Welcome to your 2020 medical plan - YOUR ELEVATE PLUS MEMBERSHIP GUIDE
←
→
Page content transcription
If your browser does not render page correctly, please read the page content below
Welcome to your 2020 medical plan. YOUR ELEVATE PLUS MEMBERSHIP GUIDE
Thank you for choosing GEHA. We’re glad you’re here.
Welcome to GEHA.
This guide gives you an introduction to your exclusive GEHA member-only
benefits and programs.
Thank you for choosing Elevate Plus, one of GEHA’s
new medical plans for 2020. With an emphasis on
innovative digital tools and convenient care, Elevate !
Plus empowers you to achieve the health you need
to live the life you want.
Your plan comes with an extensive nationwide
PLAN HIGHLIGHTS
network of 4 million provider locations and the XX $500 in rewards annually for healthy
freedom to choose any doctor — with extra savings activities (or a maximum of $1,000 for
when you see an in-network provider. two eligible family members).
XX Exclusive access to a digital wellness
Elevate Plus is designed to help you platform, hosted by Rally. Earn rewards
and access additional benefits.
do your possible.
XX Free 24/7 online doctor visits
with MDLIVE.
XX Personalized concierge support to help
get the most value out of your plan.
This is a brief description of the features of Government Employees Health Association,
Inc.'s Elevate Plus medical plan. All benefits are subject to the definitions, limitations and
exclusions set forth in the federal brochure.
WE LCOM E TO G E H A
3
What’s inside.
Get started with GEHA. Understand your benefits.
03 Welcome to GEHA. 22 What you pay in-network for your benefits.
07 Get started with GEHA & Rally. 24 Your pharmacy benefits.
08 A quick guide to your medical plan ID cards. 26 Vision coverage is included with your plan.
28 A hearing aid benefit & discount is included
Find care. with your plan.
10 Know your care options.
31 Even more discounts & savings await.
12 Free 24/7 online doctor visits with MDLIVE.
14 Access your BridgeHealth surgical concierge. Contact & resources.
32 Benefit resources.
Earn wellness rewards. 33 Prescription resources.
16 Personalize your health.
34 Plan & wellness resources.
18 Wellness Pays. Start earning rewards today.
35 Contact GEHA.
20 How to use your Wellness Pays rewards card.
4 W HAT’S IN S IDE
WH AT ’ S I N S I D E
56 G ET STARTE D WIT H GE HA
Get started with GEHA & Rally.
You can start setting up your online accounts any time on or after your
eligibility date*. You’ll need your member ID, which can be found inside the
front cover of this membership guide or on your plan ID card.
Watch for your ID cards Create your GEHA web account at
1 Your GEHA medical/prescription plan 4 geha.com/Register
ID card will come in an envelope from XX Your account gives you access to
CVS Caremark with information about your member-only services.
prescription benefits.
XX Print ID cards.
XX Track claims and deductibles, update
Create your Rally web account
2 Self-manage your health goals, earn
XX
communication preferences, and more.
Select how to receive your Explanation
rewards, enroll with a wellness coach and
more on this digital health platform. of Benefits (EOB) under Update Info &
Preferences. Choose from U.S. mail or email.
geha.com/RallyRegister
Complete your enrollment
3
Create your Wellness Pays web
account after completing your
5 questionnaire
To help us process your claims quickly
first rewardable activity. and efficiently, please complete the yellow
geha.com/RedeemRewards enrollment questionnaire included in this
packet. You can mail it to GEHA in the enclosed
* Most enrollments and changes of enrollment are effective on the first day of the pay period
after the employing office receives the enrollment form. Your employing office can give you
postage-paid envelope. You can also complete
the specific date on which your enrollment or enrollment change will take effect. it online. geha.com/EQ
G E T STA RT E D WI T H G E H A
7A quick guide to your
medical plan ID cards.
Check your mailbox. Your GEHA medical plan ID card will come from
CVS Caremark.
GEHA medical plan ID cards are issued in the name of the
subscriber who enrolled in the medical plan through FEHB.
All members covered by this plan will use the card with the
subscriber’s name. Use this medical ID card for medical care
at a doctor’s office or hospital as well as for prescriptions.
Estimate your
GEHA partners with the UnitedHealthcare Choice Plus network medication costs
for our Elevate Plus plan option. If you call your provider to Visit our Check Drug Costs tool,
confirm that they are in the GEHA network, please have your hosted by CVS Caremark, at:
GEHA ID card handy. You’ll want to ask the provider if their
info.caremark.com/GEHA
specific location(s) participate in the network indicated on
your card.
Find an in-network provider at geha.com/Elevate-Find-Care
8 G ET STARTE D WITH GE HA4
1
2
5
3
1. Member ID
2. Group ID
3. Provider network logos, including sub-network logos if applicable
4. Elevate concierge & prescription drug benefit phone numbers
5. Where to submit claims
G E T STA RT E D WI T H G E H AKnow your care options.
With 4 million provider locations, you can get convenient
health care and advice when you need it by
phone, video or in-person.
geha.com/Elevate-Find-Care
10 FI ND CAR EKnow your care options.
FREE $
Online doctor visits MinuteClinic®
24/7 doctor access with MDLIVE. Local care for minor issues.
geha.com/MDLIVE geha.com/MinuteClinic
FREE $$
Health Advice Line Urgent care
Talk to a nurse 24/7/365. Convenient local care option.
888.257.4342 geha.com/Elevate-Find-Care
$ $$$$
Primary care Emergency room
Non-emergency doctor care. Life threatening issues.
geha.com/Elevate-Find-Care Call 9-1-1
FI N D CA R E
11Free 24/7 online doctor
visits with MDLIVE.
Health care on your terms. Get online access to doctors, including
pediatricians, dermatologists and licensed therapists.
Get non-emergency care now or schedule an appointment later,
without having to travel to the doctor’s office — at $0 cost to you.
Access care
Register your account now, so it’s ready to go when you need it. anytime from your
There are two ways to activate your account:
smartphone.
XX Call MDLIVE at 888.912.1183
Download the MDLIVE app.
XX Visit geha.com/MDLIVE for a link to activate your Available on the App Store
account online.
and Google Play
Covered conditions include, but are not limited to, allergies,
cold or flu, ear problems, sore throat, constipation or diarrhea,
pink eye, acne or eczema.
Behavioral health conditions include depression, eating disorders,
panic disorders, addiction, postpartum depression and more.
12 FI ND CAR Egeha.com/MDLIVE
FI N D CA R E
13Access your BridgeHealth
surgical concierge.
geha.com/BridgeHealth
14 FI ND CAR EAccess your BridgeHealth
surgical concierge.
Get the highest quality of care for a wide range of surgical services, all at
$0 out-of-pocket cost
cost.*
No matter how hard you work to stay healthy,
sometimes life can throw you a curve. If that happens,
GEHA provides you white-gloved concierge attention Your dedicated Care Coordinator
to get the highest quality of care for a wide range of will help you every step of the way
surgical services. This is the way health care should should you need surgery for any of the
be, when you need it the most. All at no additional following conditions:
cost to you.
XX Orthopedic XX Neurologic
From scheduling appointments, to setting up the XX Cardiac XX Vascular
surgery and coordinating post-operation physical XX Women’s health XX Bariatric
therapy, your Care Coordinator will take care of
everything. Including making certain your surgery XX Spine XX General
team and facility are ranked among the nation’s best.
All of this is included in your Elevate Plus plan, which
means you will never see a bill from the time of your
first consultation to when the surgeon releases you
from his or her care. * Not all GEHA members are eligible for this service.
FI N D CA R EPersonalize your health.
Get personalized recommendations that
fit your healthy lifestyle.
Online health coaching
With GEHA’s web and mobile-enabled wellness resources, Enroll in one of GEHA’s expert-led
hosted by Rally, you have a simple and fun way to help you coaching programs to get professional
organize and self-manage your health goals, track your guidance on your wellness journey.
progress and build on your successes.
XX Fit for life
Use your Rally portal to help you make the most of your XX Stress less
benefits and get personalized recommendations on small XX Sleep well
steps you can take today to improve your quality of life.
Complete activities to earn Rally incentives that you can XX Happiness
redeem for discounts on movie tickets, clothing and XX General wellness and meditation
fitness items.
XX Family wellness
XX Financial well-being
Participate in activities that support good health.
XX Complete Rally Missions designed to help you maintain XX Weight management and eat smart
healthy goals that are personal and rewarding. XX Healthy heart
XX Compete with other federal employees through fun XX Quit tobacco/nicotine
and engaging Rally Challenges.
XX Diabetes lifestyle
geha.com/RallyRegister
EA RN WE LLN E S S RE WAR DSHit your Stride, online Take the health survey Create your personalized
Get rewarded every month Receive personalized wellness journey
when you hit your daily Stride recommendations for activities GEHA’s digital platform, hosted
step goal. Use the Rally app to and programs to work into your by Rally, highlights the benefits
manage your steps and monitor daily routine, and earn rewards that match your lifestyle. The
your progress as you stride for your healthy behavior. more you use it, the more
toward your goals. personalized it becomes.
E A R N WE L L N E S S R E WA R D S
17Wellness Pays. Start
earning rewards today.
It’s easy to earn wellness rewards.
Annual maximum of $500 Self Only or $1,000 Self Plus One or Self and Family.
$50 – $150 $100 $150 $50
Preventive screenings Health survey Complete an online Complete an online
coaching program doctor visit with MDLIVE
$250 $250 $10/month $100
Complete Real Appeal, Complete Quit for Life, Achieve Stride step goal Complete six
a weight management a tobacco/nicotine Rally Missions
program cessation program
18 EA RN WE LLN E S S RE WAR DSWellness Pays. Start
earning rewards today.
Get rewarded for your commitment to healthy living with tools and incentives
that make it easy and fun to live healthier.
You can earn rewards for healthy activities that you are
probably doing already.
There are many ways to get rewarded for your healthy lifestyle.
From routine check-ups and screenings to managing your weight
or utilizing activities offered by Rally’s digital platform, you earn
Understand your
dollars (up to $500 Self Only, $1,000 Self Plus One or Self and wellness rewards
Family annually) to pay for qualified medical expenses. geha.com/WellnessPays
Watch your rewards accumulate on your Wellness Pays rewards
card as you complete healthy activities.
E A R N WE L L N E S S R E WA R D S
19How to use your Wellness
Pays rewards card.
Your rewards card makes it easy to take advantage of your benefits.
The convenience of paying for health care expenses when and
where you want.
XX Your Wellness Pays rewards account is powered by
WageWorks. Once you have completed your first rewardable
activity, you will receive an envelope from WageWorks in the
Get started with
mail containing your card and activation instructions. Wellness Pays
XX You can use your Wellness Pays rewards card at retail locations geha.com/RedeemRewards
and provider offices for qualified medical expenses. This
includes out-of-pocket costs such as copays as well as common
care such as vision and dental/orthodontic treatment.
XX See your reward dollars accumulate year-over-year up to a
maximum balance of $2,500 Self Only, $5,000 Self Plus One
and Self and Family.
20 EA RN WE LLN E S S RE WAR DSgeha.com/RedeemRewards
E A R N WE L L N E S S R E WA R D S
21What you pay in-network
forWhat
youryou paybenefits.
for medical benefits in-network 1,2
Nothing for online doctor visits with MDLIVE $150 for emergency care
Nothing for preventive care; adult
routine screenings $200 copay / day, up to $1,000 / admission
for hospital care; inpatient including maternity
Nothing for a well-child visit; up to age 22
$200 copay / day per facility for hospital
care; outpatient
$10 MinuteClinic®, where available
$20 primary physician office visit $20 chiropractic care; up to 15 visits per year
(spinal manipulation therapy)
$35 specialist care; office visit
$20 acupuncture; up to 20 medically necessary
$50 urgent care visit treatments per year
1 For out-of-network benefits, see GEHA‘s 2020 Elevate Plus plan brochure RI 71-018 (Elevate Plus and Elevate).
2 This is a brief description of the features of Government Employees Health Association, Inc.‘s medical plans. Please read the GEHA Elevate Plus federal brochure
RI 71-018 available at geha.com/PlanBrochure. All benefits are subject to the definitions, limitations and exclusions set forth in the federal brochure.
3 The out-of-pocket maximum is the maximum amount of coinsurance, copays and deductibles you pay for all family members before GEHA begins paying for 100%
of your care. This is a combined maximum for both medical care and prescriptions.
22 U ND ERSTAN D YOUR BE N E F I TSWhat you pay in-network
for your benefits.
There‘s a good chance your doctor is in-network. Your plan comes with
an extensive nationwide network of 4 million provider locations and the
freedom to choose any doctor — with extra savings when you see an
in-network provider.
Deductible & out-of-pocket maximum
What you pay in-network1 Self Only Self Plus One Self and Family
Calendar year deductible $0 $0 $0
Out-of-pocket maximum3 $6,000 $12,000 $12,000
U N D E R STA N D YOU R B E N E FI T S
23Your pharmacy benefits.
All prescriptions must be filled at an Estimate your medication costs
in-network pharmacy location. Visit our Check Drug Costs tool, hosted by CVS
XX GEHA’s Elevate Plus plan uses the Caremark, to evaluate your medication cost.
Exclusive Choice Pharmacy Network. info.caremark.com/GEHA
XX Your options include any CVS Pharmacy
location, but you don’t have to go to a It’s easy to find an in-network pharmacy
CVS to pay in-network prices.
info.caremark.com/GEHA
XX Other pharmacies in the network include
Walmart Pharmacy, Sam’s Club Pharmacy,
Cardinal Health affiliated and more. CVS Caremark mobile app
Scan prescriptions, compare prices and check
XX If you fill a prescription at an out-of-
your refills.
network pharmacy, you’ll pay 100% of
the charges. Download on Google Play & the App Store
This plan includes a comprehensive drug list CVS ExtraCare Health Card
and mail order through CVS Caremark’s Mail Receive a 20% discount on thousands of
Service Pharmacy. Save money and have eligible CVS-brand health items by using the CVS
your routine prescriptions delivered to your ExtraCare Health Card in-store or online.
home, postage-paid, within about 14 days
XX First, register at Caremark.com/StartNow
from the time you submit your prescription.
geha.com/Prescriptions XX Second, visit Caremark.com/ExtraCareHealth
to activate your discount on an existing
ExtraCare card or request a new card.
24 U ND ERSTAN D YOUR BE N E F I TSWhat you pay for prescription medications in-network
Retail pharmacy; 30-day supply1,2 Mail service pharmacy; 90-day supply1,2
$5 generic prescriptions $12 generic prescriptions
$80 copay4 for preferred brand- $200 copay4 for preferred brand-
name medication name medication
40% of allowance4 for non-preferred brand- 40% of allowance4 for non-preferred brand-
name medication name medication
1 Refer to geha.com/Prescriptions for formulary and specialty coverage for
specific medications.
Specialty prescription CVS exclusive ;1,2
2 This is a brief description of the features of Government Employees Health
30-day supply3 Association, Inc.‘s medical plans. Please read GEHA Elevate Plus RI 71-018
federal brochure available at geha.com/PlanBrochure. All benefits are
subject to the definitions, limitations and exclusions set forth in the
federal brochure.
40% ($500 max4) for generic and preferred 3 Over 30-day specialty copay based on days of therapy. The drug cost share
brand-name medication 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.
4 If you choose a brand-name medication when a generic is available, you
40% of allowance4 for non-preferred brand- will be charged the generic copay plus the difference in cost between the
brand-name and the generic.
name medication
U N D E R STA N D YOU R B E N E FI T S
25VisionWhat
coverage isfor vision
you pay in-network
included with your plan.
Eye exams & frames Eyeglass lens options
$0 eye exam with dilation as necessary $15 UV treatment
60% of the retail price for eyeglass frames $15 tint (solid and gradient)
Eyeglass lenses (pair) $15 standard plastic scratch coating
Up to $50 standard plastic single vision
$40 standard polycarbonate
Up to $70 standard plastic bifocal
$45 standard anti-reflective coating
Up to $105 standard plastic trifocal
80% of retail for photochromatic / transitions
plastic lenses
Up to $135 standard progressive
80% of retail for premium anti-reflective
80% of retail for premium progressive
80% of retail for other add-ons
Additional pairs
Up to 60% of retail for eyeglasses Contact lenses
(complete pair)
85% of retail for conventional
These benefits are neither offered nor guaranteed under contract with the FEHB
program, but are made available to all enrollees who become members of GEHA's
No discount for disposable
Elevate Plus medical plan and their eligible family members.
26 U ND ERSTAN D YOUR BE N E F I TSVision coverage is
included with your plan.
Keep your vision health a priority with GEHA Connection Vision powered
by EyeMed.
Elevate Plus members pay a $0 copay for routine eye
exams at in-network EyeMed providers, and save
SM
on lenses, frames and specialty items such as tints, Look for your GEHA vision plan
scratch coating and polycarbonate lenses.
ID card in the mail.
For out-of-network exams, EyeMed reimburses you up You will receive your GEHA vision ID
to $45 per covered member per year. card in an envelope from EyeMed. Use
this card to receive discounted vision
geha.com/Vision care at EyeMed network providers.
Learn more at geha.com/Vision
Vision benefits include:
XX EyeMed providers include LensCrafters, Target,
independent eye doctors and top optical retailers.
XX No limit on the number of discounted glasses or
contacts purchased each year.
XX Savings on surgical procedures, including LASIK
and PRK, at participating locations.
U N D E R STA N D YOU R B E N E FI T S
27A hearing aid benefit &
discount is included with
your plan.
Your Elevate Plus plan includes a hearing aid
benefit of $1,500.
XX This benefit can be combined with exclusive pricing on
hearing aids purchased through TruHearing™ with your Learn more about
Elevate Plus medical plan. your hearing benefit
XX Most members see savings of 30% to 60%, averaging more geha.com/Hearing
than $2,100 per pair.
XX Choose from more than 100 of the latest hearing aid models
from top companies.
XX This discount can be shared with extended family members,
even those not covered under your plan.
These benefits are neither offered nor guaranteed under contract with the FEHB Program, but are made available to all enrollees who become members of GEHA’s Elevate Plus
medical plan and their eligible family members.
28 U ND ERSTAN D YOUR BE N E F I TSWhat you pay in-network for hearing aids
Average Your price Elevate Plus
Product examples retail price with TruHearing benefit What you pay
Starkey Livio 1000 $3,440 $1,790 $1,500 $290
ReSound Quattro 5 $5,560 $2,740 $1,500 $1,240
Widex Evoke 330 $5,570 $3,450 $1,500 $1,950
Signia Nx 7 $6,500 $4,190 $1,500 $2,690
Phonak Audeo M30 R $3,570 $2,500 $1,500 $1,000
These benefits are neither offered nor guaranteed under contract with the FEHB Program, but are made available to all enrollees who become members of GEHA’s Elevate Plus medical plan
and their eligible family members.
U N D E R STA N D YOU R B E N E FI T S30 U ND ERSTAN D YOUR BE N E F I TS
Even more discounts &
savings await.
Gym membership Teeth whitening Electric toothbrush
Access more than 10,000 Receive a 20% discount on GEHA members can save
Active&Fit Direct™ participating the lowest published price on more than 70% off a premium
fitness centers nationwide all Smile Brilliant home teeth electric toothbrush
for $25 a month. whitening products. Includes by cariPRO™.
geha.com/Fitness custom-fitted trays, whitening geha.com/Toothbrush
gel and desensitizing gel.
geha.com/Whitening
These benefits are neither offered nor guaranteed under contract with the FEHB Program, but are made available to all enrollees who become members of GEHA's Elevate Plus
medical plan and their eligible family members.
U N D E R STA N D YOU R B E N E FI T S
31Benefit resources.
Preferred provider network information geha.com/Elevate-Find-Care
800.296.0776
Gym discount by Active&Fit Direct™ geha.com/Fitness
800.821.6136
Premium electric toothbrush by cariPRO™ geha.com/Toothbrush
855.944.8361
Teeth whitening by Smile Brilliant geha.com/Whitening
855.944.8361
SM
Vision discounts by EyeMed geha.com/Vision
877.808.8538
Hearing aid discounts by TruHearing™ geha.com/Hearing
844.224.2711
CONTACT & R E SOUR CE SPrescription resources.
Prescription services geha.com/Prescriptions
844.443.4279
Specialty Customer Care 800.237.2767
Specialty prior authorization 866.814.5506
Check drug costs info.caremark.com/GEHA
30 CON TACT & R E S OU R C E S
33Plan & wellness resources.
Download the GEHA app On the App Store & Google Play
Online doctor visits. 24/7 care. geha.com/MDLIVE
888.912.1183
Health Advice Line. Talk to a nurse 24/7. geha.com/Healthline
888.257.4342
BridgeHealth contact information geha.com/BridgeHealth
Wellness Pays contact information geha.com/WellnessPays
Find a provider geha.com/Elevate-Find-Care
Frequently asked questions geha.com/FAQs
34 CONTACT & RE SOUR CE S
34Contact GEHA.
GEHA Customer Care
Call or email with questions about your
plan or membership benefits.
Hours
7 a.m. to 7 p.m. Central time
Monday – Friday
800.821.6136
TTY: 800.735.2966
geha.com/Contact
CON TACT & R E S OU R C E S
35P.O. Box 6707
Lee’s Summit, MO 64064-6707
geha.com
Questions? Call 800.821.6136
/gehahealth
/company/gehahealth
DO YOUR POSSIBLE.
© 2019-2020 Government Employees Health Association, Inc. All rights reserved. Please recycle.
OS-BKT-1019-002You can also read
