Standard
Welcome to your medical plan page
What’s new in 2024
- Infertility medical coverage only for artificial insemination (AI). Coverage for drugs associated with AI and in vitro fertilization (IVF limited to three cycles annually).
- Coinsurance and copay max for 30-day retail preferred brand-name prescriptions is changing from 50% ($200 max) to 40% ($250 max) and max for 30-day retail for non-preferred brand-name prescription is changing from 50% ($300 max) to 60% ($350 max)
- Coinsurance and copay max for 90-day mail service preferred brand-name prescriptions is changing from 50% ($500 max) to 40% ($550 max) and max for 90-day mail service non-preferred is changing from 50% ($600 max) to 60% ($650 max)
- Medicare Part B subsidy of $75 per month when you choose to elect GEHA Standard Medicare Advantage Plan coverage
- $0 copay for one primary care physician visit and two urgent care visits per year for children under 18
- The Health Rewards incentives are changing for 2024. Activities available for rewards include a health assessment, colorectal screening, cervical cancer screening, breast cancer screening and a MDLIVE telehealth visit. Visit geha.com/HealthRewards to view your rewardable activity opportunities.
Standard 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 max 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. 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 |
|
15% |
|
15%3 |
|
50% |
|
$100 |
|
$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.
Your prescription benefits
| Prescription benefits in-network1,2 | You pay |
|---|---|
| 30-day retail generic | $10 |
| 30-day retail preferred brand-name | 40% ($250 max3) |
| 30-day retail non-preferred brand-name | 60% ($350 max3) |
| 90-day mail service generic | $20 |
| 90-day mail service preferred brand-name | 40% ($550 max3) |
| 90-day mail service non-preferred brand-name | 60% ($650 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.
* New for 2024: GEHA Standard Medicare Advantage Plan
Standard and Medicare coverage
Yearly deductible with Medicare A & B primary1
| Yearly deductible with Medicare A & B primary1 | You pay |
|---|---|
| Self Only | $0 |
| Self Plus One or Self and Family | $0 |
Out-of-pocket maximum
| Out-of-pocket max 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.
Standard and Medicare medical benefits
| Medical benefits with Medicare A & B primary in-network1,2 | You pay |
|---|---|
|
$0 |
|
$5 |
|
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 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.
Standard and Medicare prescription benefits
| Prescription benefits in-network1,2 | You pay |
|---|---|
| 30-day retail generic | $10 |
| 30-day retail preferred brand-name | 40% ($250 max3) |
| 30-day retail non-preferred brand-name | 60% ($350 max3) |
| 90-day mail service generic | $20 |
| 90-day mail service preferred brand-name | 40% ($550 max3) |
| 90-day mail service non-preferred brand-name | 60% ($650 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.
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
Choose the right care
For helpful instructions on how to find in-network primary, specialty and urgent care using GEHA’s Find Care tool, watch this video.
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 card
Redeeming your rewards
Resources
Plan documents
| Topic |
Resource |
|---|---|
| 2024 Standard Plan Brochure | Download (PDF) |
| 2024 Standard 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 Standard 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.