GEHA, High 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 311 | $168.01 gov $352.04 | $364.03 | $364.03 | $-27.28 biweekly | $4,368 |
| Self Plus One code 313 | $376.59 gov $767.53 | $815.95 | $815.95 | $-56.36 biweekly | $9,791 |
| Self and Family code 312 | $459.39 gov $843.82 | $995.34 | $995.34 | $-65.79 biweekly | $11,944 |
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 | $500 out of network $2,000 | $1,000 out of network $4,000 | $1,000 out of network $4,000 |
| Out-of-pocket maximum | $7,500 out of network $20,000 | $15,000 out of network $40,000 | $15,000 out of network $40,000 |
What you pay for care, in and out of network
| Service | In network | Out of network |
|---|---|---|
| VISITS | ||
| Preventive care | Member Pays Nothing | 50% Coinsurance (Children pay nothing) |
| Primary care visit | $30 Copayment | 50% Coinsurance |
| Specialist visit | $45 Copayment | 50% Coinsurance |
| Urgent care | $45 Copayment | 50% Coinsurance |
| Emergency room | 30% Coinsurance | 30% Coinsurance |
| Labs and X-rays | 20% Coinsurance ($10 copay for lab) | 50% Coinsurance |
| CT, MRI, PET | 20% Coinsurance | 50% Coinsurance |
| Hospital stay, per admission | 20% Coinsurance ($200 copay/day up to 5 days) | 50% Coinsurance ($500 copay/day up to 5 days) |
| Hospital room | 20% Coinsurance | 50% Coinsurance |
| Surgeon, inpatient | 20% Coinsurance | 50% Coinsurance |
| Outpatient surgery | 20% Coinsurance | 50% Coinsurance |
| Mental health, office | $30 Copayment | 50% Coinsurance |
| Mental health, inpatient | 20% Coinsurance ($200/day, up to 5 days) | 50% Coinsurance ($500/day, up to 5 days) |
| Physical therapy | 20% Coinsurance (Plan provisions apply, see brochure) | 50% Coinsurance (Plan provisions apply, see brochure) |
| Chiropractic | $30 Copayment (Plan provisions apply, see brochure) | 50% Coinsurance (Plan provisions apply, see brochure) |
| Acupuncture | 20% Coinsurance (Plan provisions apply, see brochure) | 50% Coinsurance (Plan provisions apply, see brochure) |
| Maternity care | Member Pays Nothing | 50% Coinsurance |
| Maternity hospital stay | 20% Coinsurance ($200/day, up to 5 days) | 50% Coinsurance ($500/day , up to 5 days) |
| Infertility diagnosis and treatment | 20% Coinsurance | 50% Coinsurance |
| IVF and assisted reproduction | 20% Coinsurance (Plan provisions apply, see brochure) | 50% Coinsurance (Plan provisions apply, see brochure) |
| Hearing aids | Covered (Plan provisions apply, see brochure) | Covered (Plan provisions apply, see brochure) |
| Durable medical equipment | 20% Coinsurance | 50% Coinsurance |
| Home health | 20% Coinsurance (Plan provisions apply, see brochure) | 50% Coinsurance (Plan provisions apply, see brochure) |
| Adult dental exams | Covered (Plan provisions apply, see brochure) | Covered (Plan provisions apply, see brochure) |
| Children's dental exams | Covered (Plan provisions apply, see brochure) | Covered (Plan provisions apply, see brochure) |
| Routine eye exam | Not Covered (Plan provisions apply, see brochure) | Not Covered (Plan provisions apply, see brochure) |
| Eyeglasses | Not Covered (Plan provisions apply, see brochure) | Not Covered (Plan provisions apply, see brochure) |
| PRESCRIPTIONS | ||
| Tier 1 (usually generic) | $10 Copayment | $10 Copayment |
| Tier 2 | 25% Coinsurance | 25% Coinsurance |
| Tier 3 | 40% Coinsurance | 40% Coinsurance |
| Tier 4 | 25% Coinsurance | 100% Coinsurance |
| Mail order | Yes | Yes |
| Prescription out-of-pocket maximum, Self | $7,500 | Not listed |
| Prescription out-of-pocket maximum, family | $15,000 | Not listed |
| WITH MEDICARE | ||
| Part B premium reimbursement (Medicare Advantage option) | $1,200 | Not listed |
| Part B premium reimbursement (prescription drug plan) | None | 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
GEHA plan site · Summary of Benefits and Coverage · OPM plan comparison and brochure RI 71-006 · (800) 821-6136
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.
