Triple-S Salud, Inc., High: 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 891 | $61.05 gov $183.17 | $132.28 | $132.28 | +$2.90 biweekly | $1,587 |
| Self Plus One code 893 | $137.09 gov $411.28 | $297.03 | $297.03 | +$6.53 biweekly | $3,564 |
| Self and Family code 892 | $139.82 gov $419.46 | $302.94 | $302.94 | +$6.66 biweekly | $3,635 |
Traditional, HMO/POS network. Offered in Puerto Rico (statewide); Virgin Islands (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 | Not applicable out of network Not applicable | Not applicable out of network Not applicable | Not applicable out of network Not applicable |
| Out-of-pocket maximum | $6,600 out of network Not applicable | $13,200 out of network Not applicable | $13,200 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 | 10% Coinsurance In-network cost-sharing applies, plus any difference between our allowance and the billed amount |
| Primary care visit | $7.50 Copayment $0 copay for services rendered in SALUS facility. | 10% Coinsurance In-network cost-sharing applies, plus any difference between our allowance and the billed amount |
| Specialist visit | $7.50 Copayment $0 copay for services rendered in SALUS facility. | 10% Coinsurance In-network cost-sharing applies, plus any difference between our allowance and the billed amount |
| Urgent care | $10 Copayment $0 copay for services rendered in SALUS Urgent facility. | 10% Coinsurance In-network cost-sharing applies, plus any difference between our allowance and the billed amount |
| Emergency room | $25 Copayment | 10% Coinsurance In-network cost-sharing applies, plus any difference between our allowance and the billed amount |
| Labs and X-rays | $1 Copayment Services range from $0 to $1. $0 copay for services rendered in SALUS facility. | 10% Coinsurance In-network cost-sharing applies, plus any difference between our allowance and the billed amount |
| CT, MRI, PET | $0 Copayment Services range from $0 to 20% | 10% Coinsurance In-network cost-sharing applies, plus any difference between our allowance and the billed amount |
| Hospital stay, per admission | Member Pays Nothing | 10% Coinsurance In-network cost-sharing applies, plus any difference between our allowance and the billed amount |
| Hospital room | Member Pays Nothing Limited to semi-private room | 10% Coinsurance In-network cost-sharing applies, plus any difference between our allowance and the billed amount |
| Surgeon, inpatient | Member Pays Nothing | 10% Coinsurance In-network cost-sharing applies, plus any difference between our allowance and the billed amount |
| Outpatient surgery | $25 Copayment Included in the $25 facility copay when outpatient surgery is performed | 10% Coinsurance In-network cost-sharing applies, plus any difference between our allowance and the billed amount |
| Mental health, office | $7.50 Copayment $0 copay for services rendered in SALUS facility. | 10% Coinsurance In-network cost-sharing applies, plus any difference between our allowance and the billed amount |
| Mental health, inpatient | Member Pays Nothing | 10% Coinsurance In-network cost-sharing applies, plus any difference between our allowance and the billed amount |
| Physical therapy | $10 Copayment | 10% Coinsurance In-network cost-sharing applies, plus any difference between our allowance and the billed amount |
| Chiropractic | Member Pays Nothing | 10% Coinsurance In-network cost-sharing applies, plus any difference between our allowance and the billed amount |
| Acupuncture | Member Pays Nothing Benefit covered only for Chronic low back pain | 10% Coinsurance In-network cost-sharing applies, plus any difference between our allowance and the billed amount |
| Maternity care | $7.50 Copayment $0 copay for office visits when enrolled in Maternal Program during the first trimester | 10% Coinsurance In-network cost-sharing applies, plus any difference between our allowance and the billed amount |
| Maternity hospital stay | Member Pays Nothing | 10% Coinsurance In-network cost-sharing applies, plus any difference between our allowance and the billed amount |
| Infertility diagnosis and treatment | $7.50 Copayment | 10% Coinsurance In-network cost-sharing applies, plus any difference between our allowance and the billed amount |
| IVF and assisted reproduction | Member Pays All Charges $15,000 annual maximum through reimbursement | Member Pays All Charges $15,000 annual maximum through reimbursement |
| Hearing aids | Covered Nothing, up to the allowance covered ($1,000) | Covered Nothing, up to the allowance covered ($1,000) |
| Durable medical equipment | 25% Coinsurance | 10% Coinsurance In-network cost-sharing applies, plus any difference between our allowance and the billed amount |
| Home health | Member Pays Nothing | 10% Coinsurance In-network cost-sharing applies, plus any difference between our allowance and the billed amount |
| Adult dental exams | Covered | Covered In-network cost-sharing applies, plus any difference between our allowance and the billed amount |
| Children's dental exams | Covered | Covered In-network cost-sharing applies, plus any difference between our allowance and the billed amount |
| Routine eye exam | Covered $7.50 per office visit | Covered In-network cost-sharing applies, plus any difference between our allowance and the billed amount |
| Eyeglasses | Covered One pair of eyeglasses or contact lenses annually for members up to age 21 through reimbursement. | Covered One pair of eyeglasses or contact lenses annually for members up to age 21 through reimbursement. |
| PRESCRIPTIONS | ||
| Tier 1 (usually generic) | $2 Copayment | 25% Coinsurance |
| Tier 2 | $20 Copayment | 25% Coinsurance |
| Tier 3 | 20% Coinsurance | 25% Coinsurance |
| Tier 4 | 25% Coinsurance | 25% Coinsurance |
| Mail order | Yes | Yes |
| Prescription out-of-pocket maximum, Self | $6,600 This amount is the total sum of out-of-pocket costs for medical services and prescription drugs. | Not listed |
| Prescription out-of-pocket maximum, family | $13,200 This amount is the total sum of out-of-pocket costs for medical services and prescription drugs. | 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
Triple-S Salud, Inc. plan site · Summary of Benefits and Coverage · OPM plan comparison and brochure RI 73-016 · 787-774-6081
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.
