GEHA
GEHA Benefit Plan — High Option
FEHB Offered in 2027|GEHA|Traditional|PPO
Also listed as: GEHA
Premium
biweekly · employee paysSelf Only
$168.01biweekly · employee pays
vs 2026−$27.28 -14.0%
Lowest$91.16 (2013)
Highest$195.29 (2026)
Since 2013+84.3%
Self Plus One
$376.59biweekly · employee pays
vs 2026−$56.36 -13.0%
Lowest$229.16 (2016)
Highest$432.95 (2026)
Since 2016+64.3%
Self & Family
$459.39biweekly · employee pays
vs 2026−$65.79 -12.5%
Lowest$216.40 (2013)
Highest$525.18 (2026)
Since 2013+112.3%
Premium history
SharePeriodRate type
Year by year
follows the chart's share, period and rate-type selection| Year | Self Only | Δ | Self Plus One | Δ | Self & Family | Δ | Listed as |
|---|
Changelog
- 2012Tracked since 2012Earliest plan year in the data set.
- 2016Self Plus One enrollment addedOPM introduced the Self Plus One enrollment type government-wide in 2016.
- 2018Renamed“GEHA Benefit Plan” → “GEHA”
- 2020Renamed“GEHA” → “GEHA Benefit Plan”
- 2026Largest increase: +42.4%Self Only employee share went from $137.11 to $195.29.
- 2027Largest decrease: -14.0%Self Only employee share went from $195.29 to $168.01.
Full rate schedule
Plan yearIn-network
2027 plan benefits file| Self Only | Self Plus One | Self & Family | |
|---|---|---|---|
| Annual deductible | $500 | $1,000 | $1,000 |
| Medical account contribution | Not applicable | Not applicable | Not applicable |
| Net deductible | $500 | $1,000 | $1,000 |
| Annual out-of-pocket maximum | $7,500 | $15,000 | $15,000 |
| Prescription out-of-pocket maximum | $7,500 | $15,000 | $15,000 |
- Type of accountNot Applicable
- Medicare Part D EGWP Prescription Drug Out-of-Pocket Maximum per enrollee$2,400
- Total Annual Part B Premium Reimbursement Amount Per Enrollee (MAPD)$1,200
- Tier 0$0 Copayment
- Tier 1$10 Copayment
- Tier 225% Coinsurance
- Tier 340% Coinsurance
- Tier 425% Coinsurance
- Tier 540% Coinsurance
- Mail Order PharmacyNo
- Deductible waiver (with Medicare Part A as Primary)Deductible waived
- Deductible waiver (with Medicare Part B as Primary)Deductible waived
- Deductible Waiver with Parts A & BDeductible waived
- Out-of-Pocket Maximum with Parts A & B$7,500
- Primary Care Physician Office Visit with Medicare A & B PrimaryMember Pays Nothing
- Specialty Physician Office Visit with Parts A & BMember Pays Nothing
- Inpatient Hospital Services with Parts A & BMember Pays Nothing
- Outpatient Hospital Services with Part A20% Coinsurance
- Outpatient physician services (with Medicare Part B as Primary)Member Pays Nothing
- Part B Premium Reimbursement with Parts A & B$1,000 Maximum
- Requirement for Part B ReimbursementPart A and B
- Deductible Waiver with Part CNot applicable
- Out-of-Pocket Maximum with Part CNot applicable
- Primary Care Physician Office Visit with Medicare Advantage (Part C) PrimaryMember Pays Nothing
- Specialty Physician Office Visit with Part CMember Pays Nothing
- Inpatient Hospital Services with Part CNot applicable
- Outpatient Hospital Services with Part CMember Pays Nothing
- Outpatient physician services (with Medicare Advantage Part C as Primary)Member Pays Nothing
- Part B Premium Reimbursement with Part C$1,200 Maximum
- Preventive CareMember Pays Nothing
- Primary Care Office Visit$30 Copayment
- Specialist Office Visit$45 Copayment
- Emergency Care30% Coinsurance
- Urgent Care$45 Copayment
- Doctor Costs for Inpatient Surgery20% Coinsurance
- Hospital Inpatient Cost Per Admission20% Coinsurance
- Hospital Room Costs20% Coinsurance
- Other Inpatient Hospital Costs20% Coinsurance
- Doctor Costs for Outpatient Surgery20% Coinsurance
- Other Outpatient Surgery Costs20% Coinsurance
- Diagnostic Tests or Procedures (e.g., Blood Tests, X-rays, Urinalysis, Ultrasounds)20% Coinsurance
- Diagnostic Tests or Procedures (e.g., CT scans, MRIs, PET Scans)20% Coinsurance
- Enhanced Lab NetworkNot applicable
- Applied Behavioral Analysis (ABA)20% Coinsurance
- Chiropractic$30 Copayment
- Occupational Therapy20% Coinsurance
- Physical Therapy20% Coinsurance
- Speech Therapy20% Coinsurance
- Professional Services (Mental Health and Substance Use Disorder)$30 Copayment
- Inpatient Hospital (Mental Health and Substance Use Disorder Services)20% Coinsurance
- Outpatient Hospital (Mental Health and Substance Use Disorder Services)20% Coinsurance
- Diagnosis and Treatment (Infertility Services)20% Coinsurance
- Fertility Preservation Procedures (e.g., iatrogenic infertility) (Infertility Services)20% Coinsurance
- Artificial Insemination Services (e.g. ICI, IVI, IUI)20% Coinsurance
- Assisted Reproductive Technology (ART) (e.g., IVF, GIFT, ZIFT) (Infertility Services)20% Coinsurance
- Surgical Procedures20% Coinsurance
- Reconstructive Surgery20% Coinsurance
- Hearing Services20% Coinsurance
- Hearing Aids (external)Covered
- Prenatal Care, Screening for Gestational Diabetes, Delivery, and Postpartum Care (Maternity Care)Member Pays Nothing
- Hospital Stay--Vaginal Birth, Cesarean Birth (Maternity Care)20% Coinsurance
- Hospice CareMember Pays Nothing
- Home Health Services (Skilled Nursing Care)20% Coinsurance
- Durable Medical Equipment20% Coinsurance
- Outpatient Rehabilitation (Skilled Nursing Care Facility)20% Coinsurance
- Diabetes EducationMember Pays Nothing
- Nutritional CounselingMember Pays Nothing
- Routine Dental Exams and Cleaning for AdultsCovered
- Routine Dental Exams and Cleaning for ChildrenCovered
- Routine Eye ExamsNot Covered
- Eye Exams for Medical Condition or Non-Surgical TreatmentCovered
- EyeglassesNot Covered
- Contact LensesNot Covered
- Acupuncture20% Coinsurance
- Chronic Disease Management: Heart DiseaseCovered
- Chronic Disease Management: ObesityCovered
- Chronic Disease Management: HypertensionCovered
- Chronic Disease Management: AsthmaCovered
Out-of-network
2027 plan benefits file| Self Only | Self Plus One | Self & Family | |
|---|---|---|---|
| Annual deductible | $2,000 | $4,000 | $4,000 |
| Medical account contribution | Not applicable | Not applicable | Not applicable |
| Net deductible | $2,000 | $4,000 | $4,000 |
| Annual out-of-pocket maximum | $20,000 | $40,000 | $40,000 |
- Type of accountNot Applicable
- Tier 0$0 Copayment
- Tier 1$10 Copayment
- Tier 225% Coinsurance
- Tier 340% Coinsurance
- Tier 4100% Coinsurance
- Tier 5100% Coinsurance
- Mail Order PharmacyNo
- Deductible waiver (with Medicare Part A as Primary)Deductible waived
- Deductible waiver (with Medicare Part B as Primary)Deductible waived
- Deductible Waiver with Parts A & BDeductible waived
- Out-of-Pocket Maximum with Parts A & B$20,000
- Primary Care Physician Office Visit with Medicare A & B PrimaryMember Pays Nothing
- Specialty Physician Office Visit with Parts A & BMember Pays Nothing
- Inpatient Hospital Services with Parts A & BMember Pays Nothing
- Outpatient Hospital Services with Part A50% Coinsurance
- Outpatient physician services (with Medicare Part B as Primary)Member Pays Nothing
- Part B Premium Reimbursement with Parts A & BNot applicable
- Requirement for Part B ReimbursementNot applicable
- Deductible Waiver with Part CNot applicable
- Out-of-Pocket Maximum with Part CNot applicable
- Primary Care Physician Office Visit with Medicare Advantage (Part C) PrimaryMember Pays Nothing
- Specialty Physician Office Visit with Part CMember Pays Nothing
- Inpatient Hospital Services with Part CNot applicable
- Outpatient Hospital Services with Part CMember Pays Nothing
- Outpatient physician services (with Medicare Advantage Part C as Primary)Member Pays Nothing
- Part B Premium Reimbursement with Part CNot applicable
- Preventive Care50% Coinsurance
- Primary Care Office Visit50% Coinsurance
- Specialist Office Visit50% Coinsurance
- Emergency Care30% Coinsurance
- Urgent Care50% Coinsurance
- Doctor Costs for Inpatient Surgery50% Coinsurance
- Hospital Inpatient Cost Per Admission50% Coinsurance
- Hospital Room Costs50% Coinsurance
- Other Inpatient Hospital Costs50% Coinsurance
- Doctor Costs for Outpatient Surgery50% Coinsurance
- Other Outpatient Surgery Costs50% Coinsurance
- Diagnostic Tests or Procedures (e.g., Blood Tests, X-rays, Urinalysis, Ultrasounds)50% Coinsurance
- Diagnostic Tests or Procedures (e.g., CT scans, MRIs, PET Scans)50% Coinsurance
- Enhanced Lab NetworkNot applicable
- Applied Behavioral Analysis (ABA)50% Coinsurance
- Chiropractic50% Coinsurance
- Occupational Therapy50% Coinsurance
- Physical Therapy50% Coinsurance
- Speech Therapy50% Coinsurance
- Professional Services (Mental Health and Substance Use Disorder)50% Coinsurance
- Inpatient Hospital (Mental Health and Substance Use Disorder Services)50% Coinsurance
- Outpatient Hospital (Mental Health and Substance Use Disorder Services)50% Coinsurance
- Diagnosis and Treatment (Infertility Services)50% Coinsurance
- Fertility Preservation Procedures (e.g., iatrogenic infertility) (Infertility Services)50% Coinsurance
- Artificial Insemination Services (e.g. ICI, IVI, IUI)50% Coinsurance
- Assisted Reproductive Technology (ART) (e.g., IVF, GIFT, ZIFT) (Infertility Services)50% Coinsurance
- Surgical Procedures50% Coinsurance
- Reconstructive Surgery50% Coinsurance
- Hearing Services50% Coinsurance
- Hearing Aids (external)Covered
- Prenatal Care, Screening for Gestational Diabetes, Delivery, and Postpartum Care (Maternity Care)50% Coinsurance
- Hospital Stay--Vaginal Birth, Cesarean Birth (Maternity Care)50% Coinsurance
- Hospice CareMember Pays Nothing
- Home Health Services (Skilled Nursing Care)50% Coinsurance
- Durable Medical Equipment50% Coinsurance
- Outpatient Rehabilitation (Skilled Nursing Care Facility)50% Coinsurance
- Diabetes EducationMember Pays Nothing
- Nutritional Counseling50% Coinsurance
- Routine Dental Exams and Cleaning for AdultsCovered
- Routine Dental Exams and Cleaning for ChildrenCovered
- Routine Eye ExamsNot Covered
- Eye Exams for Medical Condition or Non-Surgical TreatmentCovered
- EyeglassesNot Covered
- Contact LensesNot Covered
- Acupuncture50% Coinsurance
- Chronic Disease Management: Heart DiseaseNot Covered
- Chronic Disease Management: ObesityNot Covered
- Chronic Disease Management: HypertensionNot Covered
- Chronic Disease Management: AsthmaNot Covered
Offered nationwide.
Service area description
| State | Description |
|---|---|
| Nationwide | Nationwide |
Service area over time
| Year | States / areas listed |
|---|---|
| 2027 | Nationwide |
| 2026 | Nationwide |
| 2025 | Nationwide |
| 2024 | Nationwide |
| 2023 | Nationwide |
| 2022 | Nationwide |
| 2021 | Nationwide |
| 2020 | Nationwide |
| 2019 | Nationwide |
| 2018 | Nationwide |
| 2017 | Nationwide |
| 2016 | Nationwide |