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High medical 2023

Lower overall medical and prescription costs

View the 2022 High Plan

Highlights:

  • Comprehensive brand-name and specialty prescription coverage
  • NEW! $1,000 Medicare Part B premium reimbursement 
  • Low copays for doctor visits
  • $2,500 hearing aid benefit

How this plan pays you back:

  • Adults ages 18 and over can earn up to $250 (maximum $500 per household) per year in Health Rewards


2023 High rates


Self Only Self Plus One Self and Family
Biweekly — employed $105.74 $243.49 $304.39
Monthly — retired $229.10 $527.56 $659.52

Costs (in-network)

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, check the GEHA Plan Brochure.

What you pay
Unlimited telehealth visits, including mental health, with MDLIVE $0
Preventive care; adult routine screenings $0
Well-child visit; up to age 22 $0
Maternity; routine care $0
Maternity; inpatient care $0
Outpatient accidental injury, including ER (within 72 hours) $0
Outpatient lab services $0
Vision coverage; eye exams1 $5
MinuteClinic (where available) $10
Primary physician office visit $20
Mental health office visit $20
Specialist care office visit $20
Chiropractic care (manipulative therapy), including X-rays; up to 20 visits per year $20
Urgent care facility $35
ER visit; medical emergency 10%2
Hospital care; outpatient 10%2
Professional surgical services 10%2
X-ray and other diagnostic services 10%2
Acupuncture; up to 20 treatments per year 10%2
Hospital care; inpatient $100 per admission plus 10%
Preventive dental care, twice yearly Balance after GEHA pays $22 per visit

Deductible and out-of-pocket max (in-network)


Self Only Self Plus One Self and Family
Yearly deductible (what you pay in-network) $350 $700 $700
Out-of-pocket max (what you pay in-network) $5,000 $10,000 $10,000

Prescription benefits

The table below summarizes your cost for prescription drugs with GEHA’s High medical plan. Members with Medicare A & B primary have even lower out-of-pocket costs for preferred and non-preferred brand-name prescriptions.

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.

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.


What you pay in-network
30-day retail generic $10
30-day retail preferred brand-name 25% ($150 max)‡¤
30-day retail non-preferred brand-name 40% ($200 max)‡¤
90-day mail service generic $20
90-day mail service preferred brand-name 25% ($350 max)¤
90-day mail service non-preferred brand-name 40% ($500 max)¤
30-day specialty CVS exclusive generic and preferred brand-name 25% ($150 max)¤
30-day specialty CVS exclusive non-preferred brand-name 40% ($200 max)¤

Highlights that are special to High



cover image for the 2023 geha medical benefits guide

2023 Medical Benefits Guide


Review this guide with all our plans, including rates, costs, extra services, and side-by-side comparisons


Ready to enroll?

 
You've thought about it, and are ready to commit. What's next?
Let's explain the process.

How to enroll

Our Benefits Advisers are available Mon. – Fri. from 7 a.m. – 7 p.m. Central time and are ready to answer your questions.
Are you a current GEHA member?
Medical questions: 800.821.6136
Dental questions: 877.434.2336