UPMC Health Plan, HDHP: 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 8W4 | $89.16 gov $267.49 | $193.18 | $193.18 | +$0.32 biweekly | $2,318 |
| Self Plus One code 8W6 | $234.60 gov $703.81 | $508.30 | $508.30 | +$22.30 biweekly | $6,100 |
| Self and Family code 8W5 | $249.08 gov $747.25 | $539.68 | $539.68 | +$11.86 biweekly | $6,476 |
HDHP, PPO network. Offered in Pennsylvania (29 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 | $2,000 out of network $2,000 | $4,000 out of network $4,000 | $4,000 out of network $4,000 |
| Out-of-pocket maximum | $6,000 out of network $8,000 | $12,000 out of network $16,000 | $12,000 out of network $16,000 |
| Health Reimbursement Arrangement contribution | $900 | $1,800 | $1,800 |
| Deductible after the account | $1,100 | $2,200 | $2,200 |
What you pay for care, in and out of network
| Service | In network | Out of network |
|---|---|---|
| VISITS | ||
| Preventive care | Member Pays Nothing | 40% Coinsurance deductibe doesnt apply |
| Primary care visit | 15% Coinsurance after deductible | 40% Coinsurance after deductible |
| Specialist visit | 15% Coinsurance after deductible | 40% Coinsurance after deductible |
| Urgent care | 15% Coinsurance after deductible | 15% Coinsurance after deductible |
| Emergency room | 15% Coinsurance after deductible | 15% Coinsurance after deductible |
| Labs and X-rays | 15% Coinsurance after deductible | 40% Coinsurance after deductible |
| CT, MRI, PET | 15% Coinsurance after deductible | 40% Coinsurance after deductible |
| Hospital stay, per admission | 15% Coinsurance after deductible | 40% Coinsurance after deductible |
| Hospital room | 15% Coinsurance after deductible | 40% Coinsurance after deductible |
| Surgeon, inpatient | 15% Coinsurance after deductible | 40% Coinsurance after deductible |
| Outpatient surgery | 15% Coinsurance after deductible | 40% Coinsurance after deductible |
| Mental health, office | 15% Coinsurance after deductible | 40% Coinsurance after deductible |
| Mental health, inpatient | 15% Coinsurance after deductible | 40% Coinsurance after deductible |
| Physical therapy | 15% Coinsurance after deductible | 40% Coinsurance after deductible |
| Chiropractic | 15% Coinsurance after deductible | 40% Coinsurance after deductible |
| Acupuncture | 15% Coinsurance | 40% Coinsurance |
| Maternity care | 15% Coinsurance after deductible | 40% Coinsurance after deductible |
| Maternity hospital stay | 15% Coinsurance after deductible | 40% Coinsurance after deductible |
| Infertility diagnosis and treatment | 15% Coinsurance after deductible | 40% Coinsurance after deductible |
| IVF and assisted reproduction | 15% Coinsurance after deductible | 40% Coinsurance after deductible |
| Hearing aids | Covered Member receives allowance of 1325 per ear/36 mo period | Covered Member receives allowance of 1325 per ear/36 mo period |
| Durable medical equipment | 15% Coinsurance after deductible | 40% Coinsurance after deductible |
| Home health | 15% Coinsurance after deductible | 40% Coinsurance after deductible |
| Adult dental exams | Not Covered | Not Covered |
| Children's dental exams | Not Covered | Not Covered |
| Routine eye exam | Covered Annual eye examination once every 24 months for adults and children, deductible applies | Covered Annual eye examination once every 24 months for adults and children, deductible applies |
| Eyeglasses | Not Covered | Not Covered |
| PRESCRIPTIONS | ||
| Tier 1 (usually generic) | $0 Copayment | Not applicable |
| Tier 2 | $20 Copayment | Not applicable |
| Tier 3 | $50 Copayment | Not applicable |
| Tier 4 | $100 Copayment | Not applicable |
| Mail order | Yes | Yes |
| Prescription out-of-pocket maximum, Self | None | Not listed |
| Prescription out-of-pocket maximum, family | None | 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
UPMC Health Plan plan site · Summary of Benefits and Coverage · OPM plan comparison and brochure RI 73-797 · 877-648-9641
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.
