Foreign Service Benefit Plan, 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 401 | $143.75 gov $352.04 | $311.46 | $311.46 | +$43.39 biweekly | $3,738 |
| Self Plus One code 403 | $429.35 gov $767.53 | $930.26 | $930.26 | +$171.39 biweekly | $11,163 |
| Self and Family code 402 | $382.65 gov $843.82 | $829.07 | $829.07 | +$134.38 biweekly | $9,949 |
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 | $300 out of network $400 | $600 out of network $800 | $600 out of network $800 |
| Out-of-pocket maximum | $6,000 out of network $8,000 | $12,000 out of network $16,000 | $12,000 out of network $16,000 |
What you pay for care, in and out of network
| Service | In network | Out of network |
|---|---|---|
| VISITS | ||
| Preventive care | Member Pays Nothing | 30% 30% + Difference Between Plan Allowance and Billed Amount |
| Primary care visit | 10% $300 Calendar Year Deductible, $600 Calendar Year Deductible, 10% | 30% $400 Calendar Year Deductible, $800 Calendar Year Deductible, 30% + Difference Between Plan Allowance and Billed Amount |
| Specialist visit | 10% $300 Calendar Year Deductible, $600 Calendar Year Deductible, 10% | 30% $400 Calendar Year Deductible, $800 Calendar Year Deductible, 30% + Difference Between Plan Allowance and Billed Amount |
| Urgent care | $35 Copayment | $35 Copayment $35 Copayment + Difference Between Plan Allowance and Billed Amount |
| Emergency room | 10% | 10% 10% + Difference Between Plan Allowance and Billed Amount |
| Labs and X-rays | 10% $300 Calendar Year Deductible, $600 Calendar Year Deductible, 10% | 30% $400 Calendar Year Deductible, $800 Calendar Year Deductible, 30% + Difference Between Plan Allowance and Billed Amount |
| CT, MRI, PET | 10% $300 Calendar Year Deductible, $600 Calendar Year Deductible, 10% | 30% $400 Calendar Year Deductible, $800 Calendar Year Deductible, 30% + Difference Between Plan Allowance and Billed Amount |
| Hospital stay, per admission | $250 Copayment | $500 |
| Hospital room | Member Pays Nothing | 20% 20% + Difference Between Plan Allowance and Billed Amount |
| Surgeon, inpatient | 10% | 30% 30% + Difference Between Plan Allowance and Billed Amount |
| Outpatient surgery | 10% $300 Calendar Year Deductible, $600 Calendar Year Deductible, 10% | 30% $400 Calendar Year Deductible, $800 Calendar Year Deductible, 30% + Difference Between Plan Allowance and Billed Amount |
| Mental health, office | 10% | 30% 30% of the Plan allowance and any difference between our allowance and the billed amount |
| Mental health, inpatient | $250 Copayment | $500 Copayment |
| Physical therapy | 10% 125 Combined Visits; $300 Calendar Year Deductible; $600 Calendar Year Deductible | 30% 125 Combined Visits; $400 Calendar Year Deductible; $800 Calendar Year Deductible; 30% + Difference Between Plan Allowance and Billed Amount |
| Chiropractic | Member Pays Nothing Nothing up to the Plan maximum of $75 per visit and then all charges up to the Plan Allowance; and all charges above 50 visits per person, per calendar year. | $75 Any Amount Over $75. There are 50 Visit Limit. |
| Acupuncture | Member Pays Nothing Nothing up to the Plan maximum of $75 per visit and then all charges up to the Plan Allowance; and all charges above 50 visits per person, per calendar year | Member Pays Nothing Nothing up to the Plan maximum of $75 per visit and then all charges up to the Plan Allowance; and all charges above 50 visits per person, per calendar year. |
| Maternity care | Member Pays Nothing | 30% 30% + Difference Between Plan Allowance and Billed Amount |
| Maternity hospital stay | Member Pays Nothing | 30% 30% + Difference Between Plan Allowance and Billed Amount |
| Infertility diagnosis and treatment | 10% 10% of the Plan allowance | 30% 30% of the Plan allowance and any difference between our allowance and the billed amount |
| IVF and assisted reproduction | 10% | Member Pays All Charges |
| Hearing aids | Covered | Covered Covered + Difference Between Plan Allowance and Billed Amount |
| Durable medical equipment | 10% | 30% 30% + Difference Between Plan Allowance and Billed Amount |
| Home health | 10% | 30% 30% + Difference Between Plan Allowance and Billed Amount |
| Adult dental exams | Covered Based on a scheduled allowance | Covered Based on a scheduled allowance |
| Children's dental exams | Covered Based on a scheduled allowance | Covered Based on a scheduled allowance |
| Routine eye exam | Not Covered | Not Covered |
| Eyeglasses | Not Covered | Not Covered |
| PRESCRIPTIONS | ||
| Tier 1 (usually generic) | $12 Copayment | Not applicable |
| Tier 2 | 35% Coinsurance | Not applicable |
| Tier 3 | 45% Coinsurance | Not applicable |
| Tier 4 | 35% Coinsurance | Not applicable |
| Mail order | Yes | Yes |
| Prescription out-of-pocket maximum, Self | None | Not listed |
| Prescription out-of-pocket maximum, family | None | Not listed |
| WITH MEDICARE | ||
| Part B premium reimbursement (Medicare Advantage option) | $2,000 | Not listed |
| Part B premium reimbursement (prescription drug plan) | $0 | 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
Foreign Service Benefit Plan plan site · Summary of Benefits and Coverage · OPM plan comparison and brochure RI 72-001 · 2028334910
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.
