Blue Cross and Blue Shield, Basic Option: 2027 FEHB premiums and benefits
| Enrollment | Employee, biweekly | Employee, monthly | Annuitant, monthly | Change in your share vs 2026 | Employee, per year (26 periods) |
|---|---|---|---|---|---|
| Self Only code 111 | $145.46 gov $352.04 | $315.17 | $315.17 | +$11.69 biweekly | $3,782 |
| Self Plus One code 113 | $350.48 gov $767.53 | $759.38 | $759.38 | +$31.23 biweekly | $9,112 |
| Self and Family code 112 | $387.54 gov $843.82 | $839.67 | $839.67 | +$30.68 biweekly | $10,076 |
Traditional, PPO network. Offered nationwide: anyone eligible for FEHB can enroll, in any state. The government share is the lesser of 72% of the program-wide average premium or 75% of this plan's premium (5 U.S.C. 8906).
Educational information only; StandWatch is not acting for OPM, and the brochure and your agency's benefits office are the final authority. Same code and assumptions as the comparison page: worst year is exact (premiums plus the in-network out-of-pocket maximum, minus an HSA deposit); the other three are estimates under stated usage profiles, each labeled copays only, has coinsurance, or not priced.
Deductibles and limits
| Self Only | Self Plus One | Self and Family | |
|---|---|---|---|
| Deductible | None out of network Not applicable | None out of network Not applicable | None out of network Not applicable |
| Out-of-pocket maximum | $8,500 out of network Not applicable | $17,000 out of network Not applicable | $17,000 out of network Not applicable |
What you pay for care, in and out of network
| Service | In network | Out of network |
|---|---|---|
| VISITS | ||
| Preventive care | Member Pays Nothing | Member Pays All Charges |
| Primary care visit | $35 Copayment | Member Pays All Charges |
| Specialist visit | $50 Copayment | Member Pays All Charges |
| Urgent care | $50 Copayment | $50 Copayment When NSA protections apply. Otherwise, member pays all charges. |
| Emergency room | $500 Copayment Per day per facility, nothing for professional services. | $500 Copayment Per day per facility, nothing for professional services. |
| Labs and X-rays | $75 Copayment Per day per facility, $40 when billed by a professional provider. Blood test and urinalysis have a 20% coinsurance when billed by a professional provider. | Member Pays All Charges |
| CT, MRI, PET | $250 Copayment Per day per facility. $100 when billed by a professional provider. Prior approval required for some services. | Member Pays All Charges |
| Hospital stay, per admission | $500 Copayment Per day, Up to $3500 per admission. | Member Pays All Charges |
| Hospital room | Member Pays Nothing These costs are included in the hospital inpat cost per admission copayment. | Member Pays All Charges |
| Surgeon, inpatient | $200 Copayment Prior approval required for some surgical services. | Member Pays All Charges |
| Outpatient surgery | $250 Copayment Per day per facility. Some services require prior approval. | Member Pays All Charges |
| Mental health, office | $35 Copayment | Member Pays All Charges |
| Mental health, inpatient | $500 Copayment Per day, up to $3500 per admission, precertification required. | Member Pays All Charges |
| Physical therapy | $35 Copayment $50 for a specialist, limited to 50 combined visits with occupational and speech therapies. | Member Pays All Charges |
| Chiropractic | $35 Copayment Limited to 20 visits per calendar year. | Member Pays All Charges |
| Acupuncture | $35 Copayment $50 for a specialist visit, limited to 12 visits per calendar year. | Member Pays All Charges |
| Maternity care | Member Pays Nothing | Member Pays All Charges |
| Maternity hospital stay | $500 Copayment Per admission. Waived when you deliver in a Blue Distinction Center for Maternity. | Member Pays All Charges |
| Infertility diagnosis and treatment | 20% Coinsurance Ultrasounds $40/$75 copayment and genetic testing $100 copayment (Prior approval required.) | Member Pays All Charges |
| IVF and assisted reproduction | Member Pays All Charges | Member Pays All Charges |
| Hearing aids | Covered 1 every 5 years for adults, yearly for children under the age of 22. You pay any amount over $2500. | Covered 1 every 5 years for adults, yearly for children under the age of 22. You pay any amount over $2500. |
| Durable medical equipment | 35% Coinsurance | Member Pays All Charges |
| Home health | $35 Copayment Limited to 25 visits per person per calendar year for 2 hours per day. | Member Pays All Charges |
| Adult dental exams | Covered $35 copayment per evaluation. | Not Covered |
| Children's dental exams | Covered $35 copayment per evaluation. | Not Covered |
| Routine eye exam | Not Covered | Not Covered |
| Eyeglasses | Not Covered Routine eyeglasses not covered. See brochure for coverage. | Not Covered |
| PRESCRIPTIONS | ||
| Tier 1 (usually generic) | $15 Copayment | Not applicable |
| Tier 2 | 35% Coinsurance | Not applicable |
| Tier 3 | 60% Coinsurance | Not applicable |
| Tier 4 | 35% Coinsurance | Not applicable |
| Mail order | No | No |
| Prescription out-of-pocket maximum, Self | None | Not listed |
| Prescription out-of-pocket maximum, family | None | Not listed |
| WITH MEDICARE | ||
| Part B premium reimbursement (prescription drug plan) | $800 | Not listed |
OPM's summary of the plan's cost sharing. The small print under a figure is OPM's own wording and usually carries the real terms: per-day charges, caps, and whether the deductible applies. The brochure is the official statement of benefits.
Official pages
Blue Cross and Blue Shield plan site · Summary of Benefits and Coverage · OPM plan comparison and brochure RI 71-005 · 3122976000
Before you enroll
Not the official statement of benefits. This plan's brochure is the only contractual statement of what it covers, excludes, and limits. Where this page and the brochure disagree, the brochure governs. Read it before you enroll.
Estimates, under published assumptions. Premiums, deductibles, and out-of-pocket maximums are OPM's figures. The year-cost figures are estimates under the usage profiles and assumed charges published on the comparison page, labeled exact, copays only, has coinsurance, or not priced. They are not predictions of what you will spend.
What the model leaves out. Out-of-network care and balance billing, whether your own doctors take this plan, whether your medications are on its formulary and at which tier, referral and prior-authorization rules, mail-order and specialty pharmacy pricing, FEDVIP dental and vision, and Medicare coordination at 65 beyond the rows shown. Postal Service employees and annuitants are in a separate program and are not covered.
No affiliation. StandWatch is not affiliated with, endorsed by, or acting for the Office of Personnel Management or any federal agency. The plan data is OPM's; the arrangement is ours. StandWatch is not a health plan, a broker, or an insurer, and nothing here is a recommendation to select, keep, or drop any plan, or medical, insurance, financial, tax, or legal advice. The full educational-purpose statement.
Source: OPM FEHB Public Use Files, plan year 2027 (rates, plan key, plan benefits, service area), and the OPM premium charts for the change from 2026.
