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GEHA Insurance Review & Complaints: Health Insurance

GEHA dental insurance has two available plans alongside a selection of policies for GEHA health insurance and a GEHA medicare supplement for government employees. Bi-weekly GEHA insurance rates for the Standard Plan are $44.71 for postal employees and $53.86 for other employees.

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Eric Stauffer is a former insurance agent and banker turned consumer advocate. His priority is to help educate individuals and families about the different types of insurance they need, and assist them in finding the best...

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UPDATED: Sep 15, 2020

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The Government Employees Health Association, or GEHA, does what the name implies – provides health insurance to government employees. A not-for-profit organization, GEHA offers both health and dental plans.

About GEHA

GEHA was founded in 1937 as the Railway Mail Hospital Association in Kansas City, MO. They initially provided medical assistance to railway postal workers, but a few decades later expanded to provide coverage to all government employees. In 1959 they began offering coverage under the Federal Employees Health Benefits Act, and followed up with a 1964 name change to the Government Employees Hospital Association. The replacement of Hospital and Health in the name took place in 2007.

Today GEHA provides medical and dental plans to 1.8 million people. Coverage is available to federal employees, their families, and retirees as well. Qualified applicants can enroll directly either online or over the phone, depending on where they work.

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GEHA Products

GEHA offers a selection of choices for health insurance, as well as Medicare and dental plans.

Standard Option

GEHA’s Standard health insurance option is one of the lower premium plans, with a $15 co pay for primary care visits. The self-only plan has a $350 deductible, while the family plan has a $700 deductible. The plan offers both in-network and out-of-network coverage options. Prescription drugs start at a $10 co pay for generic drugs.

The Standard plan also includes vision, hearing, and dental coverage.

High Option

The High Option has a slightly higher monthly premium than the Standard Plan. There is a $350 individual plan deductible, and a $700 family plan deductible, just like the standard plan. Primary care visits have a $20 co pay, as do specialist visits.

Like the Standard plan, there is coverage both in and out of network, and prescriptions start at $10. Prescription coverage has no deductible, and coverage under this plan is more comprehensive with lower co pays on higher tiers.

This option also includes some vision, dental and hearing coverage.

Health Savings Advantage

This plan has higher deductibles but utilizes an HSA to help save pre-tax dollars for medical expenses. Deductibles are $1,500 on the self-only plan and $3,000 for families. While preventative care is covered with no deductible, other services are not covered until the deductible is met. After the deductible, there is a 5% coinsurance on primary care and specialist visits.

Prescription drugs are covered starting at a 25% coinsurance after the deductible is met.

Medicare and GEHA

GEHA offers a Medicare supplement plan that covers out of pocket costs including deductibles and co pays for eligible members who are enrolled in Medicare. The plans include savings on hearing and vision care, as well as access to the GEHA network of providers.

Dental

GEHA has two dental plans available. The GEHA Connection Dental Federal is part of the Federal Employees Dental and Vision Insurance Program (FEDVIP). The Connection Dental Plus plan is not part of that program, and thus allows year-round enrollment for qualified members.

Vision

Vision benefits are available to those enrolled in any of the GEHA health plans or enrolled in the Connection Dental program. These benefits do not appear to require an extra premium.

GEHA Rates

GEHA’s insurance rates are set based on whether you are a postal employee, work for another branch, or are a retiree.

The Standard option, for self-only, starts at bi-weekly premiums of $44.71 for postal employees and $53.86 for other employees. The High option starts at $89.15 bi-weekly for postal employees and $101.46 for other employees.

Rates are more than doubled for Self Plus One plans but do not increase as much for self and family plans.

It is not surprising that these rates are very low. Since the federal government backs these plans, employees get a greatly reduced rate. These rates cannot be compared to any marketplace or employee sponsored plans anywhere else as they are specific to government employees.

Claims

Most claims for medical care will be handled directly through the provider, but with dental, vision, and hearing insurance there are sometimes out of pocket expenses that must be submitted for reimbursement.

Claims forms can be found on the GEHA website in the Forms and Document section and downloaded for printing and submission.

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Ratings and Consumer Reviews

The only Better Business Bureau (BBB) page we were able to find for GEHA references their Dental Connection plan specifically, and not the company as a whole. The BBB gives an A- rating with six customer complaints on file in the past three years.

There are many more reviews for GEHA on Yelp, a total of 50 with some positive and the majority negative. Many complaints center on poor customer service experiences and claims that are not being paid. Billing appears to be a common problem, with several similar issues noted.

The number of complaints here is not especially high for a company serving 1.8 million members, but there are some repeated comments that do bear noting.

The Bottom Line

As one of the choices offered to federal employees, GEHA has something of a niche market and a large share of that market. Their rates are low and their coverage seems to be comprehensive. With a complaint volume that is low for their size, GEHA appears to be worth considering for federal employees needing health or supplemental coverage.

For a list of companies that we recommend, visit our Best Insurance Companies page.

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Review Information

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About Eric Stauffer

Author: Eric StaufferI am a former insurance agent and banker turned consumer advocate. My priority is to help educate individuals and families about the different types of insurance they need, and assist them in finding the best place to get it.

16 Comments

  1. Does GEHA government cover any hospitalization in Canada (ie trip).

    Reply
  2. Don’t use this insurance!

    We pay more now for dental care than when we didn’t have any insurance when you factor in the cost of the monthly premiums.

    The amount GEHA figures is reasonable for any kind of service is ridiculously low.

    So you end up paying the difference.

    It’s best to pay the dentist directly without insurance and skip paying premiums to this organization!

    Reply
  3. Avoid GEHA Dental at all cost!!!

    I had worn teeth due to grinding since I was a teenager.

    I had crowns done to correct my teeth. GEHA now refuses to pay the claim.

    It has been appealed 3 times now and they say that there will be no more appeals allowed.

    Now, because GEHA refuses to pay, my dentist will no longer do any work for me or my family unless I pay in full at the time of the visit.

    I will be changing dental insurance as soon as I’m eligible.

    Reply
  4. I had GEHA when I was a military technician and had canceled the insurance back in January 2016 because I went active duty and they said I was completely paid in full.

    Now over 3 years later I have a collection agency calling me about a $92 debt they are trying to collect.

    Plus the collection agency is saying they just got the account last month.

    I’m a little confused if I had a debt how did it take over 3 years before they try to collect?

    Reply
  5. Using GEHA Dental Plan, the one that says they cover the same percentage for out of network dentists as they do for in Network.

    I’m a Military Retired member and had been using their dental plan. I was forced to switch to a plan that Federal Employees have open to them.

    I chose GEHA. NOW, I’m paying more then I was previously so I figured the Coverage and copays would not change.

    That is NOT SO. My wife and daughter have used the same Dentist for years under the plan that I had from when I was retired.

    I paid minimal fees for visits. And when that plan said the annual check ups are covered 100% free, they where.

    NOW WITH GEHA, I had to pay 70$ for my Daughter and 90$ for my wife for the same thing from the same dentist.

    It turns out what GEHA thinks is fair value for certain things is a ridiculously low amount.

    so when buying the plan from them that states they cover in and out of network dentists the same, it really is a rip off.

    You pay this extra money to them but they don’t put any of it towards coverage costs. I wish I had paid attention to the MAGIC Math,

    Reply
  6. In speaking to friends at work who are all on BCBS, there appears to be a wellness program, which is rewarded financially. Does GEHA have any program like this?

    Reply
  7. Hello. My new insurance company, GEHA, is not abiding by the ACA. My 81 mg, 90 day, Aspirin prescription, should be no cost based on the ACA and my age (62). Prior to changing to GEHA this year I had BCBS and they properly covered everything as the ACA requires. The aspirin was free. However, GEHA, with their special contract with CVS/Caremark is charging me $6.47 – for 81 mg aspirin. That is ridiculous, even if I was supposed to pay, as it is almost 8 cents per aspirin. That is more than some of my more important and expensive prescriptions such as Metformin. $6.47 is even more than the “retail” cost of $3.76 of the exact same prescription that I had under BCBS and filled at WalMart and was provided for free as per the ACA. I asked GEHA to correct the matter but they have yet to be responsive or to remedy the situation. As a result, I will not be getting my 81 mg Aspirin prescription. I know I will not die due to not taking it, just will not gain the assumed preventive benefits from taking the medication. GEHA needs to provide the benefits mandated by the ACA. You need to be aware of their lack of following the ACA as well as responsiveness to the customer. This is going to be a long year with GEHA. Thank you. I have already moved four of my prescriptions to WalMart because their non-insurance cost is actually LESS than the mandated CVS cost with GEHA. They are unresponsive, sounds like my situation is somewhat similar to others. Ridiculous. I cannot wait for open period again!

    Reply
    • I am very disappointed with CVS and believe the contract with them has only resulted in problems. Before thE healthcare program initiated a few years ago by law GEHA was top shelf now I only stay because it is cheaper for me and Medicare is my primary. If anyone is dissatisfied with healthcare insurances lack of respect and possibly even lack of concern as if communicating with a computer program you should look at Yuang2020 campaign as he has developed ideas that I think will step towards solving our dilemma involving poor insurance representation!!!!

      Reply
  8. Just made a comment about GEHA Dental Connection Federal Plan about not having a dentist within 75 miles. UPDATE: There was something wrong with their website reading my zip code. Only showed 1 provider 75 miles away. I put in a neighboring zip code and quite a few dentists popped up in my area, including my zip code. So please disregard my previous comment.

    Reply
  9. I AM ON MEDICARE AND HAVE GEHA, HOW DOES MEDICARE ADVANTAGE WORK WITH GEHA?

    Reply
  10. I am a Federal employee about to retire. Our retirement folks tell me that I will just stay on GEHA instead of switching to Medicare because it’s all Federal anyway. This doesn’t sound quite right, but my main question is this: is it more cost effective to stay with GEHA or go with Medicare plus a commercially available supplement plan?

    Reply
    • Hi Turner,

      There are a lot of variables to consider, and your personal situation will play a big part of that. For example, what is the cost difference? Additionally, there are penalties that can be faced if not electing certain Medicare sections at the onset of eligibility, so how does that fit in with the situation?

      I would seek a local Medicare/health expert to sit down with and go over your options. This is a fairly unique situation, and having information from an outside source would be helpful in making the right decision.

      Best,
      Eric Stauffer

      Reply
      • Turner, if you are retiring, you basically have no alternative except to take Medicare. Please check carefully because you might find that GEHA will not cover you unless you have Medicare. That is the way it is with Tricare for Life. It is stated very emphatically on the Medicare website.

        Reply
  11. Warning anyone considering GEHA that their mental health coverage is terrible and they are extremely hard to contact and negotiate with. I am switching insurance as soon as the open season begins and would never recommend GEHA to anyone who wants good mental health coverage and customer service.

    Reply
  12. I’ve had a problem with my GEHA prescription coverage opioid limits and CVS/Caremark is not answering my questions with solid answers. My doctor and I have been well under the CDC 90 mg limit and now they are using a pill count and I can’t get a straight answer from them. Help direct me if you can’t help me. PLEASE.

    Reply

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