Frequently Asked Questions

For new members, your ID card should arrive 10 to 14 days after GEHA receives your enrollment form.

For existing members who have requested replacement ID cards, please allow 10 to 14 days from the date of your request.

If you are already enrolled in a Self and Family medical plan, you can contact us directly to add your newborn by calling 800.821.6136.

If you are not yet enrolled in a Self and Family option, please contact your personnel office to make the change.

Click to order a free maternity resource kit.
A calendar-year deductible is a fixed-dollar amount that you pay for medical care before GEHA pays benefits. Copayments and coinsurance amounts do not count toward any deductible. You pay the deductible for medical care such as surgery, hospitalization and emergency room visits.

For in-network physician visits and prescriptions, you do not have to meet the deductible before GEHA pays benefits.

See the plan brochure (RI 71-006 for High and Standard Options, RI 71-014 for High Deductible Health Plan) for more services payable without deductible.
We provide benefits for a comprehensive range of preventive care and professional services for adults and children, including the preventive services recommended under the Patient Protection and Affordable Care Act.

Preventive care services are generally covered with no cost-sharing and are not subject to coinsurance, deductibles or annual limits when received from a network provider.

Here are some resources that can help you learn more about preventive care:

Access to 24/7 telemedicine/telebehavior is available for all GEHA medical plans through MDLIVE. Visit our telemedicine/telebehavior webpage or call 888.912.1183 to access on demand, affordable, high-quality care for adults and children experiencing non-emergency medical issues. This includes treatment of minor acute conditions and counseling for behavioral health and substance use disorder.

Note: This benefit is available only through the MDLIVE contracted telehealth provider network.

Submit claims to the network address on the back your GEHA ID card, for both in- and out-of-network claims. Submit Medicare primary claims or out-of-network charges that you have paid in full to:

GEHA
P.O. Box 21542
Eagan, MN 55121

Note: All claims submitted to GEHA should include itemized bills that show the following information:
  • Patient’s name, date of birth, address, phone number and relationship to member
  • Patient’s plan identification number
  • Name and address of person or company providing the service or supply
  • Dates that services or supplies were furnished
  • Diagnosis
  • Type of each service or supply
  • The charge for each service or supply
  • Provider signature
Note: Canceled checks, cash register receipts or balance due statements are not acceptable substitutes for itemized bills.

For more information, visit Claims for GEHA medical members.
Click LOG IN in the top right-hand corner of our website. From there, you will need to either log in or create an account. Once you are logged in, find the “Claims Inquiry” section on your member dashboard and initiate a search. You can view GEHA claims processed in the last 18 months.

When Medicare is primary, every effort must be made for Medicare to receive all required information to make an accurate benefit determination. GEHA must have the Medicare reason for denial to make our benefit determination.

Medicare does not cover all services. When GEHA has a benefit for those services, GEHA will process your claim per the guidelines in our plan brochure (RI 71-006 for High and Standard Options, RI 71-014 for High Deductible Health Plan).
Verify with your provider that they are in the network indicated on your insurance card. Next, review your Explanation of Benefits with the provider, including the notes documentation for the disallow amount and patient responsibility amount.

If your provider does not cooperate, please contact Customer Care at 800.821.6136 or write to us at:

GEHA
P.O. Box 21542
Eagan, MN 55121

For new members, your ID card should arrive 10 to 14 days after GEHA receives your enrollment form.

For existing members who have requested replacement ID cards, please allow 10 to 14 days from the date of your request.

Changes can be made outside of Open Season when you have a qualifying life event. Examples of qualifying life events include, but are not limited to, marriage, divorce, birth of child, etc.

Enrollment changes will need to be processed through your personnel office. Generally, you must make the change within 60 days of the event.

No. All GEHA ID cards are issued in the primary subscriber’s name. However, these cards are good for all covered family members.

If you have a Self Only enrollment, you may change to a Self and Family enrollment or a Self Plus One enrollment 31 days before to 60 days after you give birth. Contact your employing or retirement office to have your baby added to your medical plan.

Self and Family or Self Plus One enrollments begin on the first day of the pay period in which the child is born or becomes an eligible family member. If you give birth at an in-network facility, benefits are payable at 100% of the plan allowable for labor and delivery.

If you have a Self and Family or Self Plus One enrollment, then  you may add your child by providing a copy of your child’s birth certificate, their name and Social Security number (when available) to our Enrollment Department at enroll@geha.com.

All family member changes should also be made with your employing or retirement agency to ensure correct information is on file in your personnel folder.

If you are already enrolled in a Self and Family medical plan, you can contact us directly to add your newborn by calling 800.821.6136.

If you are not yet enrolled in a Self and Family option, please contact your personnel office to make the change.

Click to order a free maternity resource kit.
If you are an active federal employee, you'll need to change your name with your employing agency. After you do that, your employing agency will submit the name change to GEHA’s Enrollment Department.

If you are a retired federal employee or a survivor annuitant, you can send your name-change request to GEHA’s Enrollment Department at enroll@geha.com.

A legal name change for your spouse or your dependent child must be submitted to GEHA’s Enrollment Department at enroll@geha.com, and you need to attach the legal documents supporting the name change.

All changes should also be made with your employing or retirement agency to ensure that correct information is on file in your personnel folder.
We provide benefits for a comprehensive range of preventive care and professional services for adults and children, including the preventive services recommended under the Patient Protection and Affordable Care Act.

Preventive care services are generally covered with no cost-sharing and are not subject to coinsurance, deductibles or annual limits when received from a network provider.

Here are some resources that can help you learn more about preventive care:
When Medicare is primary, every effort must be made for Medicare to receive all required information to make an accurate benefit determination. GEHA must have the Medicare reason for denial to make our benefit determination.

Medicare does not cover all services. When GEHA has a benefit for those services, GEHA will process your claim per the guidelines in our plan brochure (RI 71-006 for High and Standard Options, RI 71-014 for High Deductible Health Plan).
Whether you enroll in Medicare is ultimately your choice. Most members do find it helpful to have both Medicare and GEHA because when Medicare is primary, both GEHA High Option and Standard Option waive the deductible and coinsurance and pick up Medicare's deductible and coinsurance for covered medical services.

If you do not enroll in Medicare, covered services would be payable through GEHA under regular plan benefits, including the deductible and coinsurance. Under FEHB regulations, if you are over 65 and retired, we must limit our payments for inpatient hospital care and physician care to those payments you would be entitled to if you had Medicare. Your physician and hospital must follow Medicare rules and cannot bill you for more than they could bill you if you had Medicare. You and the FEHB benefit from these payment limits.

If you are age 65 or older and retired, even if you do not enroll in Medicare, it is generally to your financial advantage to use a physician who participates with Medicare. Such physicians are permitted to collect only up to the Medicare-approved amount.

Please be aware that if you do not take Part B when you are first eligible and decide to enroll at a later date, Medicare may impose a penalty for late enrollment. Please contact Medicare directly for additional information on penalties.

For more information, visit Medicare + GEHA.
If your GEHA enrollment is through active employment, GEHA is primary. If your GEHA enrollment is through retirement, Medicare is primary.
GEHA contracts with three networks nationwide: Aetna Signature Administrators, UnitedHealthcare Options PPO and UnitedHealthcare Choice Plus. Your provider may be more familiar with the name of their local network than with GEHA.

The easiest way to verify your provider’s network status is to show your provider the network logo on your GEHA ID card. We find that most offices can readily tell patients if the doctor participates in the GEHA network. You can also check our chart of GEHA networks by state to identify the provider network in your area.
Visit our Find Care tool to find a doctor, hospital, dentist or pharmacy in the GEHA network. You can print a customized directory from provider search results.

Please remember that if you have Medicare A&B primary, you can choose any provider for your care. Medicare and GEHA together will pay 100% of your costs for covered services during doctor visits, surgical care, lab services and hospitalization, in- or out-of-network.

Important note: GEHA contracts with three networks nationwide: Aetna Signature Administrators, UnitedHealthcare Options PPO and UnitedHealthcare Choice Plus. If you call your provider to confirm that he or she is in the GEHA network, please have your GEHA ID card handy. You’ll want to ask the provider if he or she participates in the network indicated on your card. Network logos are placed on the front of the card. The back of the ID card tells the provider where to submit claims.

Chiropractors will be added to our Find Care tool in January 2019. (They were previously excluded from GEHA’s provider search due to the limited benefit for their services.)

For complete information on chiropractic benefits, refer to GEHA’s plan brochures (RI 71-006 for High and Standard Options, RI 71-014 for High Deductible Health Plan).

If your provider is not currently participating in GEHA's provider network, you may nominate him or her to join by completing a medical provider nomination form. You may also nominate a provider by calling Customer Care at 800.821.6136.

Access to 24/7 telemedicine/telebehavior is available for all GEHA medical plans through MDLIVE. Visit our telemedicine/telebehavior webpage or call 888.912.1183 to access on demand, affordable, high-quality care for adults and children experiencing non-emergency medical issues. This includes treatment of minor acute conditions and counseling for behavioral health and substance use disorder.

Note: This benefit is available only through the MDLIVE contracted telehealth provider network.

Not all providers are considered participating in-network providers at all locations where they practice. It is the member's responsibility to verify that the provider is a participating network provider at the location where services are being rendered.

In addition, not all services performed at a participating provider's office are covered services.

It is the member's responsibility to verify coverage of services.
Submit claims to the network address on the back your GEHA ID card, for both in- and out-of-network claims. Submit Medicare primary claims or out-of-network charges that you have paid in full to:

GEHA
P.O. Box 21542
Eagan, MN 55121

Note: All claims submitted to GEHA should include itemized bills that show the following information:
  • Patient’s name, date of birth, address, phone number and relationship to member
  • Patient’s plan identification number
  • Name and address of person or company providing the service or supply
  • Dates that services or supplies were furnished
  • Diagnosis
  • Type of each service or supply
  • The charge for each service or supply
  • Provider signature
Note: Canceled checks, cash register receipts or balance due statements are not acceptable substitutes for itemized bills.

For more information, visit Claims for GEHA medical members.

For new members, your ID card should arrive 10 to 14 days after GEHA receives your enrollment form.

For existing members who have requested replacement ID cards, please allow 10 to 14 days from the date of your request.

GEHA contracts with three networks nationwide: Aetna Signature Administrators, UnitedHealthcare Options PPO and UnitedHealthcare Choice Plus. Your provider may be more familiar with the name of their local network than with GEHA.

The easiest way to verify your provider’s network status is to show your provider the network logo on your GEHA ID card. We find that most offices can readily tell patients if the doctor participates in the GEHA network. You can also check our chart of GEHA networks by state to identify the provider network in your area.
Changes can be made outside of Open Season when you have a qualifying life event. Examples of qualifying life events include, but are not limited to, marriage, divorce, birth of child, etc.

Enrollment changes will need to be processed through your personnel office. Generally, you must make the change within 60 days of the event.

No. All GEHA ID cards are issued in the primary subscriber’s name. However, these cards are good for all covered family members.

Visit our Find Care tool to find a doctor, hospital, dentist or pharmacy in the GEHA network. You can print a customized directory from provider search results.

Please remember that if you have Medicare A&B primary, you can choose any provider for your care. Medicare and GEHA together will pay 100% of your costs for covered services during doctor visits, surgical care, lab services and hospitalization, in- or out-of-network.

Important note: GEHA contracts with three networks nationwide: Aetna Signature Administrators, UnitedHealthcare Options PPO and UnitedHealthcare Choice Plus. If you call your provider to confirm that he or she is in the GEHA network, please have your GEHA ID card handy. You’ll want to ask the provider if he or she participates in the network indicated on your card. Network logos are placed on the front of the card. The back of the ID card tells the provider where to submit claims.

If you have a Self Only enrollment, you may change to a Self and Family enrollment or a Self Plus One enrollment 31 days before to 60 days after you give birth. Contact your employing or retirement office to have your baby added to your medical plan.

Self and Family or Self Plus One enrollments begin on the first day of the pay period in which the child is born or becomes an eligible family member. If you give birth at an in-network facility, benefits are payable at 100% of the plan allowable for labor and delivery.

If you have a Self and Family or Self Plus One enrollment, then  you may add your child by providing a copy of your child’s birth certificate, their name and Social Security number (when available) to our Enrollment Department at enroll@geha.com.

All family member changes should also be made with your employing or retirement agency to ensure correct information is on file in your personnel folder.

If you are already enrolled in a Self and Family medical plan, you can contact us directly to add your newborn by calling 800.821.6136.

If you are not yet enrolled in a Self and Family option, please contact your personnel office to make the change.

Click to order a free maternity resource kit.
A calendar-year deductible is a fixed-dollar amount that you pay for medical care before GEHA pays benefits. Copayments and coinsurance amounts do not count toward any deductible. You pay the deductible for medical care such as surgery, hospitalization and emergency room visits.

For in-network physician visits and prescriptions, you do not have to meet the deductible before GEHA pays benefits.

See the plan brochure (RI 71-006 for High and Standard Options, RI 71-014 for High Deductible Health Plan) for more services payable without deductible.
When Medicare is primary, every effort must be made for Medicare to receive all required information to make an accurate benefit determination. GEHA must have the Medicare reason for denial to make our benefit determination.

Medicare does not cover all services. When GEHA has a benefit for those services, GEHA will process your claim per the guidelines in our plan brochure (RI 71-006 for High and Standard Options, RI 71-014 for High Deductible Health Plan).
Whether you enroll in Medicare is ultimately your choice. Most members do find it helpful to have both Medicare and GEHA because when Medicare is primary, both GEHA High Option and Standard Option waive the deductible and coinsurance and pick up Medicare's deductible and coinsurance for covered medical services.

If you do not enroll in Medicare, covered services would be payable through GEHA under regular plan benefits, including the deductible and coinsurance. Under FEHB regulations, if you are over 65 and retired, we must limit our payments for inpatient hospital care and physician care to those payments you would be entitled to if you had Medicare. Your physician and hospital must follow Medicare rules and cannot bill you for more than they could bill you if you had Medicare. You and the FEHB benefit from these payment limits.

If you are age 65 or older and retired, even if you do not enroll in Medicare, it is generally to your financial advantage to use a physician who participates with Medicare. Such physicians are permitted to collect only up to the Medicare-approved amount.

Please be aware that if you do not take Part B when you are first eligible and decide to enroll at a later date, Medicare may impose a penalty for late enrollment. Please contact Medicare directly for additional information on penalties.

For more information, visit Medicare + GEHA.
If your GEHA enrollment is through active employment, GEHA is primary. If your GEHA enrollment is through retirement, Medicare is primary.
If your provider is not currently participating in GEHA's provider network, you may nominate him or her to join by completing a medical provider nomination form. You may also nominate a provider by calling Customer Care at 800.821.6136.
If you are an active federal employee, you'll need to change your name with your employing agency. After you do that, your employing agency will submit the name change to GEHA’s Enrollment Department.

If you are a retired federal employee or a survivor annuitant, you can send your name-change request to GEHA’s Enrollment Department at enroll@geha.com.

A legal name change for your spouse or your dependent child must be submitted to GEHA’s Enrollment Department at enroll@geha.com, and you need to attach the legal documents supporting the name change.

All changes should also be made with your employing or retirement agency to ensure that correct information is on file in your personnel folder.
Verify with your provider that they are in the network indicated on your insurance card. Next, review your Explanation of Benefits with the provider, including the notes documentation for the disallow amount and patient responsibility amount.

If your provider does not cooperate, please contact Customer Care at 800.821.6136 or write to us at:

GEHA
P.O. Box 21542
Eagan, MN 55121
We provide benefits for a comprehensive range of preventive care and professional services for adults and children, including the preventive services recommended under the Patient Protection and Affordable Care Act.

Preventive care services are generally covered with no cost-sharing and are not subject to coinsurance, deductibles or annual limits when received from a network provider.

Here are some resources that can help you learn more about preventive care:

Access to 24/7 telemedicine/telebehavior is available for all GEHA medical plans through MDLIVE. Visit our telemedicine/telebehavior webpage or call 888.912.1183 to access on demand, affordable, high-quality care for adults and children experiencing non-emergency medical issues. This includes treatment of minor acute conditions and counseling for behavioral health and substance use disorder.

Note: This benefit is available only through the MDLIVE contracted telehealth provider network.

Not all providers are considered participating in-network providers at all locations where they practice. It is the member's responsibility to verify that the provider is a participating network provider at the location where services are being rendered.

In addition, not all services performed at a participating provider's office are covered services.

It is the member's responsibility to verify coverage of services.