A fee-for-service (High and Standard options) …

1 GEHA Benefit Plan 800-821-6136 2018 A fee-for-service ( high and Standard options ) health plan with a preferred provider organization IMPORTANT Rates: Back Cover Changes for 2018: Page 15 Summary of benefits: Page 123 This plan's health coverage qualifies as minimum essential coverage and meets the minimum value Standard for the benefits it provides. See page 8 for details. This plan is accredited. See page 13. Sponsored and administered by: Government Employees Health Association, 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.

2 Membership dues: There are no membership dues for the Year 2018. 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 MedicareOPM 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.

3 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 advisedIf 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.

4 Medicare s Low Income BenefitsFor 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: , or call the SSA at 800-772-1213, TTY: can get more information about Medicare prescription drug plans and the coverage offered in your area from these places: Visit for personalized help, call 800-MEDICARE 800-633-4227, TTY: 877-486-2048. Table of Contents Introduction ..4 Plain Language ..4 Stop Health Care Fraud! ..4 Discrimination is Against the Law ..5 Preventing Medical Mistakes ..6 FEHB Facts ..8 Coverage information ..8 No pre-existing condition limitation ..8 Minimum essential coverage (MEC) ..8 Minimum value Standard (MVS) ..8 Where you can get information about enrolling in the FEHB Program ..8 Types of coverage available for you and your family.

5 8 Family member coverage ..9 Children s Equity Act ..10 When you retire ..11 When you lose benefits ..11 When FEHB coverage ends ..11 Upon divorce ..11 Temporary Continuation of Coverage (TCC) ..11 Converting to individual coverage ..11 Health Insurance Marketplace ..12 Section 1. How this plan works ..13 General features of our high and Standard options ..13 How we pay providers ..14 Health education resources ..14 Your rights and responsibilities ..14 Your medical and claims records are confidential ..14 Section 2. Changes for 2018 ..15 Changes to high and Standard options ..15 Section 3. How you get care ..17 Identification cards ..17 Where you get covered care ..17 Covered providers ..17 Covered facilities ..17 Transitional care ..19 If you are hospitalized when your enrollment begins ..19 You need prior Plan approval for certain services .

6 19 Inpatient hospital admission (including Skilled Nursing Facility, Long Term Acute Care, Rehab Facility or Residential Treatment Centers) ..19 Non-urgent care claims ..20 Urgent care claims ..21 Concurrent care claims ..21 Emergency inpatient admission ..21 Maternity care ..21 NICU cases ..22 If your hospital stay needs to be extended ..22 Other services that require prior approval ..22 1 2018 GEHA Benefit Plan Table of Contents Radiology/Imaging procedures precertification ..24 If your treatment needs to be extended ..24 If you disagree with our pre-service claims decision ..24 To reconsider a non-urgent care claim ..25 To reconsider an urgent care claim ..25 To file an appeal with OPM ..25 Overseas claims ..25 Section 4. Your costs for covered services ..26 Coinsurance ..26 Copayments ..26 Cost-sharing ..26 Deductible.

7 26 If your provider routinely waives your cost ..26 Waivers ..27 Differences between our allowance and the bill ..27 Your catastrophic protection out-of-pocket maximum for deductibles, coinsurance, and copayments ..28 Carryover ..28 If we overpay you ..29 When Government facilities bill us ..29 Section 5. Benefits ..30 high and Standard Option Overview ..32 Non-FEHB benefits available to Plan members ..92 Section 6. General Exclusions - services , drugs and supplies we do not cover ..94 Section 7. Filing a claim for covered services ..96 Section 8. The disputed claims process ..99 Section 9. Coordinating benefits with Medicare and other coverage ..102 When you have other health coverage or auto insurance ..102 TRICARE and CHAMPVA ..102 Workers Compensation ..102 Medicaid ..103 When other Government agencies are responsible for your care ..103 When others are responsible for injuries.

8 103 When you have Federal Employees Dental and Vision Insurance Plan (FEDVIP) ..104 Clinical trials ..104 When you have Medicare ..105 What is Medicare? ..105 Should I enroll in Medicare? ..105 The Original Medicare Plan (Part A or Part B) ..106 Tell us about your Medicare coverage ..107 Private contract with your physician ..107 Medicare Advantage (Part C) ..107 Medicare prescription drug coverage (Part D) ..107 When you are age 65 or over and do not have Medicare ..109 When you have the Original Medicare Plan (Part A, Part B, or both) ..110 Section 10. Definitions of terms we use in this brochure ..111 Section 11. Other Federal Programs ..118 Important information about four Federal programs that complement the FEHB Program ..118 The Federal Flexible Spending Account Program FSAFEDS ..118 The Federal Employees Dental and Vision Insurance Program FEDVIP.

9 119 2 2018 GEHA Benefit Plan Table of Contents The Federal Long Term Care Insurance Program FLTCIP ..120 The Federal Employees Group Life Insurance Program FEGLI ..-1 Index ..121 Summary of benefits for the high Option of the Government Employees Health Association, Inc. 2018 ..123 Summary of benefits for the Standard Option of the Government Employees Health Association, Inc. 2018 ..125 2018 Rate Information for Government Employees Health Association, Inc. (GEHA) Benefit Plan ..130 3 2018 GEHA Benefit Plan Table of Contents Introduction This brochure describes the benefits of Government Employees Health Association, Inc. under our contract (CS 1063) with the United States Office of Personnel Management, as authorized by the Federal Employees Health Benefits law. This Plan is underwritten by Government Employees Health Association, Inc. Customer service may be reached at 800-821-6136 or through our website at The address for the Government Employees Health Association, Inc.

10 Administrative offices is: Government Employees Health Association, Inc. Box 4665 Independence, Missouri 64051-4665 This brochure is the official statement of benefits. No verbal statement can modify or otherwise affect the benefits, limitations, and exclusions of this brochure. It is your responsibility to be informed about your health benefits. If you are enrolled in this Plan, you are entitled to the benefits described in this brochure. If you are enrolled in Self and Family coverage, each eligible family member is also entitled to these benefits. If you are enrolled in Self Plus One coverage, you and one eligible family member that you designate when you enroll are entitled to these benefits. You do not have a right to benefits that were available before January 1, 2018, unless those benefits are also shown in this brochure. OPM negotiates benefits and rates with each plan annually.