Medical Mutual of Ohio (Northern), Standard 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 644 | $446.46 gov $352.04 | $967.33 | $967.33 | +$65.24 biweekly | $11,608 |
| Self Plus One code 646 | $989.18 gov $767.53 | $2,143.23 | $2,143.23 | +$147.18 biweekly | $25,719 |
| Self and Family code 645 | $1,072.57 gov $843.82 | $2,323.90 | $2,323.90 | +$156.23 biweekly | $27,887 |
Traditional, HMO network. Offered in Ohio (30 counties). The county list is on the comparison page. 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 | $6,000 out of network Not applicable | $12,000 out of network Not applicable | $12,000 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 N/A | Member Pays Nothing N/A |
| Primary care visit | $25 Copayment N/A | Member Pays All Charges N/A |
| Specialist visit | $45 Copayment N/A | Member Pays All Charges N/A |
| Urgent care | $35 Copayment N/A | Member Pays All Charges N/A |
| Emergency room | $355 Copayment Medical/ Accident al Emerge ncy waives to Network level ER copay waived if admitted | $355 Copayment Medical/ Accident al Emerge ncy waives to Network level ER copay waived if admitted |
| Labs and X-rays | Member Pays Nothing N/A | Member Pays All Charges N/A |
| CT, MRI, PET | Member Pays Nothing N/A | Member Pays All Charges N/A |
| Hospital stay, per admission | $650 Copayment N/A | Member Pays All Charges N/A |
| Hospital room | Member Pays Nothing N/A | Member Pays All Charges N/A |
| Surgeon, inpatient | Member Pays Nothing N/A | Member Pays All Charges N/A |
| Outpatient surgery | $375 Copayment per outpatie nt surgery | Member Pays All Charges N/A |
| Mental health, office | $25 Copayment our cost-sharing responsibilities are no greater than for other illnesses or conditions | Member Pays All Charges N/A |
| Mental health, inpatient | $650 Copayment Your cost-sharing responsibilities are no greater than for other illnesses or conditions | Member Pays All Charges N/A |
| Physical therapy | $25 Copayment 60 visits per calendar year (combin ed benefit for Physical and Occupat ional Therapy | Member Pays All Charges N/A |
| Chiropractic | $25 Copayment Up to 20 Chiropra ctivc visits per calendar year | Member Pays All Charges N/A |
| Acupuncture | Member Pays All Charges N/A | Member Pays All Charges N/A |
| Maternity care | Member Pays All Charges N/A | Member Pays All Charges N/A |
| Maternity hospital stay | Member Pays Nothing $650 per adminss ion hospital copaym ent applies for any inpatient hospitalization | Member Pays All Charges N/A |
| Infertility diagnosis and treatment | 30% Coinsurance 30% of the Plan allowan ce (deducti ble applies) | Member Pays All Charges N/A |
| IVF and assisted reproduction | Member Pays All Charges Member Pays All Charges | Member Pays All Charges N/A |
| Hearing aids | Covered Children up to Age 21: All charges in excess of $2,500 for each hearing impaired ear every 48 Months Adults Age 22 and over: All charges in excess of $1,000 for each hearing impaired ear every 60 months | Not Covered N/A |
| Durable medical equipment | 30% Coinsurance 30% of Plan allowan ce (deducti ble applies) | Member Pays All Charges N/A |
| Home health | Member Pays Nothing N/A | Member Pays All Charges N/A |
| Adult dental exams | Not Covered N/A | Not Covered N/A |
| Children's dental exams | Not Covered N/A | Not Covered N/A |
| Routine eye exam | Covered $45 per specialt y care office visit | Not Covered N/A |
| Eyeglasses | Not Covered N/A | Not Covered N/A |
| PRESCRIPTIONS | ||
| Tier 1 (usually generic) | $15 Copayment | Not applicable |
| Tier 2 | $75 Copayment | Not applicable |
| Tier 3 | $180 Copayment | Not applicable |
| Tier 4 | 50% Coinsurance | Not applicable |
| Mail order | Yes | Yes |
| Prescription out-of-pocket maximum, Self | None N/A | Not listed |
| Prescription out-of-pocket maximum, family | None N/A | Not listed |
| WITH MEDICARE | ||
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
Medical Mutual of Ohio (Northern) plan site · Summary of Benefits and Coverage · OPM plan comparison and brochure RI 73-017 · (800) 315-3144
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.
