SAMBA, Standard: 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 444 | $135.87 gov $352.04 | $294.39 | $294.39 | +$13.01 biweekly | $3,533 |
| Self Plus One code 446 | $264.64 gov $767.53 | $573.39 | $573.39 | +$27.91 biweekly | $6,881 |
| Self and Family code 445 | $280.66 gov $841.98 | $608.10 | $608.10 | +$23.18 biweekly | $7,297 |
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 | $350 out of network $350 | $700 out of network $700 | $900 out of network $900 |
| Out-of-pocket maximum | $6,000 out of network $8,500 | $12,000 out of network $14,000 | $12,000 out of network $14,000 |
What you pay for care, in and out of network
| Service | In network | Out of network |
|---|---|---|
| VISITS | ||
| Preventive care | Member Pays Nothing | 45% Coinsurance + difference between plan allowance and billed amount |
| Primary care visit | $20 Copayment | 45% Coinsurance + difference between plan allowance and billed amount |
| Specialist visit | $30 Copayment | 45% Coinsurance + difference between plan allowance and billed amount |
| Urgent care | $20 Copayment $30 copayment per visit to specialists | 45% Coinsurance + difference between plan allowance and billed amount |
| Emergency room | 20% Coinsurance | 20% Coinsurance + difference between plan allowance and billed amount |
| Labs and X-rays | 20% Coinsurance | 45% Coinsurance + difference between plan allowance and billed amount |
| CT, MRI, PET | 20% Coinsurance | 45% Coinsurance + difference between plan allowance and billed amount |
| Hospital stay, per admission | $250 Copayment | $450 Copayment |
| Hospital room | Member Pays Nothing | 45% Coinsurance + difference between plan allowance and billed amount |
| Surgeon, inpatient | 20% Coinsurance | 45% Coinsurance + difference between plan allowance and billed amount |
| Outpatient surgery | 20% Coinsurance | 45% Coinsurance + difference between plan allowance and billed amount |
| Mental health, office | $20 Copayment for primary care providers; $30 for specialists | 45% Coinsurance + difference between plan allowance and billed amount |
| Mental health, inpatient | $250 Copayment plus 20% for other hospital services | $450 Copayment plus 45% & any difference between plan allowance and billed amount |
| Physical therapy | 20% Coinsurance limited to 60 combined visits per year | 50% Coinsurance + difference between plan allowance and billed amount; limited to 60 combined visits per year |
| Chiropractic | 20% Coinsurance limited to 20 visits per year | 45% Coinsurance + difference between plan allowance and billed amount; limited to 20 visits per year |
| Acupuncture | 20% Coinsurance limited to 26 visits per year | 45% Coinsurance limited to 26 visits per year; + difference between plan allowance and billed amount |
| Maternity care | Member Pays Nothing | 45% Coinsurance + difference between plan allowance and billed amount |
| Maternity hospital stay | Member Pays Nothing | $450 Copayment plus 45% & any difference between plan allowance and billed amount |
| Infertility diagnosis and treatment | 20% Coinsurance | 45% Coinsurance + difference between plan allowance and billed amount |
| IVF and assisted reproduction | Member Pays All Charges | Member Pays All Charges |
| Hearing aids | Covered | Covered |
| Durable medical equipment | 20% Coinsurance | 50% Coinsurance + difference between plan allowance and billed amount |
| Home health | 20% Coinsurance limited to 25 visits per year | 50% Coinsurance + difference between plan allowance and billed amount; limited to 25 visits per year |
| Adult dental exams | Not Covered | Not Covered |
| Children's dental exams | Not Covered | Not Covered |
| Routine eye exam | Not Covered | Not Covered |
| Eyeglasses | Not Covered covered if needed as direct result of accident or intraocular surgery | Not Covered covered if needed as direct result of accident or intraocular surgery |
| PRESCRIPTIONS | ||
| Tier 1 (usually generic) | $12 Copayment | $12 Copayment |
| Tier 2 | 35% Coinsurance | 35% Coinsurance |
| Tier 3 | 50% Coinsurance | 50% Coinsurance |
| Tier 4 | Not applicable | Not applicable |
| Mail order | Yes | Yes |
| Prescription out-of-pocket maximum, Self | $6,000 Included in the medical out-of-pocket maximum; non-PPO $8500 | Not listed |
| Prescription out-of-pocket maximum, family | $12,000 Included in the medical out-of-pocket maximum; non-PPO $14,000 | Not listed |
| WITH MEDICARE | ||
| Part B premium reimbursement (Medicare Advantage option) | $900 | 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
SAMBA plan site · Summary of Benefits and Coverage · OPM plan comparison and brochure RI 71-015 · 301-984-1440
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.
