APWU Health 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 471 | $191.92 gov $352.04 | $415.83 | $415.83 | +$51.76 biweekly | $4,990 |
| Self Plus One code 473 | $374.71 gov $767.53 | $811.87 | $811.87 | +$109.60 biweekly | $9,742 |
| Self and Family code 472 | $461.61 gov $843.82 | $1,000.15 | $1,000.15 | +$123.89 biweekly | $12,002 |
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 | $450 out of network $1,000 | $800 out of network $2,000 | $800 out of network $2,000 |
| Out-of-pocket maximum | $6,500 out of network $15,000 | $13,000 out of network $30,000 | $13,000 out of network $30,000 |
What you pay for care, in and out of network
| Service | In network | Out of network |
|---|---|---|
| VISITS | ||
| Preventive care | Member Pays Nothing | 40% Coinsurance + Difference Between Plan Allowance and Billed Amount. |
| Primary care visit | $25 Copayment $0 Calendar Year Deductible | 40% Coinsurance + Difference Between Plan Allowance and Billed Amount. $1000 Calendar Year Deductible. |
| Specialist visit | $25 Copayment $0 Calendar Year Deductible | 40% Coinsurance + Difference Between Plan Allowance and Billed Amount. $1000 Calendar Year Deductible. |
| Urgent care | $30 Copayment $0 Calendar Year Deductible | 40% Coinsurance + Difference Between Plan Allowance and Billed Amount. $1000 Calendar Year Deductible. |
| Emergency room | 15% Coinsurance $450 Calendar Year Deductible | 15% Coinsurance $1000 Calendar Year Deductible |
| Labs and X-rays | 15% Coinsurance $450 Calendar Year Deductible. If LabCorp or Quest Diagnostics performs your covered lab services, you pay nothing. | 40% Coinsurance + Difference Between Plan Allowance and Billed Amount. $1000 Calendar Year Deductible. |
| CT, MRI, PET | 15% Coinsurance $450 Calendar Year Deductible | 40% Coinsurance + Difference Between Plan Allowance and Billed Amount. $1000 Calendar Year Deductible. |
| Hospital stay, per admission | 15% Coinsurance $0 Calendar Year Deductible | 40% Coinsurance + Difference Between Plan Allowance and Billed Amount. Plus $300 Copayment. |
| Hospital room | 15% Coinsurance $0 Calendar Year Deductible | 40% Coinsurance + Difference Between Plan Allowance and Billed Amount. Plus $300 Copayment. |
| Surgeon, inpatient | 15% Coinsurance $450 Calendar Year Deductible | 40% Coinsurance + Difference Between Plan Allowance and Billed Amount. $1000 Calendar Year Deductible. |
| Outpatient surgery | 15% Coinsurance $450 Calendar Year Deductible | 40% Coinsurance + Difference Between Plan Allowance and Billed Amount. $1000 Calendar Year Deductible. |
| Mental health, office | $25 Copayment In a physician's office | 40% Coinsurance In a physician's office |
| Mental health, inpatient | 15% Coinsurance $0 Calendar Year Deductible | 40% Coinsurance + Difference Between Plan Allowance and Billed Amount. Plus $300 Copayment. |
| Physical therapy | 15% Coinsurance Up to a combined 60 visits per calendar year | 40% Coinsurance Up to a combined 60 visits per calendar year. + Difference Between Plan Allowance and Billed Amount. $1000 Calendar Year Deductible. |
| Chiropractic | $25 Copayment Up to 24 visits per calendar year | 40% Coinsurance Up to 24 visits per calendar year. + Difference Between Plan Allowance and Billed Amount. $1000 Calendar Year Deductible. |
| Acupuncture | $25 Copayment $0 Calendar Year Deductible. Limited to 26 visits per person per calendar year | 40% Coinsurance + Any difference between our allowance and the billed amount. Limited to 26 visits per person per calendar year |
| Maternity care | Member Pays Nothing | 40% Coinsurance + Difference Between Plan Allowance and Billed Amount. $1000 Calendar Year Deductible. |
| Maternity hospital stay | Member Pays Nothing | 40% Coinsurance + Difference Between Plan Allowance and Billed Amount. $1000 Calendar Year Deductible. Plus $300 Copayment. |
| Infertility diagnosis and treatment | 15% Coinsurance $450 Calendar Year Deductible | 40% Coinsurance $1000 Calendar Year Deductible |
| IVF and assisted reproduction | Member Pays All Charges | Member Pays All Charges |
| Hearing aids | Covered Covered every 3 years limited to $1500 | Covered Covered every 3 years limited to $1500 |
| Durable medical equipment | 15% Coinsurance $450 Calendar Year Deductible. | 40% Coinsurance + Difference Between Plan Allowance and Billed Amount. $1000 Calendar Year Deductible. |
| Home health | 15% Coinsurance Up to 50 visits per calendar year. $450 Calendar Year Deductible. | 40% Coinsurance Up to 50 visits per calendar year. $1000 Calendar Year Deductible. |
| Adult dental exams | Covered Member pays 30% | Covered Member pays 30% |
| Children's dental exams | Covered Member pays 30% | Covered Member pays 30% |
| Routine eye exam | Not Covered | Not Covered |
| Eyeglasses | Not Covered | Not Covered |
| PRESCRIPTIONS | ||
| Tier 1 (usually generic) | $10 Copayment | 50% Coinsurance |
| Tier 2 | 25% Coinsurance | 50% Coinsurance |
| Tier 3 | 45% Coinsurance | 50% Coinsurance |
| Tier 4 | 25% Coinsurance | 100% Coinsurance |
| Mail order | Yes | Yes |
| Prescription out-of-pocket maximum, Self | $6,500 Medical and prescription is combined | Not listed |
| Prescription out-of-pocket maximum, family | $13,000 Medical and prescription is combined | 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
APWU Health Plan plan site · Summary of Benefits and Coverage · OPM plan comparison and brochure RI 71-004 · 410-424-1500
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.
