1. Geha Insurance Copay

GEHA offers discounts on prescriptions to help you save on your medical costs where you can. Depending on the medication, you will pay a set amount as a copay or a percentage of the cost. Generic drugs typically cost less than brand-name medications.Another savings option includes a lesser copay amount by getting a 90-day supply through CVS Caremark Mail Service (not available for the Elevate plan) or retail CVS pharmacies. If you are taking brand-name maintenance medication, you may want toconsider GEHA’s High Option medical plan.

Over 30-day specialty copay based on days of therapy. The drug cost share is two times for drugs that provide 60 days‘ worth of therapy and three times the copay for drugs that provide 90 days‘ worth of therapy. Difference in cost between the brand-name and the generic. This is a brief description of the features of Government Employees. Members are able to fill 90 day supplies, of maintenance medications, at mail order or retail CVS pharmacies & pay the mail order copay or coinsurance. Specialty Drug Lists If your medication appears on the Comprehensive Specialty Drug List, please call CVS Caremark Specialty Customer Care at 800-237-2767 to ensure the most accurate and up to.

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.

Searching for more information on your medications? Here are a few helpful resources:

CVS Caremark Specialty Drug Information

Blood Glucose Test Strips

Pharmacy Programs

Each GEHA medical plan offers comprehensive drug coverage.

Looking for an in-network pharmacy?

View the 2021 Standard Option plan

Traditional coverage. Affordable premiums.

With comprehensive care, this medical plan is the one you know and trust, with familiar benefits and coverage

When you enroll in GEHA’s Standard Option, you:

• Pay nothing for online doctor visits with access to certified doctors, including dermatologists, and licensed therapists through MDLIVE.
• Pay nothing for routine, in-network maternity care.
• Get a complete range of prescription services.

More Standard Option highlights:

• A 30-day supply of generic medication costs just $10.
• You can visit your primary care doctor for only a $15 copay each visit.
• This plan covers 100% of preventive care costs when you see an in-network provider.

2020 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.

Self Only	Self Plus One	Self and Family
Non-Postal biweekly	$60.54	$130.18	$155.52
Postal biweekly – Category 1	$58.12	$124.97	$149.30
Postal biweekly – Category 2	$50.25	$108.05	$129.08
Monthly (retirees)	$131.18	$282.05	$336.96

Pay nothing for online doctor visits with access to certified doctors, including dermatologists, and licensed therapists through MDLIVE.

A 30-day supply of generic medication costs just $10.

You can visit your primary care doctor for only a $15 copay each visit.

Covered benefits for routine in-network maternity care and hospital stays.

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Costs for services in 2020

The table below summarizes your in-network cost for medical benefits with GEHA Standard Option. For complete information, refer to the GEHA Plan Brochure.

Copays

Copay	What you pay in-network
Primary physician office visit	$15
Specialist	$30
MinuteClinic (where available)	$10
Urgent care	$35
Annual eye exam	$5 through EyeMed

Other services

Service	What you pay in-network
Preventive lab services	Nothing with Lab Card
Well-child visit; up to age 22	Nothing
Adult routine screening	Nothing
Preventive dental care	50% of allowance, twice yearly

Maternity care

Service	What you pay in-network
Routine provider care	Nothing
Inpatient care	Nothing

Self Only	Self Plus One	Self and Family
Calendar-year deductible (in-network)	$350	$700	$700
Out-of-pocket-maximum (in-network)	$6,500	$13,000	$13,000

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.

To find a drug cost based on your benefit plan and prescription dosage, check your drug costs.

Retail pharmacy – 30-day supply

In-Network	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

In-Network	Out of Network
Generic	$20	n/a
Preferred brand-name	50%, up to $500 max¤	n/a
Non-preferred brand-name	50%, up to $600 max¤	n/a

¤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.

^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 GEHAdental members, visit Savings for GEHA dental members.

Geha Insurance Copay

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