Forms & Brochures > Health Plan Members
 

By November each year, GEHA will distribute plan materials for the coming plan year to all GEHA members. If you have registered for a Member Web Account, you will receive your new plan materials by email. If not, you will receive a letter instructing you how to find your materials online. Either way, you don't need to place an order to receive this annual member communication. If you would like to request that a paper copy of your plan brochure be sent to you by mail at Open Season, call (866) 972-4342. You'll need to have your member ID number ready when you call.

Download Delivery

Choose any of the following materials for download to your computer in Adobe Acrobat format. To read these files, you'll need a copy of the free Adobe Acrobat Reader®.

For information on our Federal Employees Dental and Vision Insurance Program (FEDVIP) plan, go to GEHA Connection Dental Federal.

Please click on your selection below.

  • 2013 GEHA Plan Brochure, RI 71-006 - This brochure describes the benefits, exclusions, limitations and maximums of the GEHA benefit plan.


  • 2013 Summary - This piece provides an overview of GEHA Standard Option, Health Savings Advantage and High Option health plans and how GEHA works with Medicare.


  • 2013 GEHA Health Savings Advantage HDHP Brochure - This brochure describes the benefits, exclusions, limitations and maximums of the GEHA High Deductible Health Plan.


  • 2013 High-Deductible Health Plan (HDHP)/Health Savings Account (HSA) Summary - This summary gives an overview of GEHA's Health Savings Advantage HDHP and tax-advantaged health savings accounts, as well as a Health Savings Advantage benefit chart.


  • 2013 Summaries of Benefits and Coverage (SBC) and Glossary
    Standard Option SBC | High Option SBC |  Health Savings Advantage HDHP SBC | SBC Glossary


  • 2012 GEHA Plan Brochure, RI 71-006 - This brochure describes the benefits, exclusions, limitations and maximums of the GEHA benefit plan.


  • 2012 Summary - This piece provides an overview of GEHA Standard Option, Health Savings Advantage and High Option health plans and how GEHA works with Medicare.


  • 2012 GEHA Health Savings Advantage HDHP Brochure - This brochure describes the benefits, exclusions, limitations and maximums of the GEHA High Deductible Health Plan.


  • 2012 High-Deductible Health Plan (HDHP)/Health Savings Account (HSA) Summary - This summary gives an overview of GEHA's Health Savings Advantage HDHP and tax-advantaged health savings accounts, as well as a Health Savings Advantage benefit chart.


  • Health Reimbursement Arrangement Claim Form - This form is for GEHA Health Savings AdvantageSM high-deductible health plan (HDHP) members who have health reimbursement arrangements (HRAs). Use this form to get reimbursement from your HRA for qualified out-of-pocket medical expenses that are not submitted to GEHA by your doctor, hospital, dentist or pharmacy. Qualified expenses submitted by your provider are automatically reimbursed from your HRA up to the amount of your deductible.


  • Employees Statement of Claim (E-1) - Health plan members use this form to keep GEHA up-to-date on employment status (currently employed or retired), dependents, additional insurance coverage, eligibility for Medicare and accident information. The form can also be used to report a change of address.


  • Medco By Mail Order Form - GEHA health plan members use this form when mailing new prescriptions to the Medco By Mail pharmacy.


  • Medco Health, Allergy & Medication Questionnaire (HMQ) - Medco requests that GEHA members and their family members each complete this form once a year to protect against potentially harmful drug interactions and drug allergies.


  • Direct Reimbursement Claim Form - GEHA health plan members and GEHA secondary members (including members who have Medicare Part D or other primary coverage) should use this form to submit prescription receipts when a participating pharmacy is not available. GEHA secondary members must submit claims to their primary carrier before filing for reimbursement from GEHA. Please include your primary carrier's explanation of benefits (EOB) with this form. Complete instructions are included on the form.


  • International Claim Form - Members use this form to submit institutionaland professional claims for benefits for services received outside the United States.


  • Dental Provider Nomination - Online - Members use this form to nominate a dentist to the GEHA CONNECTION Dental network.


  • Medical Provider Nomination - Online - Members use this form to nominate a doctor or hospital to the GEHA provider network.


  • GEHA with Medicare - This brochure helps current and future retirees understand how GEHA can supplement their Medicare coverage.


  • Retirement Planning Guide - GEHA's Countdown to Your Federal Retirement booklet will help members start thinking about the key decisions and deadlines that make up the federal retirement process.