High
Welcome to your medical plan page
What’s new in 2024
- Medicare B subsidy of $100 per month when you choose to elect GEHA High Medicare Advantage Plan coverage.
- Infertility coverage only for artificial insemination (AI). Coverage for drugs associated with AI and in vitro fertilization (IVF limited to three cycles annually).
High coverage
Yearly deductible
| Yearly deductible in-network1 | You pay |
|---|---|
| Self Only | $350 |
| Self Plus One or Self and Family | $700 |
Out-of-pocket maximum
| 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. For out-of-network benefits, refer to GEHA’s 2024 plan brochure RI 71-006 (High and Standard).
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.
Your medical benefits
| Medical benefits in-network1 | You pay |
|---|---|
|
$0 |
|
$5 |
| $10 | |
|
$20 |
| $35 | |
|
10%3 |
|
$100 per admission plus 10% |
|
Balance after 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 the GEHA High plan and their eligible family members.
3 Calendar year deductible applies.
Your prescription benefits
| 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.
High and Medicare coverage
Yearly deductible
| Yearly deductible with Medicare A & B primary 1 | You pay |
|---|---|
| Self Only | $0 |
| Self Plus One or Self and Family | $0 |
Out-of-pocket maximum
| Out-of-pocket maximum in-network1 | 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.
High and Medicare medical benefits
| Medical benefits with Medicare A & B primary in-network1,2,3 | You pay |
|---|---|
|
$0 |
|
$5 |
|
Balance after 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 With Medicare A & B primary, go to any provider that accepts Medicare assignment.
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.
High and Medicare prescription benefits
| Prescription benefits in-network1,2 | You pay |
|---|---|
| 30-day retail generic | $103 |
| 30-day retail preferred brand-name | 20% ($150 max3,4) |
| 30-day retail non-preferred brand-name | 35% ($200 max3,4) |
| 90-day mail service generic | $15 |
| 90-day mail service preferred brand-name | 15% ($350 max4) |
| 90-day mail service non-preferred brand-name | 30% ($500 max4) |
| 30-day specialty CVS exclusive generic and preferred brand-name | 15% ($150 max4) |
| 30-day specialty CVS exclusive non-preferred brand-name | 30% ($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.
Included benefits & discounts
Pharmacy benefits
Retail pharmacy
Mail service pharmacy
Estimate medication costs
Your exclusive discounts
Vision discount1
Medical alert discount1
Hearing aid discount1
Electric toothbrush discount1,2
Teeth whitening discount1
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.
2 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.
Find care
Other care resources
Maternity resources
Your team of health professionals
New for 2024: Infertility benefits
Order your complimentary maternity resource kit
Childbirth classes
Order your breast pump
To see if your preferred breast pump is available from an in-network provider, visit
Health Rewards
How it works
Your Health Rewards reloadable debit card
Redeeming your rewards
Resources
Plan documents
| Topic |
Resource |
|---|---|
| 2024 High Plan Brochure | Download (PDF) |
| 2024 High Member Guide | Browse the e-book |
| 2024 Medical Benefits Guide | Browse the e-book |
| 2024 Summary of Benefits Coverage | Download (PDF) |
Helpful resources
| Topic |
Resource |
|---|---|
| Create your GEHA web account | geha.com/Register |
| Complete your Enrollment Questionnaire | geha.com/EQ |
| Talk with GEHA Customer Care | geha.com/Contact |
| Use the Find Care Tool | geha.com/Find-Care |
| View the frequently asked questions | geha.com/FAQs |
| Access the GEHA App | Visit the App Store or Google Play |
This is a brief description of the features of the High Option plan. Please read the Plan’s Federal brochure (RI 71-006). All benefits are subject to the definitions, limitations, and exclusions set forth in the Federal brochure.