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.
A calendar-year deductible is the amount you must pay out-of-pocket each year before the plan begins to pay benefits. Not all services are subject to the deductible.
See the plan brochure (RI 71-006 for High and Standard, RI 71-014 for High Deductible Health Plan and RI 73-903 for Elevate and Elevate Plus) 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:
To qualify for the transplant travel and lodging benefit, you must meet all of the following criteria:
- GEHA is your primary insurance carrier.
- You will be having a transplant that is considered specialized. There include: stem cell, bone marrow transplants for qualifying diagnoses and solid organ transplants including: autologous pancreas inlet cell transplant (as an adjunct to total or near total pancreatectomy) only for patients with chronic pancreatitis; heart; heart/lung; intestinal transplants (isolated small intestine; small intestine with the liver; small intestine with multiple organs, such as the liver, stomach and pancreas); kidney/pancreas (when both organs are transplanted during the same procedure); liver; lung; pancreas. (Please note: kidney-only transplants and cornea transplants are not considered specialized and do not qualify for the travel and lodging benefit.)
- The facility where you will be getting the transplant is a plan-designated facility for the transplant you are having that is over 100 miles from your home address.
For more frequently asked questions on transplant travel and lodging, view this PDF.
Access to 24/7 virtual access to certified doctors, including dermatologists and licensed therapists for all GEHA medical plans through MDLIVE.Visit our online doctor visits webpagor 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 (71-006 for High and Standard Options, 71-014 for High Deductible Health Plan and 73-903 for Elevate and Elevate Plus).
When there is a need for records from any GEHA department, all requests must go through our Records Management Office.
Member information at GEHA is confidential and protected by state law, federal laws and HIPAA regulations. Records will only be released with proper authorization from the member.
Types of requests
- Member access request – Members requesting their records must submit a Request for Access to Protected Health Information form.
- Third party authorizations – The Authorization to Disclose Health Information to a Third Party form is for members and dependents covered by GEHA health, dental, and vision plans. All non-GEHA Third Party Authorization forms must comply with HIPAA requirements.
- State subpoenas – Out-of-state subpoenas must meet the applicable state law requirements. Out-of-state subpoenas may also be submitted with a valid Authorization to Disclose Health Information to a Third Party form.
- Federal subpoenas – Subpoenas at the federal level must be signed by a judge. If not signed by a judge, it must meet satisfactory assurances.
Submitting requests
GEHA accepts record requests by mail, email, fax or in person. Please submit your requests to GEHA's Records Management Office:
GEHA, Inc.
Records Management Office, 1st Floor
201 NE Mulberry St.
Lee’s Summit, MO 64086
Email: rmo@geha.com
Fax: 816.257.3207
Pricing
GEHA retains discretion to require payment for the release of records.
Responses
Please allow 30 calendar days for a response from GEHA. When feasible, GEHA will submit requested records by way of a secure file transfer protocol (SFTP). Please provide an email address so that we can expedite your request via SFTP.
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
One plan becomes your “primary” plan and will process your claims first. The “secondary” plan may pay toward the remaining charges. This process is called coordination of benefits.
I’m a GEHA dental member. Why is GEHA asking for information about my health plan?
The Federal Employees Dental and Vision Insurance Program (FEDVIP) requires the FEHB plan to be primary over the FEDVIP plan. This is known as “coordination of benefits.” Many FEHB plans have limited preventive dental benefits. When GEHA is secondary, our payment will be the lesser of 1) our regular benefit or 2) the remaining balance which when added to the primary carrier's payment will not exceed the dentist billed amount or the negotiated rate. In addition to benefits payable by your FEHB medical plan, you should let GEHA know if you or your covered dependents have other dental coverage.
How is it determined which plan is “primary” or “secondary”?
We apply guidelines from the National Association of Insurance Commissioners (NAIC).
The most common rules for determining the order of payment are the Non-Dependent/Dependent Rule, the Active/Inactive Rule and the Birthday Rule.
- Non-dependent/Dependent Rule: The plan that covers an individual as an enrollee or subscriber is the primary payer over a plan that covers an individual as a dependent, for example, as a spouse.
- Active/Inactive Rule: The plan that covers an individual as an active employee or as the dependent of an active employee is the primary payer over the plan that covers the individual as a retired or laid off employee or as the dependent of such an employee.
- Birthday Rule: This rule determines whether a plan is primary or secondary for a dependent child who is covered by both parents' benefit plans and those parents live together. The plan covering the parent whose birthday (month and day only) falls first in a calendar year provides primary coverage for the child. If both parents have the same birthday, then the plan that has been in effect the longest pays as primary.
A different set of rules applies to a dependent child whose parents are divorced or separated or are not living together, whether or not they have ever been married:
- If a court decree states that one of the parents is responsible for the child's health care expenses/coverage ("health care coverage responsibility") and the plan covering that parent has actual knowledge of those terms, that plan is primary. If the responsible parent has no coverage for the child’s health care expenses, but that parent's spouse does, that parent's spouse's plan is the primary plan.
- If a court decree states that both parents are responsible for the child’s health care expenses/coverage, the Birthday Rule determines the order of benefits;
- If a court decree states that the parents have joint custody without specifying that one parent has health care coverage responsibility, the Birthday Rule determines the order of benefits; or
- If there is no court decree allocating health care coverage responsibility for the child, the order of benefits for the child is as follows:
- The plan covering the custodial parent;
- The plan covering the custodial parent's spouse;
- The plan covering the non-custodial parent; and then
- The plan covering the non-custodial parent's spouse.
For additional information on NAIC rules regarding the coordinating of benefits, visit the NAIC website.
How does the coordination of benefits happen?
If it is determined that GEHA is the secondary plan, copies of the primary carrier’s Explanation of Benefits (EOB) forms will need to be submitted by you or your provider. Once we have a copy of the EOB, GEHA can determine our payment on the remaining balance.
If the primary plan is a FEHB plan, GEHA will estimate benefits payable if the FEHB EOB is not received. The estimation of benefits is based on the dental benefits listed in the FEHB brochure.
How does GEHA know who my FEHB carrier is?
GEHA receives information every Open Season, through BENEFEDS, indicating the 3-digit FEHB Health Plan enrollment code. GEHA may request that you verify your health insurance plan annually or at the time of service. You may call or mail other coverage information or report it online at gehadental.com/cob.
Can’t the plans just work it out? Why do I have to get involved?
Most commercial plans only share protected health information with their members or providers.
Update your information to process claims faster
Coordinating your benefits helps us process your claims faster and maximizes your benefits, which can lower your out-of-pocket expenses. It is important that we keep your information up-to-date. We’ll send you a letter from time to time asking if you have any additional coverage. Please respond to that letter. If we don’t receive your response, we may delay processing your claims until the information is received.
We appreciate you taking an active role in making certain your information is correct.
GEHA Connection Dental Federal
P.O. Box 21542
Eagan MN 55121-9930
If you are not a GEHA FEHB medical plan member, you must first submit your dental claim to your FEHB medical plan, and then submit your dental claim to GEHA, along with the FEHB medical plan's explanation of benefits (EOB).
If the EOB from your FEHB medical plan is not submitted with your claim, we may estimate the amount your plan would have paid.
If you use an out-of-network provider, you would be responsible for paying the difference between their charge and the GEHA allowable amount.
- GEHA will accept an itemized bill or receipt that includes all of the following information:
- Name of patient and relationship to member
- Member identification number
- Name, degree (MD, RN, PhD, etc.) and address of provider
- Date of services or treatments
- Description, in English, of each service or treatment
- Tooth number, tooth surface, quadrant, and/or arch on which treatment or service was performed
- Charge for each service or treatment
Note: In most cases we are able to convert charges into dollars and translate services into English. You may aid this process by submitting a separate English-language outline of the rendered services and/or treatments. Be sure to include your name and GEHA ID number on this outline and on the original itemized bill. We will do our best to work with what you send us.
- You may also print an ADA claim form.
You or your provider may send paper claims to:
GEHA Connection Dental Federal P.O. Box 21542 Eagan MN 55121-9930
You may also send them via e-mail to overseas.gehadental@geha.com or fax them to 816.257.3241. Please send a separate fax for each patient. Also, please designate on the claim whether you want payment to be distributed to you or your provider.
In Section 5 of the Plan Brochure we have added asterisks (*) to help you identify procedures that we determined have a lower-cost treatment option.
In a separate mailing, you’ll receive your vision ID card from EyeMed. This is not your dental ID card. Members in all GEHA plans get vision benefits through Connection Vision Powered by EyeMed.
By federal regulation, open seasons are held each fall, from the Monday of the second full week in November to the Monday of the second full week in December.
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 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.
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 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.
To access the GEHA member portal, you must create a new account. Please visit member-portal.geha.com/login and select "Create account."
Here are a few tips to follow when creating your web account:
- Make sure you can access your email account, as you will need it to create your account.
- If possible, use your computer's desktop browser for this process (e.g., Google Chrome, Microsoft Edge). Please avoid using your mobile device for first time registration.
- Use your member ID card to find the information needed to create your account.
- Information provided must match your enrollment record on file.
- First and last name as it appears on your member ID card
- Relationship to subscriber
- Member ID
- Date of birth
- Visit member-portal.geha.com/login and select "Create account."
Need help? Get step-by-step instructions in our Member Login Resource Document.
If you have questions or concerns, please reach out to Customer Care at 877.927.1112.
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 (71-006 for High and Standard Options, 71-014 for High Deductible Health Plan and 73-903 for Elevate and Elevate Plus).
If your GEHA enrollment is through active employment, GEHA is primary. If your GEHA enrollment is through retirement, Medicare is primary.
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.
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.
Access to 24/7 virtual access to certified doctors, including dermatologists and licensed therapists for all GEHA medical plans through MDLIVE.Visit our online doctor visits webpagor 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.
If you use an out-of-network provider, you would be responsible for paying the difference between their charge and the GEHA allowable amount.
According to studies conducted by the University of Maryland, hacker attacks on computers with Internet access occur every 39 seconds on average, effecting 1 in 3 Americans every year.* These attacks cause major computer systems to crash. They prevent government entities and businesses from providing essential services. And perhaps even worse, they expose sensitive personal data that results in identity theft, financial loss, damage to one's personal reputation and more.
As technology advances so do the methods cybercriminals use to carry out their attacks. This means companies like GEHA must continue to evolve their security measures to protect you against this growing threat.
One effective way companies can protect your data is by implementing multifactor authentication, which requires users to provide two or more pieces of evidence to verify their identity when trying to access a digital resource.
You'll also need to be prepared to use one the following for your GEHA multifactor authentication set-up: Your valid email address, mobile phone for receiving a text message or any phone to receive a voice call.
Click to create your GEHA account | Need help? Get step-by-step instructions in our Member Login Resource Document
For new account creation please have the following ready:
- First and last name as it appears on your member ID card
- Relationship to subscriber
- Member ID
- Date of birth
To access the GEHA member portal, you must create a new account. Please visit member-portal.geha.com/login and select "Create account."
Here are a few tips to follow when creating your web account:
- Make sure you can access your email account, as you will need it to create your account.
- If possible, use your computer's desktop browser for this process (e.g., Google Chrome, Microsoft Edge). Please avoid using your mobile device for first time registration.
- Use your member ID card to find the information needed to create your account.
- Information provided must match your enrollment record on file.
- First and last name as it appears on your member ID card
- Relationship to subscriber
- Member ID
- Date of birth
- Visit member-portal.geha.com/login and select "Create account."
Need help? Get step-by-step instructions in our Member Login Resource Document.
If you have questions or concerns, please reach out to Customer Care at 877.927.1112.
If you use an out-of-network provider, you would be responsible for paying the difference between their charge and the GEHA allowable amount.
- GEHA will accept an itemized bill or receipt that includes all of the following information:
- Name of patient and relationship to member
- Member identification number
- Name, degree (MD, RN, PhD, etc.) and address of provider
- Date of services or treatments
- Description, in English, of each service or treatment
- Tooth number, tooth surface, quadrant, and/or arch on which treatment or service was performed
- Charge for each service or treatment
Note: In most cases we are able to convert charges into dollars and translate services into English. You may aid this process by submitting a separate English-language outline of the rendered services and/or treatments. Be sure to include your name and GEHA ID number on this outline and on the original itemized bill. We will do our best to work with what you send us.
- You may also print an ADA claim form.
You or your provider may send paper claims to:
GEHA Connection Dental Federal P.O. Box 21542 Eagan MN 55121-9930
You may also send them via e-mail to overseas.gehadental@geha.com or fax them to 816.257.3241. Please send a separate fax for each patient. Also, please designate on the claim whether you want payment to be distributed to you or your provider.
In Section 5 of the Plan Brochure we have added asterisks (*) to help you identify procedures that we determined have a lower-cost treatment option.
According to studies conducted by the University of Maryland, hacker attacks on computers with Internet access occur every 39 seconds on average, effecting 1 in 3 Americans every year.* These attacks cause major computer systems to crash. They prevent government entities and businesses from providing essential services. And perhaps even worse, they expose sensitive personal data that results in identity theft, financial loss, damage to one's personal reputation and more.
As technology advances so do the methods cybercriminals use to carry out their attacks. This means companies like GEHA must continue to evolve their security measures to protect you against this growing threat.
One effective way companies can protect your data is by implementing multifactor authentication, which requires users to provide two or more pieces of evidence to verify their identity when trying to access a digital resource.
You'll also need to be prepared to use one the following for your GEHA multifactor authentication set-up: Your valid email address, mobile phone for receiving a text message or any phone to receive a voice call.
Click to create your GEHA account | Need help? Get step-by-step instructions in our Member Login Resource Document
For new account creation please have the following ready:
- First and last name as it appears on your member ID card
- Relationship to subscriber
- Member ID
- Date of birth
One plan becomes your “primary” plan and will process your claims first. The “secondary” plan may pay toward the remaining charges. This process is called coordination of benefits.
I’m a GEHA dental member. Why is GEHA asking for information about my health plan?
The Federal Employees Dental and Vision Insurance Program (FEDVIP) requires the FEHB plan to be primary over the FEDVIP plan. This is known as “coordination of benefits.” Many FEHB plans have limited preventive dental benefits. When GEHA is secondary, our payment will be the lesser of 1) our regular benefit or 2) the remaining balance which when added to the primary carrier's payment will not exceed the dentist billed amount or the negotiated rate. In addition to benefits payable by your FEHB medical plan, you should let GEHA know if you or your covered dependents have other dental coverage.
How is it determined which plan is “primary” or “secondary”?
We apply guidelines from the National Association of Insurance Commissioners (NAIC).
The most common rules for determining the order of payment are the Non-Dependent/Dependent Rule, the Active/Inactive Rule and the Birthday Rule.
- Non-dependent/Dependent Rule: The plan that covers an individual as an enrollee or subscriber is the primary payer over a plan that covers an individual as a dependent, for example, as a spouse.
- Active/Inactive Rule: The plan that covers an individual as an active employee or as the dependent of an active employee is the primary payer over the plan that covers the individual as a retired or laid off employee or as the dependent of such an employee.
- Birthday Rule: This rule determines whether a plan is primary or secondary for a dependent child who is covered by both parents' benefit plans and those parents live together. The plan covering the parent whose birthday (month and day only) falls first in a calendar year provides primary coverage for the child. If both parents have the same birthday, then the plan that has been in effect the longest pays as primary.
A different set of rules applies to a dependent child whose parents are divorced or separated or are not living together, whether or not they have ever been married:
- If a court decree states that one of the parents is responsible for the child's health care expenses/coverage ("health care coverage responsibility") and the plan covering that parent has actual knowledge of those terms, that plan is primary. If the responsible parent has no coverage for the child’s health care expenses, but that parent's spouse does, that parent's spouse's plan is the primary plan.
- If a court decree states that both parents are responsible for the child’s health care expenses/coverage, the Birthday Rule determines the order of benefits;
- If a court decree states that the parents have joint custody without specifying that one parent has health care coverage responsibility, the Birthday Rule determines the order of benefits; or
- If there is no court decree allocating health care coverage responsibility for the child, the order of benefits for the child is as follows:
- The plan covering the custodial parent;
- The plan covering the custodial parent's spouse;
- The plan covering the non-custodial parent; and then
- The plan covering the non-custodial parent's spouse.
For additional information on NAIC rules regarding the coordinating of benefits, visit the NAIC website.
How does the coordination of benefits happen?
If it is determined that GEHA is the secondary plan, copies of the primary carrier’s Explanation of Benefits (EOB) forms will need to be submitted by you or your provider. Once we have a copy of the EOB, GEHA can determine our payment on the remaining balance.
If the primary plan is a FEHB plan, GEHA will estimate benefits payable if the FEHB EOB is not received. The estimation of benefits is based on the dental benefits listed in the FEHB brochure.
How does GEHA know who my FEHB carrier is?
GEHA receives information every Open Season, through BENEFEDS, indicating the 3-digit FEHB Health Plan enrollment code. GEHA may request that you verify your health insurance plan annually or at the time of service. You may call or mail other coverage information or report it online at gehadental.com/cob.
Can’t the plans just work it out? Why do I have to get involved?
Most commercial plans only share protected health information with their members or providers.
Update your information to process claims faster
Coordinating your benefits helps us process your claims faster and maximizes your benefits, which can lower your out-of-pocket expenses. It is important that we keep your information up-to-date. We’ll send you a letter from time to time asking if you have any additional coverage. Please respond to that letter. If we don’t receive your response, we may delay processing your claims until the information is received.
We appreciate you taking an active role in making certain your information is correct.
In a separate mailing, you’ll receive your vision ID card from EyeMed. This is not your dental ID card. Members in all GEHA plans get vision benefits through Connection Vision Powered by EyeMed.
GEHA Connection Dental Federal
P.O. Box 21542
Eagan MN 55121-9930
If you are not a GEHA FEHB medical plan member, you must first submit your dental claim to your FEHB medical plan, and then submit your dental claim to GEHA, along with the FEHB medical plan's explanation of benefits (EOB).
If the EOB from your FEHB medical plan is not submitted with your claim, we may estimate the amount your plan would have paid.
By federal regulation, open seasons are held each fall, from the Monday of the second full week in November to the Monday of the second full week in December.
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.
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.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).
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.
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 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.
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.
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 (71-006 for High and Standard Options, 71-014 for High Deductible Health Plan and 73-903 for Elevate and Elevate Plus).
A calendar-year deductible is the amount you must pay out-of-pocket each year before the plan begins to pay benefits. Not all services are subject to the deductible.
See the plan brochure (RI 71-006 for High and Standard, RI 71-014 for High Deductible Health Plan and RI 73-903 for Elevate and Elevate Plus) for more services payable without deductible.
We cannot guarantee the availability of every specialty in all areas. If an in-network provider is unavailable, or you do not use an in-network provider, the standard out-of-network benefits apply.
For complete information, refer to GEHA’s plan brochures (RI 71-006 for High and Standard Options, RI 71-014 for High Deductible Health Plan).
If your GEHA enrollment is through active employment, GEHA is primary. If your GEHA enrollment is through retirement, Medicare is primary.
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 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.
To access the GEHA member portal, you must create a new account. Please visit member-portal.geha.com/login and select "Create account."
Here are a few tips to follow when creating your web account:
- Make sure you can access your email account, as you will need it to create your account.
- If possible, use your computer's desktop browser for this process (e.g., Google Chrome, Microsoft Edge). Please avoid using your mobile device for first time registration.
- Use your member ID card to find the information needed to create your account.
- Information provided must match your enrollment record on file.
- First and last name as it appears on your member ID card
- Relationship to subscriber
- Member ID
- Date of birth
- Visit member-portal.geha.com/login and select "Create account."
Need help? Get step-by-step instructions in our Member Login Resource Document.
If you have questions or concerns, please reach out to Customer Care at 877.927.1112.
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:
To qualify for the transplant travel and lodging benefit, you must meet all of the following criteria:
- GEHA is your primary insurance carrier.
- You will be having a transplant that is considered specialized. There include: stem cell, bone marrow transplants for qualifying diagnoses and solid organ transplants including: autologous pancreas inlet cell transplant (as an adjunct to total or near total pancreatectomy) only for patients with chronic pancreatitis; heart; heart/lung; intestinal transplants (isolated small intestine; small intestine with the liver; small intestine with multiple organs, such as the liver, stomach and pancreas); kidney/pancreas (when both organs are transplanted during the same procedure); liver; lung; pancreas. (Please note: kidney-only transplants and cornea transplants are not considered specialized and do not qualify for the travel and lodging benefit.)
- The facility where you will be getting the transplant is a plan-designated facility for the transplant you are having that is over 100 miles from your home address.
For more frequently asked questions on transplant travel and lodging, view this PDF.
When there is a need for records from any GEHA department, all requests must go through our Records Management Office.
Member information at GEHA is confidential and protected by state law, federal laws and HIPAA regulations. Records will only be released with proper authorization from the member.
Types of requests
- Member access request – Members requesting their records must submit a Request for Access to Protected Health Information form.
- Third party authorizations – The Authorization to Disclose Health Information to a Third Party form is for members and dependents covered by GEHA health, dental, and vision plans. All non-GEHA Third Party Authorization forms must comply with HIPAA requirements.
- State subpoenas – Out-of-state subpoenas must meet the applicable state law requirements. Out-of-state subpoenas may also be submitted with a valid Authorization to Disclose Health Information to a Third Party form.
- Federal subpoenas – Subpoenas at the federal level must be signed by a judge. If not signed by a judge, it must meet satisfactory assurances.
Submitting requests
GEHA accepts record requests by mail, email, fax or in person. Please submit your requests to GEHA's Records Management Office:
GEHA, Inc.
Records Management Office, 1st Floor
201 NE Mulberry St.
Lee’s Summit, MO 64086
Email: rmo@geha.com
Fax: 816.257.3207
Pricing
GEHA retains discretion to require payment for the release of records.
Responses
Please allow 30 calendar days for a response from GEHA. When feasible, GEHA will submit requested records by way of a secure file transfer protocol (SFTP). Please provide an email address so that we can expedite your request via SFTP.
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
Access to 24/7 virtual access to certified doctors, including dermatologists and licensed therapists for all GEHA medical plans through MDLIVE.Visit our online doctor visits webpagor 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.
If you use an out-of-network provider, you would be responsible for paying the difference between their charge and the GEHA allowable amount.