GEHA

Learn how GEHA insurance covers mental health and substance use disorder treatment, including verification processes and finding providers that meet your specific needs.

Navigating mental health treatment while managing insurance concerns can feel overwhelming, especially when you or a loved one is experiencing a behavioral health crisis. The Government Employees Health Association (GEHA) offers comprehensive coverage for mental health and substance use disorder treatment as part of its commitment to whole-person care for federal employees, military retirees, and their families.


Mental health conditions affect millions of Americans each year, making access to appropriate care essential. If you're covered by GEHA insurance and seeking mental health or substance use disorder treatment, this guide will help you understand your benefits, navigate the approval process, and find the care you need.


What Makes GEHA's Mental Health Coverage Distinctive

GEHA has served over 2 million federal employees, military retirees, and their families for more than 87 years. As a member-owned, not-for-profit association, GEHA's approach to healthcare emphasizes comprehensive coverage, including robust mental health and substance use disorder benefits.


GEHA's mental health coverage is designed to comply with the Mental Health Parity and Addiction Equity Act (MHPAEA), which requires insurance plans to provide mental health and substance use disorder benefits that are comparable to medical and surgical benefits. This means GEHA plans offer extensive coverage for a wide range of mental health services for those who meet medical necessity criteria.


For 2025, GEHA has expanded its mental health offerings to include a separate maternal mental health benefit that allows five visits per year, per pregnancy for office-based treatment of prenatal and postpartum depression, at $0 cost-share (no deductible) for in-network care. This shows GEHA's commitment to addressing specific mental health needs of their members.


Mental Health Services Covered by GEHA

GEHA plans cover a wide range of medically necessary mental health and substance use disorder services. While specific coverage details may vary by plan (High Option, Standard Option, or HDHP), the following services are typically included:


Common Mental Health Services Covered


GEHA defines mental health and substance use disorders as "conditions and diseases listed in the most recent edition of the International Classification of Diseases (ICD) as psychoses, neurotic disorders, or personality disorders; other nonpsychotic mental disorders listed in the ICD; or disorders listed in the ICD requiring treatment for misuse or dependence upon substances such as alcohol, narcotics, or hallucinogens."


How Insurance Verification Works with GEHA

Understanding your GEHA coverage before beginning mental health treatment can help you avoid unexpected costs and ensure you receive the maximum benefits available.


The Verification Process

The verification process typically begins by contacting GEHA's customer service at the number on your insurance card or by calling 800-821-6136. When verifying coverage, it's important to inquire about what mental health and substance use disorder services are covered under your specific plan, which providers are in-network, what your financial responsibility will be (deductibles, copayments, or coinsurance), whether precertification is required for any services you're considering, and any limitations or exclusions that may apply to your coverage.


GEHA offers different plan options (High Option, Standard Option, and HDHP), each with its own cost structures and coverage levels. Your specific plan will determine your out-of-pocket costs for mental health services.


Understanding GEHA's Precertification Requirements

GEHA requires precertification for certain mental health and substance use disorder services. Precertification is a process where GEHA reviews and approves treatment before services are provided to ensure they are medically necessary.


Services that typically require precertification include inpatient hospital admission for mental health or substance use disorder treatment, residential treatment center care, intensive day treatment (including partial hospitalization programs), intensive outpatient programs, applied behavioral analysis therapy, and psychological testing.


The precertification process involves your provider submitting clinical information to GEHA for review. GEHA will determine whether the requested services are medically necessary based on established clinical guidelines. For emergency admissions, you or your provider must notify GEHA within 24 hours of admission.


Coverage Limitations and Out-of-Pocket Costs

While GEHA provides substantial mental health coverage, understanding potential limitations and costs will help you better plan for treatment.


Coverage Limitations

Some common limitations in GEHA plans may include network restrictions (using out-of-network providers typically results in higher out-of-pocket costs), visit limitations (some GEHA plans limit outpatient visits to a specific number per year), precertification requirements (failure to obtain required precertification may result in reduced benefits), and medical necessity requirements (services must be deemed medically necessary to be covered).


Out-of-Pocket Costs

Your financial responsibility for mental health services with GEHA will depend on your specific plan and may include deductibles (the amount you pay before your insurance begins covering services), copayments (fixed amounts paid per visit or service), coinsurance (a percentage of the cost you pay after meeting your deductible), and out-of-pocket maximums (the most you'll pay during your plan year before insurance covers 100% of costs).


For example, the GEHA High Option plan typically offers lower copayments for mental health visits compared to the Standard Option, while the HDHP requires you to meet your deductible before coverage begins. However, GEHA does cap the amount of coinsurance and deductibles you'll pay each year, providing financial protection for members requiring extensive mental health services.


Navigating GEHA's Approval Process

GEHA's approval process for mental health and substance use disorder treatment is designed to ensure members receive appropriate care while managing costs.


The Approval Process

The typical approval process for mental health services with GEHA includes an initial assessment where your provider evaluates your condition and determines the appropriate level of care, precertification (if required) where your provider submits a request to GEHA for services requiring precertification, including clinical information to support medical necessity, review and determination where GEHA reviews the request and makes a coverage decision (usually within 15 calendar days for non-urgent pre-service claims), ongoing review for continued treatment (especially for higher levels of care), and discharge planning for inpatient or residential treatment to plan for continued care after discharge.


If GEHA denies coverage for any mental health services, you have the right to appeal the decision. GEHA's appeals process is outlined in your plan documents and involves submitting additional information to support the medical necessity of the requested services.


Finding Facilities That Accept GEHA

GEHA works with numerous mental health and substance use disorder treatment providers across the country.


Finding In-Network Providers

To find in-network mental health providers, visit GEHA's website and use their provider directory, call GEHA's customer service for assistance locating providers, or ask your primary care physician for referrals to in-network mental health providers.


Using in-network providers is important for minimizing your out-of-pocket costs. In-network providers have contracted rates with GEHA, which means lower copayments, coinsurance, and overall costs for you.


For federal employees and retirees who have GEHA and Medicare as primary coverage, GEHA offers additional options through their partnership with UnitedHealthcare, providing a tailored Medicare Advantage plan that enhances coverage and reduces cost-sharing for services, including mental health care.


Recent Developments in GEHA Mental Health Coverage

GEHA continues to enhance its mental health coverage in response to growing needs and changing healthcare landscapes.


Enhanced Maternal Mental Health Benefits

For 2025, GEHA has introduced a new maternal mental health benefit that provides five visits per year, per pregnancy for office-based treatment of prenatal and postpartum depression at no cost to members when using in-network providers. This specialized benefit recognizes the importance of addressing maternal mental health as part of comprehensive care.


Telehealth Options

GEHA has expanded telehealth options for mental health care, making it easier for members to connect with providers remotely. This is especially important for members who may have difficulty accessing in-person care due to location, mobility issues, or other barriers.


Determining if Your Specific GEHA Plan Covers Needed Treatment

Each GEHA plan has different coverage levels and requirements for mental health treatment. Understanding your specific plan is essential to maximizing your benefits.


GEHA Plan Options

GEHA offers several plan options with varying levels of mental health coverage. The High Option generally features lower copayments for mental health visits and more comprehensive coverage, but with higher premiums. The Standard Option offers a balance of affordable premiums and solid coverage, typically with somewhat higher cost-sharing for mental health services compared to the High Option. The HDHP (High Deductible Health Plan) requires meeting a deductible before coverage begins but includes a Health Savings Account (HSA) with contributions from GEHA to help offset costs.


To verify your specific coverage, review your plan documents (Plan Brochure), call GEHA's customer service, or log in to your online account to access personalized plan information.


Finding the Right Mental Health Treatment Facility

Choosing the right treatment facility is a crucial step in your recovery journey. When evaluating facilities that accept GEHA insurance, consider the level of care you need (outpatient, intensive outpatient, partial hospitalization, residential, or inpatient), the facility's experience treating your specific condition, location and accessibility, treatment approaches and philosophy, whether the facility is in-network with GEHA, and the facility's accreditation and licensing.


Before committing to a treatment program, verify coverage details and understand your out-of-pocket costs by calling GEHA directly.


Taking the Next Step Toward Mental Health Care

Seeking help for mental health or substance use disorders is a courageous step toward healing and recovery. With GEHA insurance, you have access to a wide range of treatment options and providers dedicated to supporting your journey to better mental health.


Remember that navigating insurance can be challenging, but you don't have to do it alone. GEHA offers resources to help you understand your coverage and find appropriate care. By using the information in this guide and reaching out for assistance when needed, you can make informed decisions about your mental health treatment.


Ready to find mental health or substance use disorder treatment covered by GEHA? Browse our treatment directory to find facilities in your area that accept GEHA insurance and offer the specialized care you need.


References

[1] "Federal Employees Health Benefits Plans | GEHA" https://www.geha.com/

[2] "GEHA Benefit Plan brochure" https://www.opm.gov/healthcare-insurance/healthcare/plan-information/plans/BrochureJson?brochureNumber=71-006&year=2025

[3] "What's new in 2025 for G.E.H.A health plans | GEHA" https://www.geha.com/plans/medical/2025/whats-new-for-2025