GEHA President Richard Miles hosted an online chat on March 23, 2010. Below is a transcript of that chat.

Wow, that hour flew by. Thanks for all your thoughtful questions. If I did not answer your question during the chat, we will follow up by email if you provided us a valid email address.

Thanks to all our current members for choosing GEHA. And if you're not currently with GEHA, thanks for visiting us today. Be sure to let our Customer Service department know if you have any additional questions: (800) 821-6136 for our health plan and (877) 434-2336 for our FEDVIP dental plan. Best wishes to you all.

Sincerely,

Richard Miles
GEHA President

P.S. Here are two great ways to follow us online:

1. Become a fan of our Fit Federal Employees page on Facebook.
GEHA has created an online community to provide great fitness and health information for federal employees.

2. Follow us on Twitter.
www.twitter.com/GEHAhealth for health and FEHB news
www.twitter.com/GEHAdental for dental and FEDVIP news

For more information about our FEHB health plans, go to www.geha.com or call us at (800) 262-GEHA.

For more information about our FEDVIP dental plan, GEHA Connection Dental Federal, go to www.gehadental.com or call (877) 434-2336.

If you have comments about this online format, or if you would like to offer suggestions for future chats, please send an email to webmaster@geha.com.

LAS CRUCE, New Mexico: What is going to be discussed during this session?

Richard Miles: We will be answering questions from federal employees on GEHA health and dental plans. Thanks for logging in to join us today.

State College, Pennsylvania (GEHA Standard Option): If a person has a secondary insurance for dental service, how does GEHA coordinates payment with the other insurance company? Does GEHA pay the provider directly or reimburse the member? Also, does GEHA consider a person getting their iron count through blood work for a physical as part of preventative care? How many physical therapy sessions is a person allowed to receive per year?

Richard Miles: We coordinate benefits with other dental insurance carriers by following the NAIC guidelines to determine the primary, secondary and tertiary payer. We will either pay our regular benefits or the balance due, whichever is less. If there is no assignment on the claim, GEHA would pay the member directly.

For information on preventive care coverage for blood work, please contact our Customer Service department directly at (800) 821-6136. If possible, please provide the procedure code for that lab work.

GEHA allows up to 60 visits of physical therapy and occupational therapy combined per calendar year. Please remember these services do require preauthorization.

Fairfax, Virginia (GEHA HDHP Option, Connection Dental Federal (FEDVIP) High): Why is GEHA not depositing the full year Health Savings Account (HSA) contribution at one time like it did for 2009?

Richard Miles: We made that change at the direction of Office of Personnel Management (OPM). OPM is requiring that all High Deductible Health Plans (HDHPs) in the FEHB program make contributions monthly, rather than annually.

Bristow, Virginia: With the High Option GEHA dental plan, do you have a missing tooth clause exclusion?

Richard Miles: Yes, GEHA Connection Dental Federal does exclude any service or supply rendered to initially replace a natural tooth lost prior to the effective date of coverage.

This does not apply to a missing tooth that was replaced by an appliance prior to the effective date of coverage. For example: If you had a natural tooth missing prior to joining this plan that was not previously replaced by an appliance (such as a fixed bridge, removable partial or complete denture), the new appliance will not be covered. However, if you had a tooth extracted and replaced by an appliance before the effective date of coverage with this plan and the appliance needs to be replaced, the replacement of that appliance can be considered a covered service, if it meets the conditions for replacement as listed in the brochure. .

Also, if you had a natural tooth missing prior to joining this plan that was not replaced and now are having an adjoining tooth extracted and replacing both with a multi-unit appliance, only the portion of the appliance that replaces the natural tooth extracted after the effective date of coverage will be considered. For example: When one tooth is extracted prior to coverage and not replaced and another tooth is extracted after the effective date of coverage, we will cover only the portion of the multi-unit appliance for the tooth extracted after coverage was effective.

Massapequa Park, New York (GEHA Standard Option, Connection Dental Federal (FEDVIP) Standard): Does GEHA cover acupuncture?

Richard Miles: Yes, under both High and Standard options, GEHA allows for 20 acupuncture treatment procedures per calendar year for medically necessary acupuncture treatments if performed by a medical doctor (M.D.) or doctor of osteopathy (D.O.). The amount of coverage depends on which plan you’re in.

Moreland, Georgia (GEHA Standard Option): Is Coventry of Georgia going to continue to administer GEHA in Georgia in 2010?

Richard Miles: Yes, GEHA will continue to utilize Coventry in Georgia in 2010.

Fayetteville, Pennsylvania (GEHA High Option): How often does GEHA change provider networks? The preferred providers that I chose when I moved here 3 years ago are no longer preferred. In these situations, do you recommend that patients change their doctors?

Richard Miles: We try to avoid making wholesale changes in the network, but we are always interested in adding quality providers. Participation in the GEHA preferred provider network is generally determined by the individual physician. To nominate your physician to the network, please complete an online Medical Provider Nomination Form or call Customer Service at (800) 821-6136.

Each nominated provider is contacted by GEHA. It is also very helpful when members let physicians know they are being nominated to the GEHA network.

, Missouri (GEHA HDHP Option, Connection Dental Federal (FEDVIP) Standard): For members in the High-Deductible Health Plan (HDHP), are you still making a one-time deposit of $720 for self coverage and $1,440 for family coverage in their health savings account (HSA) at the first of the year?

Richard Miles: No, we are no longer depositing one lump sum at the beginning of the year. The deposit will now be made monthly. We made that change at the direction of OPM. OPM is requiring that all HDHP plans in the FEHB program make contributions monthly, rather than annually.

Mesa, Arizona (GEHA Standard Option, Connection Dental Federal (FEDVIP) Standard): Where you can get a flu shot, with GEHA insurance?

Richard Miles: You can get the flu shot anywhere it is available: your doctor’s office, pharmacy, or health department. The choice is yours. When you get a routine immunization endorsed by the CDC including pneumonia and influenza) at a participating provider, GEHA pays 100% of the plan allowable with no deductible. If the provider is not participating, you would be responsible for the plan’s deductible, coinsurance and any difference between our allowance and the billed amount.

Austin , Texas (Connection Dental Federal (FEDVIP) High): Can I use my GEHA dental insurance even if I have Blue Cross as my health care provider and they include a few minor dental cleanings in their coverage? The dental office is saying that I can’t use my GEHA as my primary dental insurance because I have BC/BS as my primary health insurance.

Richard Miles: Yes, even if your FEHB plan has dental benefits, you can still use your GEHA Connection Dental Federal coverage. By law, any benefits your FEHB plan offer are paid first. However, we will coordinate benefits and consider any remaining balance (up to our regular benefits).

New York, New York (Connection Dental Federal (FEDVIP) High): Why are dental implants not covered?

Richard Miles: Each year, when we review our covered services, we consider how to best spend our members’ premium dollars. The primary reason we have not covered dental implants is cost. While implants do represent a good choice in some situations, especially single-tooth replacement, they generally tend to be more expensive than other options. In most cases, bridges or dentures represent the least costly, dentally- acceptable treatment for a missing tooth.

15537, Pennsylvania (GEHA High Option, Connection Dental Federal (FEDVIP) High): I am a current member. Do I have to do anything to re-enroll for 2010?

Richard Miles: No, you don’t need to do anything to remain a member in 2010. You would only make changes during Open Season if you wanted to terminate or change plans.

Corpus Christi, Texas (Connection Dental Federal (FEDVIP) High): Until what age is a child eligible for dental coverage? And, what if the child needs orthodontic services but will be 19 after the 24-month waiting period?

Richard Miles: It depends on the GEHA dental plan. In the GEHA Connection Dental Federal plan, which is part of the FEDVIP program, unmarried dependent children are eligible for coverage under the dental plan until age 22. Under certain circumstances, you may continue coverage for a disabled child 22 years of age or older who is incapable of self-support. Under FEDVIP rules, there is no 31-day extension of coverage, temporary continuation of coverage (TCC), or right to convert to an individual policy (conversion policy).

In the GEHA Connection Dental Plus plan, unmarried dependent children are eligible for coverage until age 25.

To be eligible for orthodontic benefits, the child would have to be under age 19 for FEDVIP and under age 18 for Connection Dental Plus after the waiting period has ended.

San Diego, California: Can I enroll now? And can I start using your plan right away? Is there a waiting period?

Richard Miles: Enrollment in FEDVIP dental plans for the 2010 benefit year is available during Open Season, which runs this year from November 9 through December 14.

After you enroll, you will begin receiving dental benefits in 2010. BENEFEDS handles eligibility and enrollment for FEDVIP plans and will be able to provide you with an exact effective date. You can reach BENEFEDS at (877) 888-3337 or at www.benefeds.com.

The only waiting period in the GEHA Connectional Dental Federal plan is for orthodontic services. This is a 24-month period for covered dependents.

Myrtle Beach, South Carolina (Connection Dental Federal (FEDVIP) High): We need more providers in Horry County, South Carolina. What is being done to get more Dentists onboard?

Richard Miles: We are always interested in adding dentists to the network. Of course we can’t force them to join but nominations from patients are sometimes effective in getting a dentist to consider joining a network.
To nominate a dentist to the dental network, please click on our online dental nomination form. I also want to point out that we cover out-of-network dentists. In that case, the amount paid by GEHA would not change as our reimbursement is based on the network allowance. But, you may have higher out-of-pocket costs for the balance of the bill from an out-of-network dentist.

Overland Park, Kansas (GEHA High Option, Connection Dental Federal (FEDVIP) High): Will the dental option provide benefits to someone with Medicare?

Richard Miles: FEDVIP plans are available to all active and retired federal employees, whether or not you have Medicare. For complete information on eligibility, please check with BENEFEDS at (877) 888-3337 or at www.benefeds.com.

Camp Arifjan, Kuwait (GEHA High Option, Connection Dental Federal (FEDVIP) High): I am a Department of Defense employee working overseas. How can I get dental service in Kuwait?

Richard Miles: GEHA Connection Dental Federal covers members worldwide. You can use any provider. For dental services you receive outside of the United States, please send your itemized bills to GEHA along with an English translation. We will use the daily rate of exchange for the date of service and pay for covered benefits in U.S. currency. Submit all international claims to:

GEHA Connection Dental Federal
PO Box 2336
Independence, MO 64051-2336

You may also send them by fax them to (816) 257- 3241.

Members outside the United States can reach us using a dedicated, secure email form.

Peoria, Illinois (Connection Dental Federal (FEDVIP) High): We are currently signed up for the dental high plan do I need to do anything to continue with our high family plan?

Richard Miles: You do not have to do anything to continue coverage. Your coverage will automatically continue unless you choose to terminate your coverage during Open Season.

Elko, Nevada (Connection Dental Federal (FEDVIP) High): I would like to have a schedule of the plan allowance amounts allowed for specific procedures.

Richard Miles: The plan’s maximum allowance depends on three things:

1. Whether you receive services at a preferred provider;
2. Your geographic area; and
3. The contract with the specific provider you select.

If you are a current dental plan member, you can look up what the plan allows for most dental procedures online. Below are instructions on how to use this online feature:

• Go to our FEDVIP home page at www.gehadental.com.
• Select MEMBER WEB SERVICES in the left hand panel.
• If you have previously registered, log in to your account.
• If you have not previously registered, you will need to select REGISTRATION to use this feature.
• Select DENTAL PRICING LOOKUP.
• Enter the ZIP code in the ZIP code field.

Raleigh, North Carolina (GEHA High Option): Will GEHA pay for the shingles vaccine?

Richard Miles: When you use an in-network provider, the shingles vaccine is covered at 100% as a preventive benefit for adults ages 60 and older. If you use an out-of-network provider, you will pay your deductible and coinsurance.

Memphis, Tennessee (GEHA Standard Option): What happens when a retired federal employee refuses to sign up for Medicare Part B?

Richard Miles: GEHA doesn’t require you to enroll in Medicare. The decision is yours. However, if you enroll in Medicare and are retired, Medicare would be your primary carrier and GEHA would be secondary. When Medicare is primary, GEHA will waive its deductible and coinsurance and coordinate with Medicare to pay its deductible and coinsurance for covered services under our plan. If you do not have Medicare, your GEHA coverage would remain as it is now.

Norfolk, Virginia (GEHA Standard Option): I see on your website regarding the health care debate that GEHA will exist only until 2018. What happens after that?

Does this mean the federal government will no longer offer medical benefits after the proposed passage of a health care reform bill and/or the installation of a public option?

As far as I can see, health care reform does NOT include dental care; will this still continue to be offered as a federal employee benefit?

Richard Miles: Please see our latest health reform update.

We fully expect FEHB and GEHA to remain intact. We also expect that the FEDVIP program, which includes our Connection Dental Federal plan, to remain available to federal employees.

The Senate Finance Committee recently passed its version of health care reform and the Senate is working on reconciling that bill with one passed earlier by the Health Education Labor and Pensions Committee. Once the two bills are merged into one bill, it is expected to be brought to the Senate floor for debate.

Midland, Georgia (Connection Dental Federal (FEDVIP) High): I have a daughter who is a full-time college student and still under my dental benefit. I received a notice saying she would no longer be eligible for services once she turns 22. Well she does not graduate until 2010. ..which is after her 22 birthday.

Richard Miles: Unmarried dependent children are eligible under your family plan, regardless of student status, until their 22nd birthday.

We are continuing to keep an eye on bills pending in Congress that would extend coverage for dependents to age 25. If any of these proposals become law, we will let our members know.

Baton Rouge, Louisiana (GEHA Standard Option): Do you have information on the H1N1 vaccine?

Richard Miles: We will continue to cover the H1N1 vaccination under our well-child or adult preventive care benefits at 100%, just like we currently pay for the standard flu vaccine. There may be some age recommendations, and we will follow the guidelines that are established by the CDC. If you have questions about H1N1 flu, you’ll find the answers at www.flu.gov - a one-stop shop for U.S. government seasonal, H1N1, avian and pandemic flu information.

El Reno, Oklahoma (GEHA High Option): Dear President Miles: My husband is a retired federal employee and we have GEHA for our insurance. Will we lose this insurance coverage under the new health care bill? I realize the final bill is not finished but under any of the proposed plans will it get us? Are they doing away with the FEHB?

Richard Miles: There are many bills proposed but those bills that have the best chance for passage do not call for disbanding the FEHB program. The final bill may have a provision to remove members and employees of Congress from the FEHB program but that shouldn’t affect most of our members. We are concerned about the proposed taxes assessed against health plans. Those assessments will result in higher premiums for all our members. How much higher is still unknown.

Alexandria, Virginia (GEHA High Option, Connection Dental Plus): Do the health care professionals at GEHA recommend that their participants join a fitness center that monitors their exercise activities such as weights lifted and calories expended if that form of exercise is recommended by their doctor?

Richard Miles: We agree that having a healthy lifestyle is important, exercise and diet is an important factor in your health. GEHA offers discounts for new members to health fitness clubs. Log in to GlobalFit.com/GEHA to see the facility near you. GlobalFit offers a network of 12,000 participating fitness clubs nationwide, discounts on workout equipment and videos, discounts on the NutriSystem weight management program and discounts on 12-week health coaching programs.

Ogden, Utah (Connection Dental Federal (FEDVIP) High): How do I nominate a dentist?

Richard Miles: To nominate a dentist to the dental network, please click on our online dental nomination form.

I also want to point out that we cover out-of-network dentists. In that case, the amount paid by GEHA would not change as our reimbursement is based on the network allowance. But, you may have higher out-of-pocket costs for the balance of the bill from an out-of-network dentist.

El Paso, Texas (GEHA Standard Option): Is there a maximum lifetime amount GEHA will pay? Is it possible that after a certain amount paid, GEHA will no longer be responsible to pay for any other medical needs in my lifetime?

Richard Miles: GEHA doesn’t have an overall major medical lifetime limit. However, some services covered under the plan do have lifetime limitations. They are as follows:

• Vision therapy – 30 outpatient vision therapy visits by an ophthalmologist or optometrist, per person, per lifetime.
• Durable medical equipment benefits have a lifetime maximum of $25,000.00 per person.
• Smoking cessation – Up to $100 to aid in smoking cessation, per person, per lifetime, including related expenses such as drugs.
• Inpatient hospital/facility for treatment of alcoholism and drug abuse at an out of network provider – 30-day maximum per lifetime.

Stafford, Virginia (GEHA High Option, Connection Dental Federal (FEDVIP) High): I am a retired federal employee and a member of GEHA. Do you have a disability/home care insurance?

Richard Miles: No, GEHA does not offer that insurance. One option for you is the Federal Long Term Care Insurance Program (FLTCIP), which can help you pay for the potentially high cost of long-term care services.

To qualify for coverage under the FLTCIP, you must apply for and pass a medical screening (called underwriting). Certain medical conditions, or combinations of conditions, will prevent some people from being approved for coverage. You must apply to know if you will be approved for enrollment. To request an information kit and application, call (800) 582-3337 or visit www.ltcfeds.com.

Midland, Texas (GEHA High Option): Are you still staying with the First Health Network for 2010 (for PPOs)?

Richard Miles: There are no changes in the PPO Networks for 2010. First Health Network will continue to be utilized in Texas.

Coral Springs, Florida: What is your coverage for eye care?

Richard Miles: All GEHA members get vision coverage through the Connection’s Avesis Vision Plan, at no additional premium. Members in the HDHP plan pay a $10 copay for an in-network eye exam. Members in other GEHA health and dental plans pay just a $5 copay on eye exams at participating in-network Avesis locations and get discounts off the retail price of lenses, frames, specialty items such as tints, lightweight plastics, scratch-resistant coatings, contact lenses and surgical procedures (including LASIK).

For a list of participating locations or further information, go to www.avesis.com or call (800) 672-7552.

Moline, Illinois (GEHA Standard Option): When will you be adding more doctors to your network in the Quad City area?

Richard Miles: Participation in the GEHA preferred provider network is generally determined by the individual physician. To nominate your physician to the network, please complete an online Medical Provider Nomination Form or call Customer Service at (800) 821-6136.

Each nominated provider is contacted by GEHA. It is also very helpful when members let physicians know they are being nominated to the GEHA network.

Jefferson City, Missouri (Connection Dental Federal (FEDVIP) Standard): If I am not changing anything, do I have to submit or do anything during Open Season? Thank you.

Richard Miles: Thank you for your continued membership. You do not have to do anything to continue your coverage into 2010. You would only contact BENEFEDS during Open Season if you wanted to cancel or make changes to your existing plan.

Rockville, Maryland (GEHA High Option, Connection Dental Federal (FEDVIP) High): Is it usually sufficient to drop back to GEHA Standard Coverage, with a Medicare Part D policy to help out on drug costs when we retire and Medicare A & B? Our primary day-to-day issue is that my husband takes several drugs that have no generic equivalent and are very expensive. Does it make sense in our case to stay with the High Option?

Richard Miles: GEHA’s prescription drug coverage is, on average, better than the standard Medicare prescription drug coverage. So, as long as you keep your GEHA health plan, you do not have to join a Medicare drug plan now and will not have to pay a penalty for Medicare prescription drug coverage if you decide to join a plan later. Some people will save money by having dual coverage but everyone’s coverage needs are different. Many seniors with Medicare A & B primary do switch to Standard Option. Standard Option has a much lower premium. The big difference between our High and Standard plans is how we cover brand-name prescription drugs. Under either plan, generic drugs are available for just a $5 copay. If you need brand-name drugs, however, you pay 50% of that cost in the Standard Option plan up to a $200 maximum for up to a 30 day supply and a $500 maximum for supplies over 30 days. (The maximum is new in 2010). If you move to Standard and anticipate needing brand-name drugs, adding a low-premium Medicare D prescription drug plan may help you save money.

Omaha, Nebraska: I was in GEHA once but was told that it was no longer available in Nebraska and I had to switch companies. Has this changed? Can I switch back to GEHA?

Richard Miles: GEHA is a nationwide plan and available in all states. During Open Season, you can change to GEHA by contacting your Personnel or Retirement Office.

Detroit, Michigan: Several employees have been disappointed in the coverage of their current federal dental plans and are looking to switch during open season. GEHA may offer a good option for them to consider. Which GEHA plans best cover dental work such as onlays and crowns, and are there any exclusions employees need to know in order to elect the most comprehensive coverage?

Richard Miles: The Connection Dental Federal High Option is the most comprehensive dental care plan offered by GEHA. With it, you receive 50% benefit for bridges, along with other major services such as crowns, partials, dentures, root canal treatment, etc. In addition, GEHA pays a 100% benefit for preventive services such as exams, cleanings and X-rays under the High Option, and we pay 80% for fillings and extractions. There is not a pre-existing condition clause. However, we do not cover services to replace teeth missing that had not been replaced by a prosthetic prior to enrollment. All covered services, with the exception of children’s orthodontia, are available from the beginning effective date.

Cheboygan, Michigan (GEHA HDHP Option): What is the advantage of the high-deductible health plan (HDHP)?

Richard Miles: Many individuals find that they can save money with a HDHP, which has affordable premiums. In addition, your plan comes with a health savings account (HSA), funded through monthly deposits from GEHA. When you enroll at Open Season and stay in the plan all year, GEHA will contribute $720 (Self Only) or $1,440 (Self and Family) to your HSA. You can withdraw HSA funds as needed to pay for health care costs. Unused HSA funds roll over and earn tax-free interest. GEHA’s HDHP plan encourages preventive care such as annual physicals, mammograms and flu shots by paying 100% in-network.

A high-deductible health plan is the best plan for many people, but it may not the best plan for everyone. To learn more, please see the comparison tools available at www.opm.gov/insure.

Hillside, Illinois (GEHA Standard Option): 1. What is Lab Card, and how does it work? I have Medicare Part A only. If I choose Standard Option, will it reduce my copayment and or deductable? What are the allowance percentages?

Richard Miles: Lab Card is a voluntary program to use for covered outpatient lab tests. You show your Lab Card ID card and tell your physician you would like to use the Lab Card benefit. The physician can draw the specimen and call to have it picked up, or you can go to an approved collection site and show your Lab Card and your test requisition form from your physician and have the specimen drawn there. You must show your Lab Card each time you obtain lab work whether in the physician’s office or collection site.

Having Medicare Part A only will make no difference in your copayments or deductible.

When you visit a participating provider, the plan benefit percentage is 85% and the non-participating provider percentage is 65%. This is after your calendar year deductible is satisfied.

Ellicott City, Maryland (GEHA Standard Option, Connection Dental Federal (FEDVIP) Standard): How do you get discounts on gym membership, workout equipments and NutriSystem meals? What gyms are under the plan for discount on membership?

Richard Miles: Our CONNECTION Fitness program has partnered with GlobalFit to offer our members discounts on gym memberships, at-home workout equipment, NutriSystem meals and health coaches. GlobalFit now offers discounts on 24 Hour Fitness memberships, boosting its national network to more than 12,000 gyms.

To find participating gyms in your area or for more information on discounts, go to www.globalfit.com/geha or call GlobalFit at (800) 294-1500.

I notice in the Fall 2009 GEHA Keynotes a table of premiums that await us in 2010. It points to increases in three categories, where obviously the majority of members are grouped. Are these the money-making categories for GEHA? The High Option Plan will enjoy a 13% decrease and 0.4 increase respectively compared to 8.0% across the board increase for the Standard Option Plan. Is this equitable? Why must my wife and I pay the same premium as a family of four, which must necessarily result in a greater liability to GEHA than the two of us?

Richard Miles: Actual health care expenses of our members, not profits, determine GEHA health care premiums.

At GEHA, more than 95 cents of every premium dollar we receive is paid back to members in benefits. Each of our health plans must bring in enough premium income to pay for the prescriptions, doctor visits and hospitalizations for the members within that plan.

It is equitable that members in High Option pay a higher premium for a higher level of benefits and that members in Standard Option pay a lower premium along with a more of the cost of prescription drugs.

All FEHB plans operate within the same guidelines set by the federal government and are not able to charge a different premium for family coverage according to the size of the family.

Sebastian, Florida (GEHA Standard Option, Connection Dental Federal (FEDVIP) High): Why doesn’t GEHA have emergency room doctors and ambulance service in-network?

Richard Miles: We do have some emergency room doctors in our networks, though they typically are reluctant to join networks. Emergency room doctors contract with their hospital, and as a result don’t typically have their own practice and billing. We extend in-network benefits to hospital-based physicians like emergency room doctors, anesthesiologists, radiologists and pathologists when the hospital is in our network.

Many ambulance services are run by counties or cities, and they are unwilling to join networks and discount their services because there is no competition.

Vienna, Virginia: Can a federal employee join both the GEHA FEDVIP Dental Plan and the Connection Dental Plus plan for 2010 and then receive 100% coverage for crowns/bridges provided by a PPO dentist?

Richard Miles: While there is nothing preventing a federal employee from joining both GEHA Connection Dental Federal (part of the FEDVIP program) and GEHA Connection Dental Plus, we generally don’t recommend it.

Connection Dental Plus has a 12-month waiting period for major services and pays last after other dental coverage. For that reason, you would have to participate for 12 months before the remaining balance on crowns and bridges could be considered.

There is no waiting period in the GEHA Connection Dental Federal (FEDVIP) plan for crowns and bridges.

Calexico, California: Do you guys have an international dental plan?

Richard Miles: Yes, our GEHA Connection Dental Federal covers member anywhere in the world.

Oklahoma City, Oklahoma: Are all your plans going up 8.8% like BCBS is doing and all others. Do you have the same or better coverage as BCBS does, or can you beat what they offer?

Richard Miles: GEHA has three health plan options. Our high-deductible health plan had no change in premium. Our High Option plan had a small decrease in premium for members with Self Only coverage and a very small increase for members with Self and Family coverage.

The member share of the Standard Option plan biweekly premium will increase 8%, though it remains one of the most affordable plans in the FEHB program. Standard Option non-postal premiums are $37.02 biweekly for Self coverage and $84.13 biweekly for Self and Family coverage.

Although I cannot compare our plan to other FEHB plans, I do believe our health plans provide great coverage and great value.

Georgetown, Texas (GEHA High Option, Connection Dental Plus): Does GEHA cover chiropractor services?

Richard Miles: Yes, The plan will cover up to 12 chiropractic, hands-on spinal manipulations per calendar year at up to $20 per visit and up to $25 for one spinal X-ray per year. Services are first subject to the calendar year deductible.

Dallas, Texas (GEHA High Option): I will be eligible for Medicare in fewer than five months. I know that I must enroll in Medicare, but do I get to keep GEHA? If so, what is the monthly cost?

Richard Miles: Yes, you certainly can keep GEHA when you have Medicare. When you have Medicare A&B primary, and GEHA as your secondary insurance, Medicare pays first and GEHA pays the rest of your covered hospital and doctor expenses. You get 100% coverage for most medical care and will continue to pay copays for your prescription drugs.

Your biweekly cost for High Option (non-postal) is $79.54 for Self coverage or $186.06 for Self and Family coverage.

Hinsdale, Montana (GEHA High Option): Do I have optometry coverage?

Richard Miles: As a High Option GEHA Member, you have access to our Connection’s Avesis Vision Plan, which allows for one eye exam per year for only $5 if you use a participating Avesis provider. You can also receive discounts on glasses, contacts from participating providers. These benefits are not part of the FEHB contract but are provided free of charge to GEHA members.

Redmond, Oregon (GEHA Standard Option, Connection Dental Federal (FEDVIP) Standard): Hello. Where do I find out what the plan allowance amounts are? Thanks.

Richard Miles: Information on the maximum allowable charge can be found on the GEHA website. Below are instructions on how to use this online feature:


• Go to www.GEHAdental.com
• Select MEMBER WEB SERVICES in the left hand panel.
• If you have previously registered, log in to your account.
• If you have not previously registered, you will need to select REGISTRATION to use this feature.
• Select DENTAL PRICING LOOKUP.
• Enter the zip code in the zip code field.

You should be able to view the current list of the plan’s maximum allowable charge by treatment.

Battle Mountain, Nevada: I am looking for the best plan for my families current health needs. Our current major health concern is chiropractic care. How is this coverage offered? (i.e. number of visits per year, co-pay, etc.)

Richard Miles: Chiropractic services are limited to 12 visits per calendar year (for manipulation of the spine) at $20/visit, $25 per calendar year for chiropractic x-rays (to detect nerve interferences due to spinal suluxations or misalignments).

Burke, Virginia (GEHA High Option): I have been receiving individual psychotherapy from a therapist who is
* Licensed Professional Counselor (LPC), Virginia
* Licensed Marriage and Family Therapist (LMFT), Virginia
* Registered Nurse (RN), Virginia Why was my claim totally rejected?

Richard Miles: In 2009, LPC, LMFT, and RN would not be considered covered providers. In 2010, LPCs and LMFTs are GEHA covered providers (exception: marriage counseling is not a covered service).

HOUSTON, Texas (GEHA High Option): I turn 65 next year,what happens to my wife who is on my policy and she is 60. I will go on Medicare. How does that work?

Richard Miles: When you are retired and eligible for Medicare, GEHA would then become your secondary carrier. However, for your spouse we would remain primary for them and their benefits would remain the same.

Pueblo, Colorado (GEHA High Option, Connection Dental Federal (FEDVIP) High): Where can I check to see if my doctor is in your network?

Richard Miles: Our websites provide quick, up-to-date access to our provider networks. For doctors, hospitals and pharmacies, go to our health provider search. For dentists, try our dental provider search.

New Orleans, Louisiana (Connection Dental Federal (FEDVIP) High): How do I file a claim online?

Richard Miles: We currently do not have a process for stateside members to file claims online. However, you may fax them to us at (816) 257-3241. You can also mail your claim to: GEHA Connection Dental Federal PO Box 2336 Independence, MO, 64051-2336.

Charlotte, North Carolina (GEHA Standard Option, Connection Dental Federal (FEDVIP) High): Will Connection Dental Federal be covering dental implants at anytime in the future?

Richard Miles: We currently have no plans to add coverage for implants or implant-related services.

Macon, Georgia (GEHA High Option): Does GEHA have a counselor that can advise me on whom I need to see concerning what condition I have?

Richard Miles: I suggest you contact our Nurse Advice Line at (800) 892-8260. Registered nurses are available to help members with questions 24 hours a day, 7 days a week.

Blue Springs, Missouri (GEHA High Option): What effect will the proposed health insurance legislation have on my GEHA benefits?

Richard Miles: We are monitoring proposed legislation carefully and don’t anticipate any major changes to the FEHB program with the current health care reform proposals. However we are concerned about the assessments to health insurance plans that are being considered. The assessments or taxes would increase premiums. Click to see our latest health reform update on our web site.

San Antonio, Texas (GEHA Standard Option): Do you think the cost of health insurance would go down if doctors did not have to pay for malpractice insurance? What about a nominal fee included in the health insurance to pay the cost of malpractice for all physicians?

Richard Miles: Yes, I think the cost of health care would be less if doctors were not concerned about malpractice insurance premiums, but there may be the unintended consequence of an increase in malpractice. It is not just the cost of the premiums but also the cost of "defensive medicine," which refers to the extra tests doctors order to protect themselves from litigation. The actual reduction in cost is open for debate as estimates vary from very little to several percent.

The malpractice insurance fees are already included in the charges that doctors bill health insurers. The costs for malpractice insurance vary greatly by specialty.

Burlington, New Jersey (GEHA Standard Option): Why don’t you include the YMCA’s in your fitness plan?

Richard Miles: YMCA does not offer an option for a nationwide contract. GlobalFit offers a network of 12,000 participating fitness clubs nationwide.

Columbia, Maryland (Connection Dental Federal (FEDVIP) High): I live in Maryland, and my husband is in Ohio. Will my plan in Maryland cover him also?

Richard Miles: Yes, you and your covered dependents are covered worldwide under the GEHA plan.

Uhland, Texas (GEHA High Option, Connection Dental Federal (FEDVIP) High): I need to know about mental health benefits.

Richard Miles: When you receive mental health services, your cost-sharing and limitations will not be more than what you would pay for similar benefits for other illnesses or conditions.

For inpatient hospital services, inpatient residential treatment and outpatient intensive day treatment, preauthorization is required. Psychological testing does require precertification.

In 2010, GEHA will start to cover Licensed Professional Counselors and Licensed Marriage and Family Therapists for covered mental health services.

For complete information, please see pages 50-52 of the GEHA 2010 benefit brochure.

Columbus, Ohio (GEHA High Option, Connection Dental Plus): What is the statute of limitations for submitting a medical claim?

Richard Miles: We ask that you send all documents for your claim as soon as possible. You must submit your claim by December 31st of the year after the year you received the service to meet timely filing requirements.

Desoto, Texas (GEHA Standard Option, Connection Dental Plus): What steps do I need to take to add my 14 month old grandson to my health insurance?

Richard Miles: In many situations, your grandchild would be eligible for benefits. However, that determination is made through your Personnel or Retirement Office. Please contact them for documentation requirements and to inquire about adding your grandchild.

Moline, Illinois (GEHA Standard Option): When will 2010 booklets be mailed to current members?

Richard Miles: Current members should have their new year benefit packets by the beginning of November.

Plato, Missouri (GEHA Standard Option): Is the flu shot covered under preventative medicine? Is the whole family covered: husband, wife and child?

Richard Miles: Yes! Starting in 2009, routine immunizations (including pneumonia and influenza) performed by a participating provider and endorsed by the Centers for Disease Control and Prevention (CDC) are payable under the well child and adult preventive benefit at 100% of the plan allowable. The deductible is also waived at a participating provider. If the provider is not participating, you would be responsible for the plan’s deductible, coinsurance and any difference between our allowance and the billed amount.

Fresno, California (Connection Dental Federal (FEDVIP) High): I went to the dentist recently and learned that it would cost almost $10,000 dollars to fix my teeth. GEHA will only pay half. I can’t make payments due to bad credit and have no co-signer. What do I do? My health is at risk.

Richard Miles: I am sorry to hear about your situation.

I would strongly recommend that you get a second and perhaps even a third opinion from other dentists. Dental treatments and costs can vary greatly. It may be possible to stage your treatment out over a longer period of time.

When you use an in-network dentist, the dentist is under contract and must write-off the difference between the billed amount and the plan allowance. The dentist may charge you no more than your coinsurance.

It might be best to have your dentist submit a pre-estimate to get pre-approval by us. That way, you will know if the services are covered and will know exactly how much you will be responsible for paying. Be sure to include X-rays and any other information, such as charting or patient notes, that can help in our review .

You might want to check with a few dentists to see if they will work with you on a payment plan for your coinsurance. However, this would be at the dentist’s discretion and not a requirement of their contract.

To find dentists in your area, go to www.gehadental.com and use the online Provider Search tool.

We are only able to consult with you about the coverage of the plan. While we understand your financial difficulties, we are unable to help in this area. Please do not hesitate to email us or call our Customer Service Department at (877) 434-2336 if you have any questions.

Corydon, Indiana (GEHA Standard Option, Connection Dental Federal (FEDVIP) Standard): For both High Option and Standard, how long would I have to wait for coverage on a root canal and crown? Is there a waiting period for coverage?

Richard Miles: Under our FEDVIP Connection Dental Federal plan, the only waiting period is for orthodontic services. There are no waiting periods for services such as crowns and root canals.

Cleveland, Ohio (Connection Dental Federal (FEDVIP) High): Do you cover implants?

Richard Miles: No, implants and implant-related services are not covered under our FEDVIP plan.

West Babylon (GEHA High Option): For the 2010 season, is there still a $4,000 out-of-pocket expense for medications?

Richard Miles: The High Option prescription benefit has not changed. Your copayments and coinsurance for prescription drugs go toward a $4,000 annual prescription out-of-pocket limit. Not included in this limit are:

• the difference between the costs of generic and multi-source brand drugs;
• the 50% coinsurance for retail drugs after the first two fills;
• the 70% coinsurance for non-preferred sleep aid drugs.

Annandale, Virginia (GEHA Standard Option, Connection Dental Plus): If we want to make sure we have better dental coverage after we retire, do we need to sign up for Dental Connection Federal (High or Standard Option) prior to our retirement...or can we add this better coverage after retirement? Thank you, in advance, for your time in answering this question for us.

Richard Miles: The FEDVIP Connection Dental Federal Plan is available to active and retired federal employees. You do not have to be enrolled in the plan for any length of time to continue enrollment into retirement. After you retire, you can join GEHA’s Connection Dental Federal plan at any Open Season enrollment.

Bethesda, Maryland: I am considering switching my family’s health plan to GEHA High Option. One of my kids currently receives a non-formulary prescription medication. I could not tell from the plan documents what the reimbursement rate would be for this. The compounding pharmacy we use is part of Medco’s network.

Richard Miles: GEHA’s prescription drug program includes a voluntary “formulary” feature - our benefit for a formulary medication is the same as it is for a non-formulary medication. When a compound medication claim is submitted, the pricing is based on the contractual discounted Average Wholesale Price (AWP) cost for the ingredient with the highest cost and the total quantity of ingredients.

Alexandria, Virginia (GEHA High Option): Medicare will be my primary plan when I retire. I assume that my GEHA premiums will go down. Is this correct?

Richard Miles: Medicare does not have any effect on your GEHA premium. The FEHB program does not allow federal health plans to charge a lower premium to Medicare members.

However, when you have Medicare Parts A & B as your primary insurance, GEHA pays 100% of covered hospital and doctor expenses after Medicare. You pay no deductibles or copays for surgical or medical benefits with GEHA Standard Option or High Option.

Washington, DC: Hello, Richard. While GEHA provides global coverage for federal employees living abroad, do you allow for domestic employees to choose an international site of care, in the vein of medical tourism? I know that lots of self-insured employers are hesitating to jump on this bandwagon. Why exactly is this?

Richard Miles: GEHA will cover services performed abroad. We provide benefits for care that is consistent with medically accepted standards of care and are appropriate to the condition being treated. We do exclude care that is considered experimental or cosmetic in nature as we do not cover these services if they were performed in the U.S. I can’t comment why private insurers do not offer benefits under their policies.

Boulder, Colorado (GEHA Standard Option): For 2010, GEHA recommends combining a low cost Medicare D plan with Standard GEHA for seniors. Why have you started recommending this? In previous years you indicated that the GEHA prescription benefit was better that Medicare D plans. Is this recommendation tied to the many expensive drugs that are included in the Specialty Pharmacy that will cost us a lot?

Richard Miles: When considering whether to purchase Medicare D coverage, we advise estimating your out-of pocket costs for drugs. GEHA’s Standard Option has very low premiums, but requires members to pay 50% of the cost of brand-name drugs. For Standard Option members with Medicare A&B, adding a low-premium Medicare D plan can help make brand-name prescriptions more affordable.

When Medicare Part D drug plans became available in 2006, we advised members that the new program was not intended to replace drug coverage through GEHA. The prescription drug coverage through GEHA is considered to be “creditable” coverage, at least as good as Medicare prescription drug coverage. Seniors with “creditable” coverage would not be penalized if they did not join Medicare D when it was first available, but later chose to purchase one of these plans.

Spring, Virginia (GEHA Standard Option, Connection Dental Plus): Who is the administrator? Coventry?

Richard Miles: GEHA is the administrator of your coverage in the State of Virginia. The Provider Network that we utilize in Virginia is One Net. You can look up providers in your area by going to GEHA.com then click on the Find a Provider tab. Or you can call Customer Service at (800) 296-0776.

East Orange, New Jersey (GEHA Standard Option): What does it mean when the plan states that I would pay 15% of allowance as inpatient hospital for Standard Option? What does the allowance mean?

Richard Miles: You are correct that you pay 15% of the plan allowance for in-network inpatient hospital charges. Our plan allowance is the amount we use to determine our payment and your coinsurance for covered services. Our in-network plan allowance is negotiated with participating hospitals and may be based on a standard reduction or on a negotiated fee schedule. For these allowances, the hospital has agreed to accept the negotiated reduction.

San Francisco, California: I noticed that, according to the OPM website, GEHA isn’t NCQA accredited? Why is this?

Richard Miles: GEHA is URAC accredited for Health Network. URAC is an accrediting organization that reviews a company’s operations to ensure that the company is conducting business in a manner consistent with national standards. URAC is similar to NCQA.

Pollock Pines, California: Why do I, a person who exercises regularly, eats healthy and doesn’t smoke, have to pay the same premium that an obese smoking sedentary person does? Why don’t you require a physical with a drug test for a special insurance rate for us healthy people?

Richard Miles: Congratulations to you on your healthy lifestyle.

In the federal program, GEHA and other carriers are not allowed to charge different premiums to different members in the same health plan. Just as we don’t charge less when you are healthy, we won’t charge you more in the unfortunate event you have an accident or illness.

Members who choose unhealthy lifestyles, of course, do need more medical care and do incur higher costs for themselves and for GEHA. We encourage all members to take advantage of GEHA’s preventive care benefits. We offer programs such as discounted gym memberships and NutriSystem, along with resources such as the Health e-Report health & wellness newsletter.

Austin, Texas (Connection Dental Federal (FEDVIP) High): Considering GEHA. Does GEHA mandate you use generic drugs or can I choose brand name? Lots of prescription drug use in my family: would you suggest High Option or Standard?

Richard Miles: You certainly have the option to choose branded or generic products. GEHA encourages the use of generic medications with a low generic copay. The big difference between our High and Standard plans is how we cover brand-name prescription drugs. The High Option plan has better coverage for brand-name drugs. Under either plan, generic drugs are available for just a $5 copay.

Mechanicsburg, Pennsylvania: I am checking out dental plans for Open Season. What if my dentist is not part of your network? Are the services still covered?

Richard Miles: Yes, our Connection Dental Federal plan pays the same for any dentist. We do not have special deductibles or reduce your calendar year maximum when you use a non-participating provider. However, when you use a participating, Connection Dental Provider, you can save money because the provider has agreed to accept what the plan allows for covered services.

Corpus Christi, Texas (Connection Dental Federal (FEDVIP) High): I am covered under your dental plan. I am very pleased with the coverage. I want to know if I have to file with my medical plan before filing with my dental plan? And why since the medical plan does not cover dental?

Richard Miles: Many medical plans have a very limited dental benefit. If your FEHB medical plan does not cover any dental benefits, you do not need to send the claim to them first. We will estimate benefits (zero if they don’t allow for dental coverage), if we receive a claim without your FEHB plan’s explanation of benefits.

Atlanta, Georgia (Connection Dental Federal (FEDVIP) High): Benefits for in- or out-of-network services are great, but if the plan allowance is not sufficient to cover a service, then this amounts to a penalty just the same. Are the rate allowances reasonable? How do I know? Thanks.

Richard Miles: If you are a member, you can view the plan’s maximum allowance for common procedures in the Member Web Services portion of the website at www.gehadental.com.

If you are not a member, you can ask our Customer Service department for a sample list of what the plan allows in your area.

Long Beach, Arkansas (Connection Dental Federal (FEDVIP) High): I lost my insurance card and need a new one. How do I go about getting it?

Richard Miles: You can contact our customer service at (877) 434-2336 and request a replacement card be mailed. If you need one quickly, you can also print a temporary ID card from the Member Web Services portion of our website.

Fort Worth, Texas (GEHA High Option): Is it possible that GEHA would pay for the shingles vaccine?

Richard Miles: Yes. When you use an in-network provider, the shingles vaccine is covered at 100% as a preventive benefit for adults ages 60 and older. If you use an out-of-network provider, you will pay your deductible and coinsurance.

San Diego, California: We presently have dental insurance but would like to change. I am considering enrolling in your FEDVIP dental plan. I know my son needs braces. Do we have to wait two years before we are covered for them?

Richard Miles: Yes, covered children must meet a 24-month waiting period for orthodontic benefits.

Canyon Lake, Texas (GEHA High Option): Those of us with Medicare pay the same rate as non-Medicare. However it seems that the savings GEHA obtains by this factor is greater than the benefits provided. Why can’t other benefits be increased, such as dental, etc.? Looking forward to your comments.

Richard Miles: The law that governs the FEHB program does not allow plans to offer a lower rate for members with Medicare primary. We do waive deductibles and offer a lower co-insurance for our Medicare members with Part A and B as primary.

Dodge City, Kansas (GEHA Standard Option, Connection Dental Plus): Does the FEDVIP GEHA dental plan replace the current dental benefit in the health plan? Will there no longer be a dental benefit included in the health plan?

Richard Miles: The FEDVIP GEHA Connection Dental Plus plan supplements any dental benefits in your health plan. After you health plan pays their portion, the dental plan considers the remaining balance. The dental plan also offers coverage for major services, such as crowns, bridges, root canals and dentures which are not normally covered under the health plans.

Mansfield, Ohio (GEHA High Option, Connection Dental Federal (FEDVIP) High): My dentist is not a preferred provider. What is the process to submit a claim for services rendered by a non-preferred provider? Thank you.

Richard Miles: The process to submit a bill for in-network and out-of-network providers is the same. Most providers will submit the claim for you. If not, ask your provider to give you a copy of their itemized bill and sent it to us at:

GEHA Connection Dental Federal
PO Box 2336
Independence, MO, 64051-2336

Fayetteville, North Carolina: Can two spouses work for the federal government and have two separate policies, with each policy covering each spouse?

Richard Miles: FEHB regulations prohibit dual federal coverage. However, the guidelines will allow each of you to enroll in a Self Only plan. Please contact your personnel office for additional information.

Lakeland, Tennessee: I’ll be going on Medicare this December and have BCBS Basic. Would it be to my advantage to change to GEHA?

Richard Miles: Thanks for considering a switch to GEHA. Because I am not allowed to compare GEHA to other health plans (federal rules prohibit plan comparisons), my best advice may be to ask another GEHA member about his or her experience.

GEHA members report very high satisfaction with their plan. In an independent member survey, 84% of our members rated GEHA an 8, 9 or 10 on a 10-point scale, where 10 is the best health plan possible. We offer affordable coverage, helpful service and great value. And, GEHA members with Medicare A&B get 100% coverage (no copays or deductibles) for doctor visits, lab work and hospital stays. You can choose any provider for your care and are not limited to network providers.

Good luck with your decision.

Arlington, Virginia (GEHA Standard Option): Does the regular dental benefit under the Standard Option cover any portion of crowns?

Richard Miles: No, crowns are not covered in the Standard Option health plan.

Round Rock, Texas (Connection Dental Plus): I am a government employee whose son is a full-time student but is 23 years old and doesn’t qualify to be on my insurance. Do you have health and dental packages that I can purchase for him?

Richard Miles: As a member of GEHA Connection Dental Plus your dependent, unmarried child remains eligible on your plan until he turns age 25. Coverage for dependent children in our health plan end at age 22.

West Grove, Pennsylvania (GEHA High Option): What are the rates for High Option with dental? Is my location covered?

Richard Miles: We offer our GEHA Connection Dental Federal in all areas. You can look up the premium for your area by entering your zip code in our online 2010 Premium Search tool.

San Francisco, California (GEHA High Option): I am a GEHA member domicile in California. What portion, if any, of my medical costs would be covered if I were to receive medical care in Florida?

Richard Miles: That’s what is great about GEHA you have benefits available to you wherever you seek care. You can locate participating providers online just click on the Find a Provider tab. The Network we use in Florida is First Health so if you use a preferred provider you have the same copay and coinsurance as you do at home in California.

Baton Rouge, Louisiana (GEHA High Option, Connection Dental Federal (FEDVIP) Standard): When is Open Season? I will be out of the country during November and December. Would like to know the details of GEHA health insurance; what is covered, what is the premium, etc.? I am a retired federal employee. Thanks.

Richard Miles: Open Season begins on November 9 and ends December 14. You can find information here about our 2010 health benefits or by phone at (800) 821-6136.

Parkersburg, West Virginia: I have Fed Blue Cross/Blue Shield for a number years. The reason Ikeep it is for the prescription plan. It has gone out of reason. Please send me a detailed account of your prescription plan. The medical coverage probably does not differ much from Blue Cross/Blue Shield since we have Medicare as our primary. I will not be available during the time of your chat.

Richard Miles: You can find details of our 2010 prescription drug plan design on www.GEHA.com or by contacting us by phone at 800 821 6136.

Greenacres, Florida (GEHA High Option): Do I have to get clearance for a second opinion from an orthopedic doctor? I’ve had cortisone and Supartz injections from one doctor for knee pain, but I am still in a lot of pain? If yes, what is the procedure for getting a second opinion. Thank you.

Richard Miles: You are free to make an appointment with another physician to offer you a second opinion on your response to the current treatment. There is no precertification required for physician visits.

Charlotte, North Carolina (Connection Dental Federal (FEDVIP) High): I will retire from the Post Office effective October 31, 2009, and want to continue my dental insurance. Please advise what is necessary for payment of premiums and cost for previous employee and a spouse.

Richard Miles: Benefeds has been contracted by OPM to administer the FEDVIP program and is responsible for determining eligibility, enrollment and collecting premiums. Please contact them to let them know about your payroll office change and to set-up premium payments by e-mailing them at service@BENEFEDS.com or calling 1(877) 888-3337. Retired federal employees pay premiums monthly. For High Option, Self plus one in North Carolina, your premium should be $64.03 per month.

Medford, Wisconsin (GEHA Standard Option): No question. Just want to let the enrollees know that we have had GEHA for one year and are very, very satisfied.

Richard Miles: That’s great to hear. Thanks for being a member.

Washington, DC (GEHA High Option): Will today’s chat transcript remain online so I can refer to these Q&As later?

Richard Miles: Yes. Today’s transcript will remain posted on our website all the way through Open Season.