GEHA’s High Option is a smart pick if you take brand-name prescription drugs because it includes comprehensive prescription coverage with potentially the lowest out-of-pocket costs.
All in-network preventive care is covered at 100%.
In-network doctor visit copays are an affordable $20.
You can get 30-day supplies of generic drugs for just $10.
Once your deductible is met, GEHA pays a bigger share of the cost for hospital stays and outpatient care.
These rates do not apply to all enrollees. If you are in a special enrollment category, please refer to the FEHB Program website or contact the agency or Tribal Employer that maintains your health benefits enrollment.
The table below summarizes your in-network cost for medical benefits with GEHA High Option. For complete information see the GEHA Plan Brochure.
Category 1: Postal Category 1 rates apply to career bargaining unit employees who are represented by the following agreements: APWU, IT/AS, NALC, NPMHU, and NRLCA.
Category 2: Postal Category 2 rates apply to career bargaining unit employees who are represented by the following agreement: PPOA.
|Cost of Services In-Network|
|Primary physician and Specialist||$20|
|MinuteClinic (where available)||$10|
|Annual eye exam||$5 through EyeMed|
|Covered lab services||$0, through Lab Card|
|Well child visits; up to age 22||$0|
|Routine adult screenings||$0, 100% coverage|
|Dental diagnostic/preventive||Balance, after GEHA pays $22 per visit, 2 times/year|
|From a physician or when you go to the hospital||$0, 100% coverage|
|Inpatient (you must pre-certify)||$100 per admission copay, 10% of other charges|
|Outpatient, emergency room and other charges||10% of allowance (calendar-year deductible applies)|
The table below summarizes your cost for prescription drugs with GEHA High Option. For complete benefit information, including details on specialty drugs that are injected or infused, refer to the GEHA Plan Brochure.
To find a drug cost based on your benefit plan and prescription dosage, check your drug costs.
Enrolled in Medicare? Visit Medicare + GEHA to see how GEHA works with Medicare.
|Retail pharmacy — 30-day supply|
|Generic||$10‡||$10 copay‡# plus difference between plan and drug cost|
|Preferred brand-name medication||25%, up to $150 max‡¤||25%, up to $150 max‡¤#|
|Non-preferred brand-name medication||40%, up to $200 max‡¤||40%, up to $200 max‡¤#|
|Mail-order pharmacy — 90-day supply|
|Preferred brand-name medication||25%, up to $350 max¤||n/a|
|Non-preferred brand-name medication||40%, up to $500 max¤||n/a|
‡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.
¤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.
#Your claim will be calculated on the coinsurance or the appropriate copayments. Reimbursement will be based on GEHA’s costs had you used a participating pharmacy. You must submit original drug receipts.
^GEHA supplemental benefits are neither offered nor guaranteed under contract with the FEHB, but are made available to all enrollees and family members who become members of a GEHA medical plan. For information on year-round savings for GEHA dental members, visit Savings for GEHA dental members.
This is a brief description of the features of the GEHA High Option medical plan. Before making a final decision, 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.