GEHA (Government Employee Health Association) is a not-for-profit insurance program which provides medical and dental insurance plans for federal employees, retirees, and their families. GEHA started in Missouri in 1937 and has since evolved to provide insurance to about 1.8 million people worldwide
GEHA’s Standard and High health plans both cover some or all of substance abuse treatment. You can expect to see common forms of treatment covered, including:
One of GEHA’s largest requirements is around accreditations. They require clients to receive treatment from programs that are nationally certified through organizations like CARF or The Joint Commission, and be licensed by the state they work in. These requirements are meant to ensure you receive substance abuse treatment through a qualified program.
In order to qualify for GEHA’s rehab coverage you will need to meet a specific criteria to ensure treatment is medically necessary. When considering treatment, an addiction specialist or your primary care physician will likely ask:
While both types of GEHA plans cover addiction to varying degrees, they both aim to address substance abuse as a whole. If you meet criteria, GEHA typically covers alcohol treatment, opioid treatment, cocaine treatment, meth treatment, benzo treatment, and more.
Addiction and mental health diagnoses often go hand-in-hand, this is typically referred to as a dual diagnosis. GEHA offers a variety of behavioral health coverage options that can be used inside or outside of rehab. When searching for treatment, be sure to inquire about mental health programs offered alongside addiction treatment to truly heal your mind and body.
Medication-assisted treatment (MAT) is an option for those seeking to battle their addiction with a combination of medications and therapy. Typically, MAT is used with opioid-specific medications and alcohol-specific medications. They are FDA-approved and proven to help people battle opioid or alcohol addictions.
GEHA covers a wide range of prescription medications and may cover some or all of your MAT medications if your personalized program includes MAT. Medications are typically covered separately from rehab, but the medical teams on staff should be able to determine coverage before prescribing and ensure you’re receiving a solution within your budget.
GEHA, as with all insurance companies, are federally required to cover essential services. While the exact coverage will vary, substance abuse treatment and behavioral health services are considered an essential service and you may qualify for assistance from your insurance provider.
Typically, the standard option has higher out-of-pocket costs with a lesser monthly premium, while the high option offers extended coverage at a higher monthly rate.
For any out-of-pocket costs or deductible minimums, federal employees and those under GEHA may have established a Health Care Flexible Savings Account (HCFSA). This account has unique tax benefits and can make treatment more cost effective.
You can expect length of treatment coverage to vary per plan and per client. GEHA covers treatment deemed medically necessary, which typically equates to 1-6 weeks of inpatient rehab and roughly 4-12 weeks of intensive outpatient rehab. This number will vary widely per client.
While rehab is deemed essential, your particular plan will dictate how much is covered and how much you will have to pay out-of-pocket. Most likely you will have a deductible requirement before your GEHA insurance kicks in. If you’ve yet to meet your deductible for the year, you have a variety of options to pay for rehab until insurance kicks in:
The Hope House is an Arizona-based luxury rehab program with two beautiful locations in the desert mountains of Scottsdale. Both of our addiction treatment centers are partnered with GEHA to help alleviate the financial worries associated with treatment. Both facilities offer extensive addiction treatment options, a robust mental health program, relaxing luxury amenities, and executive treatment options for business professionals.
Our team will work closely with your insurance to fully understand your unique benefits plan and ensure maximum coverage to make your stay as easy as possible.
GEHA’s insurance policies are one of many national providers that offer addiction treatment coverage. If you or your loved one are on an insurance policy other than GEHA, review their benefits specifically:
