GEHA Insurance Coverage for Addiction Treatment in North Carolina

Find out if your GEHA Insurance Policy covers addiction treatment in North Carolina – or verify your insurance coverage with Southeastern Recovery Center now.

addiction treatment covered by geha insurance

People face many obstacles when seeking addiction treatment in North Carolina – whether it be overcoming the addiction or the financial burdens that accompany it. Over 1,469,000 adults in North Carolina have a mental condition. This number equals more than three times the number of residents in Raleigh. Of the 452,000 who did not receive treatment for their mental condition, 44.8% of them cited cost as the main reason.

There are several ways to pay for addiction treatment in North Carolina, but the first to consider is using your insurance. When the Affordable Care Act (ACA) was enacted, provisions were included that aimed to improve access to mental health services and insurance coverage for mental health conditions. Addiction, which is categorized under the broad term “substance use disorder,” is included in the diagnostic manual used to classify mental disorders – Diagnostic Manual of Mental Disorders Volume 5 (DSM-5).

Ready To Begin Healing?

We offer holistic & evidence-based treatment which is proven to increase success rates in recovery. Please reach out to our team today. We are available 24/7 to take your call.

Ready To Begin Healing?

What is GEHA?

GEHA stands for Government Employees Health Association. It’s a not-for-profit provider of health and dental plans for federal employees, retirees, and their families. GEHA offers a range of health insurance options, including fee-for-service, high-deductible health plans, and health maintenance organization plans. It aims to provide comprehensive coverage and competitive rates to meet the needs of government employees and their dependents.

Here is a timeline of the history of GEHA insurance:

Types of GEHA Insurance Plans Available

It is important to point out that GEHA insurance plans are only available to federal employees, retirees, and their families – they are not open to the general public. The plans available through GEHA for those who qualify, are:

  • GEHA Standard Option Health Plan: This plan provides comprehensive coverage with a focus on affordability. It includes benefits such as coverage for doctor visits, hospital stays, prescription drugs, preventive care, and more. Members have the flexibility to choose their healthcare providers.
  • GEHA High Option Health Plan: The High Option plan offers enhanced benefits and coverage compared to the Standard Option. It typically includes lower deductibles, copayments, and coinsurance, as well as additional benefits such as coverage for chiropractic care, acupuncture, and hearing aids.
  • GEHA HDHP (High Deductible Health Plan) with HSA (Health Savings Account): This plan combines a high deductible health insurance plan with a tax-advantaged health savings account (HSA). It offers lower premiums and allows members to save money tax-free for eligible medical expenses.
  • GEHA Elevate Health Plan: This plan provides comprehensive coverage with added features like enhanced preventive care benefits, telehealth services, and access to wellness programs. It is designed to promote proactive health management and preventive care.

Important Terms to Know When Reviewing Your GEHA Insurance Coverage

When reviewing your GEHA insurance policy, it’s important to understand several key terms to ensure you fully grasp your coverage and benefits. Here are some important terms commonly found in GEHA insurance policies:

addiction treatment covered by geha insurance

Premium: The amount you pay for your insurance coverage, typically on a monthly basis.

Deductible: The amount you must pay out of pocket for covered services before your insurance plan starts to pay.

Coinsurance: The percentage of the covered costs you pay after you’ve met your deductible. For example, if your coinsurance is 20%, you would pay 20% of the covered costs, and your insurance would pay the remaining 80%.

Copayment (Copay): A fixed amount you pay for covered services, such as a doctor’s visit or prescription medication.

Out-of-Pocket Maximum (OOPM): The maximum amount you have to pay for covered services in a plan year before your insurance covers 100% of the costs. This includes deductibles, coinsurance, and copayments, but typically excludes premiums.

In-Network Provider: Healthcare providers who have contracted with your insurance company to provide services at a discounted rate. Using in-network providers usually results in lower out-of-pocket costs for you.

Out-of-Network Provider: Healthcare providers who have not contracted with your insurance company. Visiting out-of-network providers may result in higher out-of-pocket costs or may not be covered at all, depending on your plan.

Prior Authorization: Approval required from your insurance company before certain medical services, treatments, or medications are covered. Failure to obtain prior authorization may result in denied coverage.

Formulary: A list of prescription drugs covered by your insurance plan. Drugs may be categorized into different tiers, with different cost-sharing amounts for each tier.

Explanation of Benefits (EOB): A statement from your insurance company explaining how your medical claims were processed, including what services were covered, what the insurance company paid, and any amount you may owe.

Preventive Care: Routine healthcare services, screenings, and vaccinations intended to prevent illness or detect health conditions early when they are most treatable are typically covered at no cost or with minimal cost-sharing under most insurance plans.

Full Color Logo No Text

Getting Help with Your GEHA Insurance Coverage for Addiction Treatment in North Carolina

As an insurance provider for federal employees, retirees, and their families, GEHA coverage is helping thousands of Americans get the health and mental health care they need—even in North Carolina. When you are looking for addiction treatment, the biggest worry you may have is how the financial part of it works, but don’t worry, Southeastern Recovery Center is here to help. 

Our staff is trained in handling your GEHA insurance coverage questions and we even offer online verification of benefits. We try to make the process as easy and as transparent as possible – that way you aren’t held back by the cost of addiction treatment in North Carolina.

If you are ready to get started, give Southeastern Recovery Center a call to get started verifying your GEHA insurance coverage for addiction and mental health treatment.

Full Color Logo No Text

Ready To Begin Healing?

We are available 24/7 to help you or a loved one.