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GEHA Insurance Coverage for Drug and Alcohol Rehab 

What is GEHA Insurance?

GEHA (Government Employees Health Association) is a non-profit, member-based health insurance provider that provides plans to federal employees and their families. GEHA was founded in 1937 and it is headquartered in Lee’s Summit, Missouri.

GEHA offers a variety of health insurance plans, including medical, dental, vision and prescription drug coverage.

GEHA also offers a wellness program that provides resources and support for members to help them improve their health and well-being.

What Types of Substance Abuse Treatment Does GEHA Cover?

The coverage for substance use disorders can vary based on the specific plan that you have. However, typically, GEHA health plans cover the following types of treatment:

  1. Inpatient treatment: residing at a facility for a specified period, typically from 30 to 90 days. GEHA’s plans generally cover inpatient treatment, including room and board, medical care, therapy and medications.
  2. Outpatient treatment: allows individuals to receive care while still living at home. Plans generally cover outpatient therapy, medications and other services.
  3. Detox: helps individuals to safely and comfortably withdraw from drugs or alcohol. GEHA covers medically supervised detox and medication management.
  4. Counseling and therapy: counseling and therapy services such as individual, group and family therapy will be covered.

It’s important to note that the specifics of coverage for addiction rehab will differ between plans. Some may have limits on the number of days or visits covered, while others may not cover certain types of treatment or services.

You should carefully review your plan details to understand your addiction rehab coverage. You can do this by calling GEHA directly or seeking the help of a treatment center such as Luxe Recovery who can help check your benefits and get things started for you.

The importance of addiction treatment at a quality drug and alcohol rehab 

Drug and alcohol rehab programs are crucial for individuals who are struggling with addiction. Here are some reasons why:

  • Provides a Safe Environment: provides a safe and supportive environment for individuals to detoxify and recover from addiction. This is especially important because withdrawal symptoms can be severe and potentially life-threatening
  • Offers Professional Treatment: Rehab programs are staffed with professionals who are trained in addiction treatment and can provide individualized treatment plans, counseling, and therapy 
  • Addresses Underlying Issues: help individuals identify and address the underlying issues that contribute to addiction, such as mental health disorders or trauma, and develop the skills and tools needed to achieve and maintain sobriety
  • Provides Support: addiction is a complex and challenging disease, and recovery can be a lifelong journey which requires ongoing support through things like group therapy and counseling to help individuals stay sober and avoid relapse
  • Improves Quality of Life: addiction can have a devastating impact on an individual’s life, including relationships, career and overall well-being which treatment can work on

Factors to consider when choosing an addiction treatment program

When choosing a drug and alcohol rehab facility, there are several factors to consider, including:

  • In-network providers: It’s important to choose a rehab facility that is in-network with GEHA insurance to avoid out-of-pocket costs. Check with GEHA or the facility directly to confirm their network status.
  • Treatment programs: Different rehab facilities offer different treatment programs, such as inpatient, outpatient or intensive outpatient programs. Consider which one is the most effective for your specific needs.
  • Location: The location of the rehab facility can impact your ability to attend treatment regularly. Choose a facility that is easily accessible and convenient for you.
  • Staff credentials: Look for a rehab facility that employs licensed and experienced medical and mental health professionals, such as doctors, nurses, therapists and counselors.
  • Treatment approach: Different rehab facilities use different treatment approaches, such as cognitive-behavioral therapy, medication-assisted treatment or holistic therapies. Research and consider which approach resonates with you.
  • Amenities: Some rehab facilities offer amenities such as private rooms, outdoor spaces and recreational activities. Consider what amenities are important to you and factor that into your decision-making.
  • Reviews and ratings: Read reviews and ratings from former patients and their families to get a sense of the quality of care and outcomes at the rehab facility.
  • Cost: While GEHA insurance can cover a significant portion of rehab costs, there may still be out-of-pocket expenses. Consider the cost of the facility and any additional expenses, such as travel or missed work, before making a decision.

Plans offered by GEHA

High Option Plan 

The GEHA High Option Plan provides comprehensive coverage with low out-of-pocket costs. Some key features include:

  • Comprehensive medical coverage: covers a wide range of medical services, including doctor visits, hospital stays, surgeries and prescription drugs.
  • Low out-of-pocket costs: low deductibles and coinsurance rates.
  • Nationwide coverage: provides access to a large network of healthcare providers.
  • No referrals required: you can see any healthcare provider you choose without a referral from a primary care physician.
  • Wellness benefits: preventive screenings and immunizations.
  • Telehealth services: allows you to consult with a healthcare provider remotely from your home or office.
  • Dental and vision coverage: for additional out-of-pocket costs.

Standard Option Plan 

The Standard Option Plan provides coverage for a variety of healthcare services, including preventive care, hospitalization, surgery, mental health services and prescription drugs.

Members have access to a nationwide network of healthcare providers, including doctors, hospitals, and other medical facilities and can also choose to see out-of-network providers, although they may have to pay higher out-of-pocket costs for these services.

The plan has a deductible, which is the amount members must pay out-of-pocket before the plan begins to cover their healthcare expenses. Once the deductible is met, the plan typically covers a percentage of the remaining costs, with members responsible for paying the rest.

In addition to the standard healthcare benefits, this plan also offers coverage for certain wellness programs and services, such as weight management, smoking cessation and stress management.

FEP Blue Focus

FEP Blue Focus is designed to provide comprehensive medical coverage at an affordable price and offers a range of benefits including hospitalization, physician visits, prescription drugs and preventive care services. It also offers access to a network of providers and hospitals that have agreed to provide services at a reduced rate.

One of the key features of this plan is its focus on preventive care meaning that many preventive services are offered at no cost to the member, including routine wellness exams, mammograms and certain cancer screenings.

Another feature of the FEP Blue Focus plan is its emphasis on cost-sharing. Members are encouraged to take an active role in managing their healthcare costs by selecting providers and services that are cost-effective.

The plan also offers resources and tools to help members make informed healthcare decisions and manage their healthcare expenses.

GEHA Insurance Plan Copayments and Deductibles 

The copayments and deductibles for GEHA plans vary depending on the specific plan but here are some general guidelines:

Copayments:

  • A copayment is a fixed amount of money that the insured person pays for a covered service. The amount of the copayment varies depending on the service provided and the specific plan.
  • In general, GEHA copayments range from $10 to $50 for doctor visits, again, depending on the plan.
  • Copayments for prescription drugs can range from $5 to $100, depending on the plan and the specific medication.

Deductibles:

  • A deductible is the amount of money that the insured person must pay out of pocket before the insurance company starts paying for covered services.
  • In general, GEHA deductibles range from $250 to $3,000, depending on the plan.
  • Plans with higher deductibles usually have lower monthly premiums, while plans with lower deductibles usually have higher monthly premiums.

Benefits of Using GEHA to Pay for Substance Use Treatment 

If you or a loved one are struggling with addiction and seeking treatment, GEHA may cover rehab center costs and be a valuable resource to consider. Here are some of the benefits of using GEHA to pay for addiction rehab treatment:

  • Comprehensive coverage: offers comprehensive coverage for addiction treatment, including inpatient and outpatient rehab, medication-assisted treatment and counseling services. This means that you can get the care you need without having to worry about the cost.
  • Affordable options: offers a range of affordable health insurance plans to suit different needs and budgets. Depending on the plan you choose, you may be able to access addiction treatment services with low out-of-pocket costs.
  • Network of providers: GEHA has a broad network of healthcare providers, including many addiction treatment providers making it easier to find a treatment program that is covered and meets your needs.
  • Access to telehealth: you can receive addiction treatment and counseling from the comfort of your own home. This can be especially beneficial if you live in a rural area or have mobility issues.
  • Confidentiality: GEHA is bound by federal regulations that protect the privacy of your medical information. This means that your addiction treatment will be kept confidential and you can receive care without fear of stigma or discrimination.

GEHA Limitations and Exclusions 

While GEHA plans provide comprehensive coverage, there are limitations and exclusions to keep in mind. Some of these include:

  • Cosmetic procedures: such as facelifts or breast implants, unless they are deemed medically necessary.
  • Experimental treatments: treatments that are still in the experimental phase and have not yet been approved by the FDA.
  • Long-term care: such as nursing home care, unless it is medically necessary.
  • Non-prescription drugs: such as over-the-counter medications.
  • Non-medical services: such as housekeeping or transportation, even if they are related to a medical condition.
  • Self-inflicted injuries: does not cover injuries or illnesses that are self-inflicted.
  • Cosmetic dentistry: such as teeth whitening, unless it is deemed medically necessary.
  • Weight loss programs: does not cover weight loss programs or surgeries, unless they are deemed medically necessary.

How to Verify GEHA Insurance Coverage for Addiction Rehab 

To verify GEHA Insurance coverage for addiction rehab, you can call the customer service number on the back of your insurance card or visit their website.

They will let you know what services are covered, any deductibles, copays or out-of-pocket expenses you may be responsible for and any pre-authorization requirements.

Remember, once you have verified your coverage and chosen a rehab facility, be sure to follow up with GEHA to make sure that all necessary authorizations are obtained and that your treatment will be covered.

You can also contact Luxe Recovery and they can help with this as well.

Luxe Recovery Accepts GEHA Health Insurance Policies 

Luxe Recovery offers quality treatment options for drug and alcohol abuse and co-occurring mental health disorders. The amazing team at Luxe Recovery will help you every step of the way.

They work with GEHA to verify benefits and coverage and communicate with them for authorizations and approvals. 

If you or a loved one have GEHA insurance cover and are dealing with drug and alcohol addiction issues, give Luxe Recovery a call today and let them help you on your journey to recovery.

The serene environment is far removed from your daily stresses and triggers and the world class treatment will be tailored to meet your individual needs.

You can fill out this form or call us directly

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