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Learn more with free e-books & videosLearn more about your options with Medicare and GEHA, download free e-books and view informative videos at:
geha.com/Medicare
With GEHA’s Standard Option or High Option plan, a sudden hospital stay, a prolonged illness or a major surgical procedure won’t overwhelm your budget.
X $600 Medicare Part B premium reimbursement: New in 2020 for the High Option only, this reimbursement will help with your Medicare Part B premium payments.
X Waived deductibles, copays and coinsurance: GEHA waives deductibles, copays and coinsurance whether your provider is in- or out-of-network.
X No cost to you: For covered inpatient and outpatient hospital services, surgeries and office visits, your cost is nothing.
X Care wherever you are: If you need medical care while you’re outside the United States, copays and deductibles are still waived.
X Comprehensive prescription coverage: GEHA’s Standard and High Option plans include quality prescription coverage. High Option members have reduced copays for covered prescriptions.
X Added coverage: GEHA members also get vision coverage and $2,500 toward hearing aids (every three years).7
GEHA works with Medicare A & B.
Medicare + GEHA
How to enrollIf you are a retired federal employee, you can sign up for a GEHA medical plan by completing OPM form 2809, available through the Office of Personnel Management. Learn more at geha.com/Enroll
OPM Open Season online system:retireefehb.opm.gov
OPM Open Season Express:800.332.9798
7 See endnotes on page 8.This is a brief description of the features of GEHA medical plans. 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.
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Medical benefits: What you pay
Medicare A & B with Standard Option
Medicare A & B with High Option
Preventive care; adult routine screenings Nothing Nothing
Preventive lab services Nothing Nothing
Primary care physician; office visit Nothing Nothing
Specialist care; office visit Nothing Nothing
Online doctor visits Nothing Nothing
Urgent care Nothing Nothing
MinuteClinic® (where available) Nothing Nothing
Emergency care Nothing Nothing
Hospital care; inpatient Nothing Nothing
Hospital care; outpatient Nothing Nothing
Preventive dental care 50% of allowance, twice yearly
Balance after GEHA pays $22 / visit, twice yearly
Compare plan pricing
When Medicare A & B is primary, GEHA’s Standard Option and High Option plans help cover expenses not covered by Medicare.
Learn more at geha.com/Medicare
Learn more at geha.com/Medicare | Questions? Call 800.262.4342
With Medicare A & B, GEHA’s Standard and High Option plans offer: X Deductibles, copays and coinsurance waived whether your provider is in- or out-of-network.
X Covered inpatient and outpatient hospital services, surgeries and office visits, at no cost to you.
X Coverage when you’re out of the country, where Medicare does not cover you.
2020 rates*
Retirees monthlySelf Only Self Plus One Self and Family
Standard Option $131.18ENROLL CODE 314
$282.05ENROLL CODE 316
$336.96ENROLL CODE 315
High Option $228.41ENROLL CODE 311
$534.11ENROLL CODE 313
$659.51ENROLL CODE 312
Compare plan benefits
Up to $600 in reimbursements per calendar year. This amount may be used on Medicare Part B premium payments, for High Option plan members enrolled in Medicare Parts A & B.
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*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.
This is a brief description of the features of Government Employees Health Association, Inc.’s medical plans. Before making a final decision, please read GEHA federal brochure RI 71-006 available at geha.com/PlanBrochure. All benefits are subject to the definitions, limitations and exclusions set forth in the federal brochure.
Retail: You’ve got optionsTo pay less, get your prescriptions filled in person at any in-network location. Your options include any retail CVS Pharmacy location, but you don’t have to go to a retail CVS Pharmacy to pay in-network prices.
Save more with mail orderWith CVS Caremark’s Mail Service Pharmacy, you can save money and have your routine prescriptions delivered to your home, postage-paid, within about 14 days from the time you submit your prescription.
Check drug costs in advanceDon’t be surprised at the pickup counter. Check drug costs to estimate what you’ll pay based on your GEHA medical plan and prescription dosage. Check your drug costs here:
info.caremark.com/GEHA
Compare prescription benefitsLearn more3 at geha.com/Prescriptions
Visit geha.com/Find-Care to find in-network locations including Rite Aid, Walmart, Walgreens, Costco, Kroger, Meijer, Safeway, Albertson’s, Publix, Giant and many more.
Mail service pharmacy2
What you pay in-network
Medicare A & B with Standard Option
Medicare A & B with High Option
90-day supply
Generic $20 $15
Preferred brand-name medication 50% ($500 max4) 15% ($350 max4)
Non-preferred brand-name medication 50% ($600 max4) 30% ($500 max4)
Specialty prescription2
What you pay in-network
Medicare A & B with Standard Option
Medicare A & B with High Option
30-day supply; CVS exclusive5
Generic and preferred brand-name medication 50% ($250 max4) 15% ($150 max4)
Non-preferred brand-name medication 50% ($400 max4) 30% ($200 max4)
Retail pharmacy2
What you pay in-network
Medicare A & B with Standard Option
Medicare A & B with High Option
30-day supply
Generic $10 $10 copay6
Preferred brand-name medication 50% ($200 max4) 20% ($150 max4,6)
Non-preferred brand-name medication 50% ($300 max4) 35% ($200 max4,6)
2,3,4,5,6 See endnotes on the back cover.
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Vision coverage & discounts
X $5 copay for Standard and High Option for routine eye exams at qualified EyeMed™ providers. X For out-of-network exams, EyeMed reimburses you up to $45 per covered member per year. X No limit on the number of glasses or contacts purchased each year with savings on LASIK and PRK. X Access to thousands of EyeMed providers, including LensCrafters, Pearle Vision, Target, JCPenney
Optical and independent eye doctors.
Contact lenses Your in-network cost
Conventional 85% of the retail price
Disposable No discount
Learn more at geha.com/Vision
Discounts for Standard Option and High Option Your in-network cost
Eye exam; with dilation as necessary $5
Eyeglass frames 60% of the retail price
Included benefits & savings
Eyeglass lenses Your in-network cost
Standard plastic, single vision Up to $50
Standard plastic bifocal Up to $70
Standard plastic trifocal Up to $105
Standard progressive lens Up to $135
Premium progressive lens 80% of the retail price
Eyeglass lens options Your in-network cost
UV treatment $15
Tint (solid and gradient) $15
Standard plastic scratch coating $15
Standard polycarbonate $40
Standard anti-reflective coating $45
Photochromatic / transitions plastic 80% of the retail price
Premium anti-reflective 80% of the retail price
Other add-ons 80% of the retail price
Additional pairs Your in-network cost
Eyeglasses (complete pair) Up to 60% of the retail price
Contacts (conventional lenses) Up to 85% of the retail price
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 complete information, see GEHA Plan Brochure RI 71-006 at geha.com/PlanBrochure5
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Health Advice Line As a GEHA medical plan member, you can talk with a nurse for free, 24/7.
geha.com/Healthline
Online doctor visits As a GEHA medical plan member, you can receive care via phone or video 24/7using online doctor visits from MDLIVE 24/7. Includes dermatologists.
geha.com/MDLIVE
Biometric screening7
Spot the early warning signs of serious conditions such as heart disease and diabetes with this easy test. You can have a free confidential screening at home, at work or at one of 2,300 Quest Diagnostics locations nationwide.
geha.com/Screenings
Gym discount With GEHA’s Connection Fitness® program, all GEHA medical plan members can access more than 10,000 Active&Fit Direct™ participating fitness centers nationwide for $25 a month (plus a $25 enrollment fee and applicable taxes). Search for gyms and track your progress online.
geha.com/Fitness
Medical alert system GEHA members and extended family are eligible for discounted services from Life Alert®, the industry leader in responsive emergency care. Members receive free activation, plus a 10% monthly discount.
geha.com/LifeAlert
Electric toothbrush1
GEHA members receive an exclusive discount of more than 70% off premium electric toothbrushes by cariPRO™.
geha.com/Toothbrush
Teeth whitening Receive a 20% discount on the lowest published price on all Smile Brilliant home teeth whitening products. This includes custom-fitted trays, whitening gel and desensitizing gel.
smilebrilliant.com/GEHA
Learn how to enroll at geha.com/Enroll | Questions? Call 800.262.4342
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 complete information, see GEHA Plan Brochure RI 71-006 at geha.com/PlanBrochure
Examples of common hearing aid product ranges
Products given as examples onlyAverage retail price
TruHearing price
Plan benefit You pay
Starkey Muse iQ i1000 $3,410 $1,950 $2,500 Nothing
TruHearing Advanced 19 $4,890 $2,500 $2,500 Nothing
Widex Beyond 220 $4,260 $2,500 $2,500 Nothing
Oticon Opn 3 $4,830 $2,790 $2,500 $290
ReSound LiNX 3D 5 $4,950 $3,190 $2,500 $690
Hearing aid savings X For Standard and High Option plans, enjoy a hearing aid benefit of $2,500 with no deductible. X Benefit is per person, every three years for adults — and annually for dependents up to age 22. X In addition, GEHA members and their extended family members can also take advantage of
TruHearing’s discounted pricing. Most people see savings of 30% to 60%, averaging more than $2,100 per pair.
Learn more at geha.com/Hearing
1,7 See endnotes on the back cover.
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S Helpful resources
Helpful tools Description Learn moreFind a provider Search our nationwide network for a doctor
or medical facility near you.geha.com/Find-Care
Online decision tool Take our quiz to see which GEHA medical plan might be the best fit for your lifestyle.
geha.com/Select-A-Plan
Urgent care Get the care you need, anytime, at any in-network urgent care facility near you.
geha.com/Find-Care
Pharmacy program Verify drug costs based on your benefit plan and prescription dosage.
info.caremark.com/GEHA
MinuteClinic® Get basic care in many retail CVS Pharmacies, no appointment needed.
cvs.com/MinuteClinic/Clinic-Locator
Plan resources Description Learn moreCustomer Care Contact GEHA with questions about
your plan benefits or coverage.800.262.4342
Medical plans Details on GEHA’s medical plans and supplemental benefits.
geha.com/Rates
Medicare plans Discover how GEHA plans offer extra coverage with your Medicare plan.
geha.com/Medicare
Overseas information Information about medical coverage when you’re outside of the United States.
geha.com/OutsideUSA
Enrollment help Tips for new enrollees or members who are changing plans.
geha.com/Enroll
The National Active and Retired Federal Employees Association
Dedicated to helping federal employees and retirees manage their benefits.
narfe.org
U.S. Office of Personnel Management
Official information for federal employees eligible for FEHB plans.
opm.gov/Healthcare-Insurance
If you have questions after reviewing this benefits guide, the online tools, phone numbers and websites below are great places to find helpful answers.
If you’re stuck or overwhelmed, call 800.262.4342 and talk to one of our helpful Customer Care advisers.
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geha.com/MedicareQuestions? Call 800.262.4342
/gehahealth /company/gehahealth
WHAT’S NEW X Up to $600 in reimbursements per calendar year. This amount may be used on Medicare
Part B premium payments, for High Option plan members enrolled in Medicare Parts A & B.
X Expanded online doctor visits now includes coverage for dermatology care in addition to previously available coverage for non-emergency medical and behavioral health consultations.
X Increased coinsurance maximums for Standard Option, from $200 to $250 for generic and preferred brand specialty drugs, and from $300 to $400 for non-preferred brand specialty drugs.
For details on all of the changes for 2020, see “Section 2: Changes for 2020” in plan brochure RI 71-006, which is available at geha.com/PlanBrochure
This is a brief description of the features of Government Employees Health Association, Inc.’s medical plans. Before making a final decision, please read GEHA federal brochure RI 71-006 available at geha.com/PlanBrochure. All benefits are subject to the definitions, limitations and exclusions set forth in the federal brochure.
For complete information, see GEHA Plan Brochure RI 71-006 at geha.com/PlanBrochure© 2019 Government Employees Health Association, Inc. All rights reserved. Please recycle.
1 The cariPRO™ premium electric toothbrush removes seven times more plaque than a regular brush, is completely waterproof, and comes with a two-year manufacturer’s warranty. Replacement brush heads with high-quality DuPont™ bristles are also available at this exclusive, members- only price.
2 For out-of-network benefits, see GEHA’s Standard and High Option plan brochure RI 71-006, available online at geha.com/PlanBrochure
3 Refer to geha.com/Prescriptions for formulary and specialty coverage for specific medications.
4 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.
5 Over 30-day specialty copay based on days of therapy. The drug cost share is two times the copay for drugs that provide 60 days’ worth of therapy and three times the copay for drugs that provide 90 days’ worth of therapy.
6 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.
7 These 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.
Endnotes
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