COVID-19 information
What you need to know about GEHA’s COVID-19 coverage.
Frequently asked questions
The frequently asked questions below apply to all GEHA medical plan members, including Medicare primary members. The information presented by GEHA in these frequently asked questions does not constitute medical advice for any person who requires direct medical attention. It should not be used as a substitute for medical care or the advice of your physician. Please consult your medical provider for any symptoms that are severe or concerning.
Yes. As of September 25, every U.S. household can again place an order from covidtests.gov to receive four free COVID-19 rapid tests delivered to their home.
Yes. As of January 15, 2022, GEHA covers COVID-19 OTC test kits through its pharmacy benefit. Members may visit a participating retail network pharmacy (subject to availability and participation) to obtain certain OTC COVID-19 test kits at $0.00 cost using their prescription benefit card. A prescription is not required for the COVID-19 test kit, but the kit must be processed through the pharmacy. Find a pharmacy
Members may purchase a test online and pick it up at a participating CVS Pharmacy. Click to see detailed instructions.
Members may also purchase a COVID-19 test online, have it shipped to their home and submit for reimbursement through the GEHA prescription benefit. For reimbursement through the prescription benefit, the member will sign in to the portal at Caremark.com with their Username and Password, and submit a claim form.
Tests purchased online will be reimbursed up to $12 per test (or the actual price of the test, if less).
Tests purchased online will be reimbursed up to $12 per test (or the actual price of the test, if less).
Members may purchase a COVID-19 test from a retailer outside of GEHA’s preferred pharmacy network. Members should save their receipts and submit for reimbursement through the GEHA prescription benefit. For reimbursement through the prescription benefit, the member will sign in to the portal at Caremark.com with their Username and Password, and submit a claim form.
Tests purchased outside GEHA’s preferred pharmacy network will be reimbursed up to $12 per test (or the actual price of the test, if less).
GEHA will cover at-home over-the-counter COVID-19 tests purchased on or after January 15, 2022. GEHA has provided coverage for at-home over-the-counter COVID-19 tests purchased before January 15 with an order from an authorized health care provider.
Members who purchased a test prior to Jan. 15, 2022, can request reimbursement by submitting a claim form with the receipt and copy of health care provider order using the GEHA Medical Claim Form.
Members may only be reimbursed once for the purchase of an at-home OTC COVID-19 test.
GEHA is required to provide reimbursement for 8 tests per rolling 30-day period per covered member, meaning 8 tests per GEHA subscriber plus 8 tests per spouse, child or other dependent who’s covered on the subscriber's plan. That means, for example, a family of four can be reimbursed for 32 tests per rolling 30-day period, regardless of whether the tests are bought all at once or at separate times throughout the rolling 30-day period. GEHA recognizes that some OTC COVID-19 tests are sold in packages containing more than one test. In applying the quantity limit of 8, GEHA may count each test separately, even if multiple tests are sold in one package.
GEHA will continue to cover COVID-19 tests if they are ordered by a physician, non-physician practitioner, pharmacist or other authorized health care professional.
Member reimbursements for at-home over-the-counter COVID-19 tests occur within the same 30-day turn-around time for all GEHA claims processing.
GEHA is not required to provide coverage of testing (including an at-home over-the-counter COVID-19 test) that is for employment or academic institution attendance purposes.
For people covered by original fee-for-service Medicare, Medicare pays for COVID-19 diagnostic tests performed by a laboratory, such as PCR and antigen tests, with no beneficiary cost sharing when the test is ordered by a physician, non-physician practitioner, pharmacist, or other authorized health care professional. People with Medicare can access one lab performed test without cost sharing per patient per year without an order. At this time original Medicare cannot pay for at-home tests through this program. Medicare Advantage plans may offer coverage and payment for at-home over-the-counter COVID-19 tests, so consumers covered by Medicare Advantage should check with their plan.
If a doctor orders or recommends diagnostic or antibody testing for COVID-19, GEHA will cover it at no cost, for both in-network and out-of-network CDC-approved testing sites during this national emergency. This includes waiving deductibles, coinsurance and copayments. This coverage extends to drive-through diagnostic testing.
Locate a test center
Important note: For GEHA to cover COVID-19 diagnostic or antibody tests as described above, the test must be performed at the direction of the doctor. If you think you need a test, talk to a provider right away. If you choose to be tested using QuestDirect or another direct-to-consumer program without a doctor’s order, you will be responsible for all costs of the testing.
GEHA is also covering the visit associated with COVID-19 testing. If you see a provider, virtually or in person, and that provider orders or administers a COVID-19 test, that visit, and its costs will also be covered. For in-network providers, you will pay nothing for the associated visit. For out-of-network providers, GEHA will pay 100% up to the plan allowance; you may be responsible for any difference between the allowance and the provider’s billed amount.
If the testing site does not bill insurance directly, you can submit a paper claim directly to GEHA in order to be reimbursed for the covered service. Please see this
PDF claim form
for information on how to submit the claim directly to GEHA for reimbursement. Important note: If you choose to be tested using QuestDirect or another direct-to-consumer program, you must include with your claim form a health care professional's order for the test, and an itemized statement with all description details, complete cost and proof of purchase; if not included, you will be responsible for all costs of the testing.
As of July 1, 2021, your cost-sharing for COVID-19 inpatient and outpatient treatment will be according to your benefit plan. You will be responsible for any copay, coinsurance, deductible or out-of-network costs as indicated in your
plan brochure.
Oral antiviral treatments Lagevrio (Molnupiravir) and Paxlovid (Nirmatrelvir/Ritonavir) are currently covered at $0 cost to members.
GEHA has eliminated prior authorization and referral requirements for medical benefits related to COVID-19.
GEHA, as a one-time courtesy, is waiving prescription refill limits on maintenance medications. Members can obtain an additional 30-day supply of medications at retail and an additional 90-day supply of medication through mail order. Members are responsible for any applicable copay/coinsurance on these early refills and are encouraged to call CVS Caremark at
844.443.4279 with
questions.
Yes, GEHA provides 100% coverage for the COVID-19 vaccination if the booster/vaccine is received from an in-network pharmacy, is FDA approved and is recommended by CDC/ACIP for use.
No. These are all commonly used words for the same type of physician visit through your telephone, tablet or computer.
GEHA has expanded our access to telehealth coverage. The use of these visits allows members to connect with care providers from home, minimizing potential exposure to infection while keeping emergency rooms and urgent care clinics available for those with the highest level of need.
As of July 1, 2021: Your cost-sharing for COVID-19 inpatient and outpatient treatment (including telehealth) will be according to your benefit plan. MDLIVE telehealth visits will still be covered 100% (deductible applies for the HDHP plan). All other telehealth visits will take the appropriate copay, coinsurance and deductible outlined in your member materials.
Members can learn more about MDLIVE by calling
Customer Care at
800.821.6136 or by
visiting
geha.com/MDLIVE.
Yes, they are offering e-clinic visits with
MinuteClinic providers in 33 states and Washington,
D.C.
MAKE AN APPOINTMENT
Behavioral telehealth visits are covered the same as other telehealth visits. See above How are telehealth visits covered?
As dental offices reopen, many are prioritizing their patients with previously mid-progress treatment as they begin to reschedule routine dental care appointments. Contact your dentist for more information.
Effective from March 1 through July 31, 2020 only, we will accept claims for an exam through a teledentistry consultation, only when required to determine a member’s need for emergency care. By allowing this additional consultation type during the COVID-19 timeframe, we are increasing the member maximum from two exams to three exams for 2020. This maximum can be met through any combination of allowed exam types, typically via routine cleaning/exam appointments.
You can call GEHA Customer Care at 800.821.6136 during our normal business hours, which are 7 a.m. to 7 p.m. Central time, Monday through Friday (except holidays). Or you can send an email to Customer Care using our secure
Contact GEHA form.
GEHA has several methods for you to speak to
someone.
You can schedule a call to speak to a Customer Care
adviser when it fits into your schedule.
SET APPOINTMENT
You also have access to a personal care team that
can help you with symptoms or concerns.
CALL 800.821.6136
You can also speak with a registered nurse at any
time of the day.
CALL 888.257.4342
Help is here
Call Customer Care
We're here to answer your questions. Call 800.821.6136 to speak to a Customer Care representative Monday-Friday, 7 a.m.–7 p.m. Central time.
Call a nurse
Medical plan members can speak to a registered nurse — anytime, 24 hours a day, 7 days a week. Call 888.257.4342.
Connect with an online doctor
Try telehealth. Online doctor visits through MDLIVE are covered at no cost for all medical members (after deductible for HDHP plan members*).
COVID-19 self-checker
Rally Health's tool will check your COVID-19 risk levels. Although the full Rally experience is for our Elevate/Elevate Plus members, this self-checker is open to all.
Thank you, members
Thanks you for being here for us, so we can be here for you.
COVID-19 has touched our lives in a way many of us could not imagine. While the Centers for Disease Control and Prevention has officially declared an end to the COVID-19 public health emergency, GEHA wants you to know that you and your family are our number one priority. We are here to help you navigate your health and wellness, so we can all keep moving forward. The information on this page will be updated frequently to make you aware of additional benefit changes. If you have specific questions about your benefits, please call us at 800.821.6136.
Additional resources
Centers for Disease Control (CDC) updates
Visit cdc.govCOVID-19 test site finder
Find testing near youWorld Health Organization (WHO) updates
Visit who.int*If the deductible is met, high deductible health plan (HDHP) member will be charged by MDLIVE but GEHA will then reimburse the member 100% of the billed charges.
The frequently asked questions apply to all GEHA medical plan members, including Medicare primary members. The information presented by GEHA in these frequently asked questions does not constitute medical advice for any person who requires direct medical attention. It should not be used as a substitute for medical care or the advice of your physician. Please consult your medical provider for any symptoms that are severe or concerning.
This is a brief description of the features of the Government Employees Health Association, Inc.’s medical plans regarding COVID-19 benefits. Please refer to the GEHA Federal brochures available at geha.com/PlanBrochure. All benefits are subject to the definitions, limitations, and exclusions set forth in the Federal brochure.