Traditional coverage & affordable premiums.
Standard Option 2021
Traditional coverage. Affordable premiums.
A dependable plan that is there when you need it.
Why you might like Standard Option:
- $15 copay for in-network primary care visits, $30 copay for in-network specialist visits.
- Pay $0 for routine, in-network maternity care.
- Pay $0 for unlimited telehealth visits, including pediatricians, licensed behavioral health therapists and dermatologists, through MDLIVE.
- Plan works well with Medicare.
2021 rates
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.Costs for services in 2021
The table below summarizes your in-network cost for medical benefits with GEHA Standard Option. 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 the GEHA Plan Brochure.| What you pay in-network | |
|---|---|
| Unlimited telehealth visits with MDLIVE | $0 |
| Preventive care; adult routine screenings | $0 |
| Well-child visit; up to age 22 | $0 |
| Maternity; routine preventive care | $0 |
| MinuteClinic (where available) | $10 |
| Primary physician office visit | $15 |
| Specialist care; office visit | $30 |
| Urgent care | $35 |
| Emergency care | 15%1 |
| Hospital care; inpatient and outpatient | 15%1 |
| Hospital care; inpatient maternity | $0 |
| Professional surgical services | 15%1 |
| Lab Card services | $0 |
| Lab services (non-Lab Card) | 15% |
| Other diagnostic services | 15%1 |
| Chiropractic care (spinal manipulation therapy) | Balance after GEHA pays $20 per visit, up to 20 visits per year |
| Chiropractic X-rays | Balance after GEHA pays $25 per year |
| Preventive dental care, twice yearly | 50% |
| Acupuncture; up to 20 treatments per year | 15%1 |
1Calendar year deductible applies.
Prescriptions
The table below summarizes your cost for prescription drugs with GEHA’s Standard Option. For complete benefit information, including details on specialty drugs that are injected or infused, refer to the GEHA Plan Brochure.
For added convenience and management of medications, your GEHA prescription benefits include access to presorted multi-dose packets. Presorted packets can be delivered to your home or, if available, picked up at a retail location.
To find a drug cost based on your benefit plan and prescription dosage, check your drug costs.
Retail pharmacy – 30-day supply
| What you pay in-network | What you pay out-of-network | |
|---|---|---|
| Generic | $10 | $10, plus difference between plan allowance and cost of drug |
| Preferred brand-name | 50%, up to $200 max¤ | 50%, up to $200 max, plus difference between plan allowance and cost of drug**¤ |
| Non-preferred brand-name | 50%, up to $300 max¤ | 50%, up to $300 max, plus difference between plan allowance and cost of drug**¤ |
Mail service pharmacy – 90-day supply
| What you pay in-network | What you pay out-of-network | |
|---|---|---|
| Generic | $20 | No benefit |
| Preferred brand-name | 50%, up to $500 max¤ | No benefit |
| Non-preferred brand-name | 50%, up to $600 max¤ | No benefit |
¤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.
**Retail fills eligible for a greater than a 30-day supply will be subject to the 50% coinsurance up to the maximum of $500 for preferred or $600 for non-preferred.
Key plan features
HEALTH REWARDS
PREGNANCY AND CHILDBIRTH
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.