    - COBRA coverage/insurance
    - Medicare expenses (Part B or D premiums, but not Medigap)

    NOTE: You will not be allowed to withdraw funds for non-qualified expenses.
  • What fees will I pay for the HRA?
    There are no set-up or administrative fees.
  • What fees will I pay for this account?
    GEHA pays your account set-up fee, charges for your initial debit card(s) and bank administrative fees. Other charges are your responsibility and can include checks ($7.95 for 50) and ATM withdrawals ($2.00). There is no charge when using your debit card at the point of service with a signature (like a credit card) rather than a PIN. A list of fees can be found at hsabank.com. You will receive quarterly bank statements via mail and online statements are available through Internet Banking. There is a small charge for requesting mailed monthly bank statements.
  • What happens to HRA amounts not used at the end of the year?
    Unused funds carry over to future years without limit to the accrual amount.
  • What happens to HSA funds I don’t use each year?  What if I change jobs or health plans?
    The HSA account is yours and unused funds carry over to future years. If you change jobs or leave the GEHA health plan, you may keep your HSA with HSA Bank or transfer it to another institution.
  • What happens to my HRA funds if I terminate my employment with the federal government or switch plans?

    Subject to timely filing requirements, individuals may apply for reimbursement from their HRAs for any qualified medical expenses incurred during the period of time they were enrolled in the HDHP and HRA. Any remaining funds are forfeited.

    The HRA funds are credited to the HRA at the beginning of the plan year, allowing for immediate access to the funds. GEHA assumes the individual will be enrolled for the entire plan year. For individuals who terminate employment or otherwise leave GEHA’s HDHP, the amount will be prorated for the months enrolled in the plan. If a member leaves during the plan year after using the entire plan year allotment, he or she will be responsible for returning the overpayment for the number of months remaining in the plan year.

  • What happens when I turn 65?

    After age 65, you can continue to use your HSA funds tax-free for eligible medical expenses. At this age, you also have the option to use funds in your HSA for any reason, even for non-medical expenses, though you will pay taxes on those withdrawals at your normal tax rate.

    When you enroll in Medicare, you are no longer eligible for an HSA. You will automatically transition to a health reimbursement arrangement (HRA) the month prior to the month of your 65th birthday, unless you notify GEHA that you will not be enrolled in Medicare Part A, B or D.

  • What if my medical expenses are more than my health reimbursement arrangement balance?
    You will pay any difference between the balance in your HRA and the deductible. After the deductible is met, traditional PPO health coverage would be applied through GEHA’s Health Savings Advantage according to the plan benefits.
  • What if my medical expenses are more than my health savings account?
    You will pay any difference between the balance in your HSA and the deductible. After the deductible is met, traditional PPO health coverage through GEHA’s Health Savings Advantage HDHP will be applied according to the plan benefits.
  • What if my spouse is on Medicare and his or her expenses aren’t subject to the higher deductible?
    Eligibility for an HSA is determined separately from what is eligible for reimbursement under an HSA. For this reason, a member enrolled in a Self Only HDHP can be reimbursed from his or her HSA for the qualified medical expenses of the account holder and the account holder’s spouse and dependents, even if the spouse is on Medicare.
  • What interest rate is earned on the health reimbursement arrangement?
    Interest is not earned on the HRA.
  • What is a high-deductible health plan?

    A high-deductible health plan (HDHP) is a health plan to provide insurance coverage for qualified medical expenses. The IRS requirements for a HDHP with an HRA are different from that required of the HSA-qualified HDHP. GEHA’s deductible for 2014 is $1,500 for Self Only with an out-of-pocket maximum of $5,000, or $3,000 for Self + Family coverage with an out-of-pocket maximum of $10,000.

  • What is an HRA? How does it work?
    A health reimbursement arrangement (HRA) is an employer-provided tax-sheltered arrangement that allows individuals to pay for qualified medical expenses. It is not a bank account. The HRA works in conjunction with GEHA Health Savings AdvantageSM high-deductible health plan (HDHP) when the covered individual is not eligible for an HSA to cover qualified medical expenses prior to meeting the deductible. Neither HRA credits nor distributions for qualified medical expenses are taxed.
  • What is the tax treatment of an eligible individual's HSA contributions?
    Contributions made by an eligible individual to an HSA are deductible by the eligible individual in determining adjusted gross income (i.e., "above the line"). A member’s voluntary contributions are deductible whether or not the eligible individual itemizes deductions. However, the individual cannot also deduct the contributions as medical expense deductions under section 213. (Notice 2004-2, Q-A #17)
  • What is the tax treatment of contributions made on behalf of an eligible individual?
    Contributions made to an HSA by a family member on behalf of an eligible individual are deductible by the eligible individual in computing adjusted gross income. The contributions are deductible whether or not the eligible individual itemizes deductions. An individual who may be claimed as a dependent on another person's tax return is not an eligible individual and may not deduct contributions to an HSA. (Notice 2004-2, Q-A #18)
  • When can I use my HRA?
    You can use funds as available to reimburse yourself for your or your covered dependent’s deductible or other out-of-pocket medical expenses.
  • When is the first deposit made?
    For active employees who enroll at Open Season and complete forms promptly, the first monthly contribution will be made February 15. Once your application has been processed, your account will be opened on the first of the following month. A contribution will be made on the 15th of the month after the HSA is effective.
  • When should I submit my claim forms for the HRA?

    There is no need to submit a claim form for your HRA if the claim has been sent to GEHA’s Health Savings Advantage high-deductible health plan. If you have not met your deductible, claims will be reimbursed from the HRA automatically. Sending claims to GEHA before you pay the provider assures that the appropriate amounts will be attributed to your deductible and that you will receive the network discount. Be sure to receive the network discounts, whether you are receiving pharmacy, vision, medical or dental care.

    With medical claims, wait until you receive the explanation of benefits (EOB) and reimburse the provider based on the balance noted under “your responsibility.”

    Subject to timely filing requirements, individuals may apply for reimbursement from their HRA funds for any qualified medical expenses incurred during the period of time they were enrolled in the HDHP and HRA.

  • Where do I send my claim forms for the health plan?

    Your provider should send claims to GEHA for you so that the appropriate amounts will be attributed to your deductible. It also assures that the appropriate network discount will be applied.

    If you are using an out-of-network provider who requires you to submit the claim form yourself, please forward to GEHA, P.O. Box 168, Independence, MO 64051-0168.

  • Where do I send my claim forms for the HSA?
    Health savings accounts do not have claim forms. However, with medical claims, wait until you receive the explanation of benefits (EOB) and reimburse the provider based on the balance noted under “patient responsibility.” This assures that the appropriate amounts will be attributed to your deductible and that you will receive the network discount. Be sure to receive the network discounts, whether you are receiving pharmacy, vision, medical or dental services.
  • Who administers this HRA?
    GEHA administers the health reimbursement arrangement and HDHP. If you have questions, contact GEHA at (800) 821-6136.
  • Who administers this HSA?
    HSA Bank, a division of Webster Bank, N.A., is the trustee and has received an “excellent” rating by the Bauer Financial bank rating service. Although all new health savings accounts are FDIC-insured through Webster Bank, if you decide in the future to invest HSA funds under HSA Bank’s brokerage option, those funds are not FDIC-insured.
  • Who is eligible for a health savings account (HSA) and who qualifies for a health reimbursement arrangement (HRA)?

    To be eligible for an HSA or an HRA, you must first enroll in a high-deductible health plan such as GEHA’s Health Savings Advantage HDHP. Then, to be eligible for an HSA, you must not have Medicare or any other health coverage that is not a qualified high-deductible health plan, including coverage under a spouse’s health plan or flexible spending account (FSA). A member who is not eligible for an HSA will default to the HRA.

    EXAMPLE 1: Member elects family coverage with GEHA Health Savings Advantage HDHP plan and wishes to open an HSA. Member’s spouse has a family policy with an HMO and no deductible. This member does not qualify for an HSA.

    EXAMPLE 2: Member has a health care flexible spending account through FedFlex. This member does not qualify for an HSA.

    EXAMPLE 3: Member has a limited health care flexible spending account through LEXFSA. This member does qualify for an HSA.

    EXAMPLE 4: Member elects family coverage with GEHA Health Savings Advantage plan and wants to open an HSA. Member’s spouse has an FSA that is limited to dental and vision only. This member does qualify for an HSA.

    If you have questions about whether you are eligible for an HSA, please contact the HSA Bank at (866) 471-5964 (toll-free) or GEHA at (800) 821-6136. If you are calling from outside the United States, you may call the HSA Bank at (920) 803-4100, extension 34101. Or, call GEHA’s dedicated overseas toll-free number, (877) 320-9469 (You must first call the AT&T Direct® access number for the country from which you are calling.).

  • Will I have to pay out of my pocket at the time of service?

    You do not have to pay at the time of service when you see a health care provider. Your provider submits your claim to GEHA, and then GEHA applies network discounts to the bill. GEHA will pay any amount below the deductible up to the maximum in your HRA. You will receive an explanation of benefits (EOB) showing your HRA balance.

    The exception to this payment arrangement is at a pharmacy. Present your GEHA identification card to receive the discount, pay the balance and then submit the claim to GEHA for reimbursement determination.

Medicare

  • Am I required to purchase Medicare’s prescription drug plan if I am a GEHA health plan member?

    OPM has determined that GEHA’s prescription drug coverage is creditable coverage and will, on average, pay out as much as the standard Medicare prescription drug coverage will pay for all plan participants. You are not required to enroll in Medicare Part D and pay extra for prescription drug benefit coverage. If you decide to enroll in Medicare Part D later, you will not have to pay a penalty for late enrollment as long as you keep your FEHB coverage.

    If you choose to participate in Medicare Part D, you can keep your FEHB coverage and your FEHB plan will coordinate benefits with Medicare. We recommend you review the medications you are currently taking and your costs to determine the best option for your coverage.

  • How should I file my claims if I have GEHA and Medicare?

    Most of your claims can be filed electronically by GEHA Express. For information on electronic claims filing, call GEHA Express at (800) 282-4342.

    • If Medicare is your primary insurance and you have not enrolled in GEHA Express, you should first submit your claims to Medicare. After Medicare has paid its benefits, they will send you a Medicare Summary Notice (MSN). Send the MSN along with copies of all bills to GEHA for processing.
    • If GEHA is your primary insurance, submit your bills to GEHA’s claim office first. GEHA will
      process your claim and send you an Explanation of Benefits (EOB). You should then send the EOB and copies of your bills to Medicare.
  • I have Medicare and GEHA coverage. Do I need to use GEHA’s in-network providers?

    When you have GEHA and Medicare, in most instances, you receive the same benefits whether you use providers in the GEHA network or out-of-network.

    You’re free to use any provider you choose. However, using the GEHA network helps control overall plan costs. Please consider using our nationwide network of more than 1 million health care providers – yours is probably one of them! You’ll find the most current listing in our online Provider Search.
  • What is the best GEHA plan to use with Medicare?
    If you have Medicare Parts A&B as your primary insurance, GEHA pays 100% of covered doctor and hospital expense after Medicare. You pay no deductible or copays for surgical and medical benefits with GEHA Standard Option or High Option. The High Option plan offers greater reimbursement for brand-name medications when no generic equivalent is available. High Option members pay 20% for a 30-day supply at in-network pharmacies and 15% for a 90-day supply through our mail-order program. Standard Option plan members pay 50% for brand-name medications. If you use mostly inexpensive, generic medications, Standard Option is a good choice. Please review your personal health care details and financial situation to determine the best fit for your needs.
  • Will my GEHA premiums reduce after I turn 65 and start paying Medicare Part B premiums?
    FEHB laws do not allow for a FEHB plan to charge different premiums to members enrolled in the same plan option regardless of other coverage. However, when Medicare A & B are primary, GEHA pays 100% of covered hospital and medical expenses after Medicare. You pay no deductible or copays for hospital and medical benefits with GEHA Standard Option or High Option.

Network

  • How do I find a GEHA doctor or hospital?

    To find a doctor, hospital, dentist or pharmacy in the GEHA network, visit our online Provider Search. The online tool also allows you to print a personalized directory.

    Please remember that if you have Medicare A&B primary, you can choose any provider for your care. Medicare and GEHA together will pay 100% of your costs for covered services during doctor visits, surgical care, lab services and hospitalization, in or out-of-network.

    Important note: GEHA partners with a number of medical networks across the country. If you call your provider to confirm that he or she is in the GEHA network, please have your GEHA ID card handy. You'll want to ask the provider if he/she participates in the network indicated on your card. Network logos are placed on the front of the card. The back of the ID card tells the provider where to submit claims.

  • My doctor is in-network but practices in more than one location. Am I covered for services provided at all locations?
    Not all providers are considered participating in-network providers at all locations in which they practice. It is the member's responsibility to verify with the provider, prior to services being rendered, that the provider is a participating network provider at the location services are being rendered. In addition, not all services performed at a participating provider's office are covered services. It is the member's responsibility to verify coverage of services.
  • My doctor is listed in your Provider Search tool but she doesn’t recognize GEHA. How can I verify that she is an in-network provider?

    To ensure that GEHA has in-network providers in all 50 states, we have entered into arrangements with a number of health networks throughout the country. Health care providers may be more familiar with the name of their local network than with GEHA.

    We ask that members verify network status with their doctor’s office – the easiest way is to show your provider the network logo on your GEHA ID card. We find that most offices can readily tell patients if the doctor participates in the GEHA network. You can also check our PDF chart of GEHA networks by state to identify the provider network in your area.

  • Why can’t I find any chiropractors in GEHA’s online provider search tool?
    Because GEHA pays the same scheduled benefit for chiropractics in or out of the network, chiropractors are not listed in the GEHA Provider Search. Find complete information on chiropractic benefits in the GEHA Plan Brochure.

Outside U.S.

  • How do I process a claim for reimbursement for prescription drugs filled overseas?

    To expedite the processing of your foreign prescription drugs, please complete GEHA's prescription drug statement, attach a copy of your drug receipt(s) and submit to:

    GEHA Foreign Claims Department
    P.O. Box 4665
    Independence, MO 64051-4665

    Please note: In some instances, a copy of your prescription may be requested.

  • I live outside the U.S. How can I contact you?
    Call the AT&T USADirect® access number for the country from which you're calling. Then, call us toll-free at (877) 320-9469. Do not dial a "1" before the 877. You may also email us at overseas@geha.com.
  • What exchange rate do you use to convert my claims into U.S. dollars?
    Benefits are reimbursed in US Dollars based on the exchange rate for the date of service.
  • Will you cover emergency expenses if I am traveling out of the country?
    GEHA provides benefits for its members outside of the United States for medically necessary covered services. Covered services would be payable at the PPO rate of benefits.