GEHA Benefit Plan www.geha.com 800-821-6136 2020 A Fee-for-Service (High and Standard Options) health plan with a Preferred Provider Organization This plan's health coverage qualifies as minimum essential coverage and meets the minimum value standard for the benefits it provides. IMPORTANT See page 7 for details. This plan is accredited. See page 12. • Rates: Back Cover • Changes for 2020: Page 14 Sponsored and administered by: • Summary of Benefits: Page 125 Government Employees Health Association, Inc. Who may enroll in this Plan: All Federal employees and annuitants who are eligible to enroll in the Federal Employees Health Benefits Program may become members of GEHA. You must be, or must become a member of Government Employees Health Association, Inc. To become a member: You join simply by signing a completed Standard Form 2809, Health Benefits Registration Form, evidencing your enrollment in the Plan. Membership dues: There are no membership dues for the Year 2020. Enrollment codes for this Plan: 311 High Option - Self Only 313 High Option - Self Plus One 312 High Option - Self and Family 314 Standard Option - Self Only 316 Standard Option - Self Plus One 315 Standard Option - Self and Family RI 71-006 Important Notice from Government Employees Health Association, Inc. About Our Prescription Drug Coverage and Medicare OPM has determined that the Government Employees Health Association, Inc. prescription drug coverage is, on average, expected to pay out as much as the standard Medicare prescription drug coverage will pay for all plan participants and is considered Creditable Coverage. This means you do not need to enroll in Medicare Part D and pay extra for prescription drug coverage. If you decide to enroll in Medicare Part D later, you will not have to pay a penalty for late enrollment as long as you keep your FEHB coverage. However, if you choose to enroll in Medicare Part D, you can keep your FEHB coverage and your FEHB plan will coordinate benefits with Medicare. Remember: If you are an annuitant and you cancel your FEHB coverage, you may not re-enroll in the FEHB Program. Please be advised If you lose or drop your FEHB coverage and go 63 days or longer without prescription drug coverage that’s at least as good as Medicare’s prescription drug coverage, your monthly Medicare Part D premium will go up at least 1% per month for every month that you did not have that coverage. For example, if you go 19 months without Medicare Part D prescription drug coverage, your premium will always be at least 19 percent higher than what many other people pay. You will have to pay this higher premium as long as you have Medicare prescription drug coverage. In addition, you may have to wait until the next Annual Coordinated Election Period (October 15 through December 7) to enroll in Medicare Part D. Medicare’s Low Income Benefits For people with limited income and resources, extra help paying for a Medicare prescription drug plan is available. Information regarding this program is available through the Social Security Administration (SSA) online at: www.socialsecurity.gov, or call the SSA at 800-772-1213, TTY: 800-325-0778. You can get more information about Medicare prescription drug plans and the coverage offered in your area from these places: Visit www.medicare.gov for personalized help, call 800-MEDICARE 800-633-4227, TTY: 877-486-2048. Table of Contents Introduction ...................................................................................................................................................................................3 Plain Language ..............................................................................................................................................................................3 Stop Health Care Fraud! ...............................................................................................................................................................3 Discrimination is Against the Law ................................................................................................................................................4 Preventing Medical Mistakes ........................................................................................................................................................5 FEHB Facts ...................................................................................................................................................................................7 Coverage information .........................................................................................................................................................7 • No pre-existing condition limitation ...............................................................................................................................7 • Minimum essential coverage (MEC) ..............................................................................................................................7 • Minimum value standard (MVS) ....................................................................................................................................7 • Where you can get information about enrolling in the FEHB Program .........................................................................7 • Types of coverage available for you and your family ....................................................................................................7 • Family member coverage ...............................................................................................................................................8 • Children’s Equity Act .....................................................................................................................................................9 • When benefits and premiums start .................................................................................................................................9 • When you retire ............................................................................................................................................................10 When you lose benefits .....................................................................................................................................................10 • When FEHB coverage ends ..........................................................................................................................................10 • Upon divorce ................................................................................................................................................................10 • Temporary Continuation of Coverage (TCC) ...............................................................................................................10 • Finding Replacement Coverage ...................................................................................................................................10 • Health Insurance Marketplace ......................................................................................................................................11 Section 1. How This Plan Works ................................................................................................................................................12 General features of our High and Standard Options .........................................................................................................12 How we pay providers ......................................................................................................................................................13 Your rights and responsibilities .........................................................................................................................................13 Your medical and claims records are confidential ............................................................................................................13 Section 2. Changes for 2020 .......................................................................................................................................................14 Changes to High and Standard Options ............................................................................................................................14 Section 3. How You Get Care .....................................................................................................................................................16 Identification cards ............................................................................................................................................................16 Where you get covered care ..............................................................................................................................................16 • Covered providers .........................................................................................................................................................16 • Covered facilities ..........................................................................................................................................................16 • Transitional care ...........................................................................................................................................................18 • If you are hospitalized when your enrollment begins ...................................................................................................18