GEHA for Therapy

GEHA stands for Government Employees Health Association. Its plans are available for federal government workers, partnering with UnitedHealthcare and Aetna Signature Administrators to access their vast provider network.

Does GEHA cover therapy?

Yes, all GEHA plans offer coverage for mental health services, including therapy sessions with a qualified therapist. GEHA has several plans to choose from, and the coverage for mental health services differs based on which plan you have. As with many other healthcare plans, if you work with a therapist in GEHA’s provider network, you’ll pay less than if you work with a therapist who is out-of-network with GEHA.

How do I check if my GEHA plan covers therapy?

To check if your GEHA plan covers therapy, locate and read through a document called the Summary of Benefits. Summary of Benefits documents share the coverage available for members of that particular plan. They differentiate between different service categories, as well as in-network benefits and out-of-network benefits. By looking at your GEHA plan’s Summary of Benefits, you’ll be able to see how much you’ll need to pay out-of-pocket per therapy session.

You can also book a consultation with a GEHA benefits coordinator. They can help you understand your mental health benefits, including how much coverage you receive from your GEHA plan. Another option is to call the GEHA customer service number and request information on your mental health benefits.

How much does therapy cost with my GEHA plan?

There are several GEHA plans, so how much therapy will cost you out-of-pocket depends on which plan you have. Most plans have both copays and coinsurances, which means that you may have to pay a regular fee per session as well as a portion of your therapist’s session fee. However, coinsurance rates may begin only after you have reached your deductible.

Your costs will change whether you’re seeing an in-network provider or an out-of-network provider. For in-network providers, here are the general costs per GEHA plan:

Standard: $20 copay
Elevate: $10 copay
HDHP: 5% coinsurance
Elevate Plus: $30

To see what the costs for therapy are with out-of-network providers, refer to your Summary of Benefits document. You can expect that your costs will be a 25-50% coinsurance.

What types of mental health conditions does GEHA cover?

GEHA plans cover many mental health conditions, including:

Generally, your therapist will give you a mental health diagnosis after working with you for a few sessions. This diagnosis, which you may request to be withheld from you, tells GEHA how to process your mental health benefits according to your plan. Diagnoses are usually required for insurance purposes and may appear on your statements or documents.

What types of therapy does GEHA cover?

GEHA plans cover many types of therapy, including most therapies that have scientific evidence that they benefit clients with your specific diagnosis or situation. Therapy approaches, while often blended or integrated by therapists, must have clinical rigor behind them to qualify for GEHA coverage.

Some common therapy approaches that are covered by insurance include:

What types of therapy does GEHA NOT cover?

Many therapists incorporate other types of therapy into their regular sessions with you, however not all therapies are covered by GEHA plans. Therapy approaches that do not have the scientific backing required to show efficacy are generally not reimbursable. This includes approaches like life coaching, reiki healing, aromatherapy, and more.

That’s not to say that these therapies aren’t beneficial, as many people enjoy and gain well-being from these techniques. However, they lack the same clinical rigor as other therapy approaches, and GEHA prioritizes therapy approaches that show a direct benefit to the client.

Does GEHA cover online therapy?

Yes, GEHA plans cover online therapy. Should you prefer to see your therapist online rather than in-person, as many people do for the sake of convenience and comfort, you’ll still pay the same amount per session.

Many GEHA plans offer members access to MDLive, an app that connects individuals with doctors in an online setting. This could include a primary doctor, psychiatrist, or even a therapist. These visits are completely covered by GEHA plans.

Does GEHA cover couples therapy?

GEHA does not cover couples therapy. This is standard of many health insurance plans — it’s rare to find an insurance plan that has mental health benefits for couples. As mentioned above, most therapy services need to be in pursuit of treatment for a specific diagnosis. Couples cannot receive a diagnosis, which means that it’s difficult for GEHA and other health insurance companies to process these benefits.

However, there are still low cost options for seeing a couples therapist. Ask about sliding scale options if your budget is tight but you still would benefit from working on your relationship together with a mental health professional.

Do I need to see my primary doctor before starting therapy?

GEHA plans are PPO plans, which means that you do not need to see your primary doctor before starting therapy. You will not need a referral from a doctor to access your mental health benefits, which can often be inconvenient and an administrative burden. Instead, you can start using your GEHA plan benefits as soon as you’re ready to start your therapy journey.