The Government Employees Health Association, otherwise known as GEHA, is a nonprofit organization that provides dental and health plans to federal employees, retirees, and their families. It is the largest national medical/dental plan provider for federal employees and retirees. Founded in 1937 by federal employees, GEHA rehab coverage serves over two million policyholders.
So, what is the extent of what GEHA covers? The dental and health portion is very welcomed to those who have it, but does it go further? Is there coverage for things that exist out of the primary two parts of coverage? There are many behavioral health benefits included, such as detox, mental health support, dual diagnosis, and even rehabilitation. So, what is needed when it comes to locating GEHA rehab coverage? Throughout this guide, we will touch base on the many questions one may have regarding these services and review the types of addiction treatments covered.
GEHA greatly benefits federal employees as it helps them care for themselves and their families. Let’s see how a plan with GEHA can go even further.
Do GEHA Insurance Plans Cover Substance Abuse Addiction Rehab?
GEHA insurance plans cover addiction rehab as part of their benefits for behavioral health. Determining how much is covered with most insurance plans depends on your plan. You must review what is covered, whether standard, high, or HDHP. Multiple options fall under the umbrella of GEHA, like inpatient and outpatient rehab, as well as dual diagnosis for addiction and mental health issues. Remember that some choices, like the GEHA high option, may offer a more comprehensive rehab benefit plan than others. In-network and out-of-network will also impact the money spent on the policyholder’s side. Review your plan’s Summary of Benefits and coverage and contact GEHA directly with any follow-up questions if needed.
Mental Health Treatment That Works
Call 949-625-0564What Types Of Drug And Alcohol Addiction Treatment Does GEHA Cover?
Now that we know that GEHA will most likely cover substance abuse rehab, the question is, what types of treatment do they cover? Keep in mind that your plan’s benefits will determine the cost to the policyholder. Treatment needs to be in-network and, in most cases, pre-authorized. Typically, the following services are included in GEHA rehab coverage, but always double-check your plan or speak to a representative to ensure you are covered before proceeding.
Rehabilitation (inpatient and outpatient)
- Coverage for residential treatment for addiction with medical care, therapy, and programs.
PHP Options
- Partial hospitalization programs where you will have a high level of care akin to inpatient hospitalization but with the ability to return home every day
- Intensive outpatient programs where you will be able to go home but have multiple appointments a week to go to for care
- Outpatient therapy sessions and residential treatment
- Dual-diagnosis treatment
There are many other avenues that GEHA covers, like detox, therapy, and counseling for addiction, and medication-assisted treatment, which is used for more serious addictions like methadone. Most forms of service need to be pre-authorized, so making sure you contact a representative who can assist you with what your specific plan covers is ideal.
How Long Will GEHA Health Plans Insurance Cover Treatment?
When it comes to addiction, there is not a one-size-fits-all answer on how long recovery takes. One may be able to kick the habit quickly, but recovery itself is a lifelong battle. So, when it comes to GEHA rehab coverage, how much time do you have is a question that may be on your mind. What needs to be considered when asking this question is, what service?
Inpatient treatment plans vary depending on the length of a dual diagnosis on the plan held. They usually have a maximum number of days, such as 30, 60, or 90. Outpatient treatment usually ranges from 20 to unlimited. PHP plans can be compared to inpatient care regarding the maximum number of days but may include extra costs. The length of a dual diagnosis also depends on the plan and the service needed.
Remember to check what your plan covers online or by calling GEHA directly. Knowing exactly what is covered and how long the coverage will last will prevent unnecessary surprises later.
Checking Your GEHA Health Plan Insurance Benefits
Due to multiple plans with different price points, you should first tackle your specific plan and its entailments. Then, check your Geha plan’s Summary of Benefits and coverage for GEHA rehab coverage. After reviewing your SBC, you should call GEHA directly with any additional questions or concerns.
- GEHA standard: Covers inpatient and outpatient treatment, with cost-sharing to the policyholder. Detox is usually covered as part of these inpatient and outpatient plans. Therapy and counseling are offered but with co-plays. The out-of-pocket cap is usually about $5,000 for in-network and $7,000 for out-of-network.
- GEHA high: Both inpatient and outpatient services for mental health are offered with more comprehensive coverage and lower out-of-pocket costs to the policyholder. Detox is also covered at a reduced cost, as are therapy and counseling, with broad coverage for groups and families and lower copays. The out-of-pocket cap is $4,000 in-network and $6,000 out-of-network.
- GEHA HDHP: This plan has a high deductible, and most options are usually met when the deductible is met. The out-of-pocket cap is $5,000 in-network and $10,000 out-of-network.
Again, it is important to review your SBC before proceeding to ensure that all aspects of your plan are covered for GEHA rehab coverage.
Know How Your GEHA Rehab Coverage Can Help
GEHA can be a huge benefit for a federal employee and their families. It provides health and dental coverage to millions across the nation. However, not all trips to a health facility have to do with physical health and dental hygiene. There are many benefits to having a behavioral health portion included in your coverage. Addiction treatment and dual diagnosis are just some of them, and for those suffering from the weight of substance abuse, it can make all the difference for the opportunity to turn one’s life around.
However, with health plans anywhere, knowing your coverage plan and what is included is a must before moving forward with treatment. Pre-authorization may also be needed before moving forward as well. Under a broad umbrella, GEHA plans can cover inpatient/outpatient rehab, detox, PHP plans, and more. GEHA also covers co-occurring mental health conditions as well, which is very helpful as some mental health issues can co-exist with an addiction problem. Reach out by calling Moment of Clarity at 949-625-0564 today to see how our different services, like mental health treatment, can help you start a new life.
