HMSA, 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 871 | $115.21 gov $345.65 | $249.63 | $249.63 | +$12.34 biweekly | $2,995 |
| Self Plus One code 873 | $252.45 gov $757.35 | $546.97 | $546.97 | +$27.05 biweekly | $6,564 |
| Self and Family code 872 | $259.00 gov $777.02 | $561.18 | $561.18 | +$27.75 biweekly | $6,734 |
Traditional, HMO/POS network. Offered in Hawaii (statewide). 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 None | None out of network None | None out of network None |
| Out-of-pocket maximum | $3,000 out of network $3,000 | $6,000 out of network $6,000 | $9,000 out of network $9,000 |
What you pay for care, in and out of network
| Service | In network | Out of network |
|---|---|---|
| VISITS | ||
| Preventive care | Member Pays Nothing | 30% Coinsurance Coinsurance applies to eligible charge; member pays difference between actual charge and eligilble charge |
| Primary care visit | $15 Copayment | 30% Coinsurance Coinsurance applies to eligible charge; member pays difference between actual charge and eligilble charge |
| Specialist visit | $15 Copayment | 30% Coinsurance Coinsurance applies to eligible charge; member pays difference between actual charge and eligilble charge |
| Urgent care | $20 Copayment | 30% Coinsurance Coinsurance applies to eligible charge; member pays difference between actual charge and eligilble charge |
| Emergency room | 20% Coinsurance ER facility; coinsurance applies to eligible charge | 20% Coinsurance ER facility; coinsurance applies to eligible charge; member pays difference between actual charge and eligible charge |
| Labs and X-rays | $0 Copayment Deductible may or may not apply; coinsurance applies to eligible charge | 30% Coinsurance Coinsurance applies to eligible charge; member pays difference between actual charge and eligilble charge |
| CT, MRI, PET | 20% Coinsurance Coinsurance applies to eligible charge | 30% Coinsurance Coinsurance applies to eligible charge; member pays difference between actual charge and eligilble charge |
| Hospital stay, per admission | $200 Copayment Based on semiprivate room rate; per admission | 30% Coinsurance |
| Hospital room | $200 Copayment Based on semiprivate room rate; per admission | 30% Coinsurance Based on semiprivate room rate; coinsurance applies to eligible charge; member pays difference between actual charge and eligible charge |
| Surgeon, inpatient | Member Pays Nothing Benefits may vary depending on services rendered | 30% Coinsurance Coinsurance applies to eligible charge; member pays difference between actual charge and eligilble charge; benefits may vary depending on services rendered |
| Outpatient surgery | Member Pays Nothing | 30% Coinsurance Coinsurance applies to eligible charge; member pays difference between actual charge and eligilble charge |
| Mental health, office | $15 | 30% Coinsurance applies to eligible charge; member pays difference between actual charge and eligible charge |
| Mental health, inpatient | $200 Per admission | 30% Coinsurance applies to eligible charge; member pays difference between actual charge and eligible charge |
| Physical therapy | 20% Coinsurance applies to eligible charge | 30% Coinsurance applies to eligible charge; member pays difference between actual charge and eligible charge |
| Chiropractic | 20% Coinsurance applies to eligible charge | 30% Coinsurance applies to eligible charge; member pays difference between actual charge and eligible charge |
| Acupuncture | Member Pays All Charges | Member Pays All Charges Not a covered benefit |
| Maternity care | Member Pays Nothing | 30% Coinsurance applies to eligible charge; member pays difference between actual charge and eligible charge |
| Maternity hospital stay | $200 Per admission | 30% Based on semiprivate room rate; coins applies to EC; member pays diff between AC and EC |
| Infertility diagnosis and treatment | 20% Coinsurance applies to eligible charge | 30% Coinsurance applies to eligible charge; member pays difference between actual charge and eligible charge |
| IVF and assisted reproduction | 20% Coinsurance applies to eligible charge | 30% Coinsurance applies to eligible charge; member pays difference between actual charge and eligible charge |
| Hearing aids | Covered Amount 20%; One/ear/60 months; coinsurance applies to eligible charge | Covered Amount 30%; One/ear/60 months; coinsurance applies to eligible charge; member pays difference between actual charge and eligible charge |
| Durable medical equipment | 20% Coinsurance applies to eligible charge | 30% Coins applies to EC; member pays diff between AC and EC |
| Home health | 20% 150 visits/year; coinsurance applies to eligible charge | 30% 150 visits/year; coinsurance applies to eligible charge; member pays difference between actual charge and eligible charge |
| Adult dental exams | Covered Adult dental care does not count toward max out-of-pocket | Covered Adult dental care does not cout toward max out-of-pocket; coinsurance applies to eligible charge; member pays difference between actual charge and eligible charge |
| Children's dental exams | Covered | Covered Coinsurance applies to eligible charge; member pays difference between actual charge and eligible charge |
| Routine eye exam | Covered Adult vision care does not count toward max out-of-pocket; coinsurance applies to eligible charge | Covered Adult vision care does not count toward max out-of-pocket; coinsurance applies to eligible charge; member pays difference between actual charge and eligible charge |
| Eyeglasses | Covered For certain medical conditions; adult vision care does not count toward max out-of-pocket; coinsurance applies to eligible charge | Covered For certain medical conditions; adult vision care does not count toward max out-of-pocket; coinsurance applies to eligible charge; member pays difference between actual charge and eligible charge |
| PRESCRIPTIONS | ||
| Tier 1 (usually generic) | $7 Copayment | $7 Copayment |
| Tier 2 | $35 Copayment | $35 Copayment |
| Tier 3 | $70 Copayment | $70 Copayment |
| Tier 4 | $140 Copayment | Not applicable |
| Mail order | Yes | Yes |
| Prescription out-of-pocket maximum, Self | $3,000 Combined with medical | Not listed |
| Prescription out-of-pocket maximum, family | $9,000 Combined with medical | 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
HMSA plan site · Summary of Benefits and Coverage · OPM plan comparison and brochure RI 73-010 · 808-948-6499
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.
