Calvo's SelectCare, 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 B41 | $66.89 gov $200.68 | $144.93 | $144.93 | +$0.00 biweekly | $1,739 |
| Self Plus One code B43 | $130.54 gov $391.62 | $282.84 | $282.84 | +$0.00 biweekly | $3,394 |
| Self and Family code B42 | $177.18 gov $531.53 | $383.88 | $383.88 | +$0.00 biweekly | $4,607 |
Traditional, HMO network. Offered in Guam (statewide); Northern Mariana Islands (statewide); Palau (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 $500 | None out of network $1,500 | None out of network $1,500 |
| Out-of-pocket maximum | $2,000 out of network Not applicable | $4,000 out of network Not applicable | $6,000 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 | 30% Coinsurance After $500 deductible plus the difference between billed charges and eligible charges |
| Primary care visit | $15 Copayment | 30% Coinsurance After $500 deductible plus the difference between billed charges and eligible charges |
| Specialist visit | $40 Copayment | 30% Coinsurance After $500 deductible plus the difference between billed charges and eligible charges |
| Urgent care | $15 Copayment | 30% Coinsurance After $500 deductible plus the difference between billed charges and eligible charges |
| Emergency room | $100 Copayment | $100 Copayment |
| Labs and X-rays | Member Pays Nothing Ultrasound requires copayment of $40 | 30% Coinsurance After $500 deductible plus the difference between billed charges and eligible charges |
| CT, MRI, PET | $40 Copayment Ultrasound requires $40 copayment | 30% Coinsurance After $500 deductible plus the difference between billed charges and eligible charges |
| Hospital stay, per admission | $200 Copayment | 30% Coinsurance After $500 deductible plus the difference between billed charges and eligible charges |
| Hospital room | Member Pays Nothing Included in admission copayment | 30% Coinsurance After $500 deductible plus the difference between billed charges and eligible charges |
| Surgeon, inpatient | Member Pays Nothing | 30% Coinsurance After $500 deductible plus the difference between billed charges and eligible charges |
| Outpatient surgery | Member Pays Nothing Included in outpatient surgery copayment | 30% Coinsurance After $500 deductible plus the difference between billed charges and eligible charges |
| Mental health, office | $40 Copayment included in specialty office visit copayment | 30% Coinsurance After $500 deductible plus the difference between billed charges and eligible charges |
| Mental health, inpatient | $200 Copayment | 30% Coinsurance After $500 deductible plus the difference between billed charges and eligible charges |
| Physical therapy | $15 Copayment | 30% Coinsurance After $500 deductible plus the difference between billed charges and eligible charges |
| Chiropractic | Member Pays All Charges Member pays charges above $25 per visit, up to 20 visits | Member Pays All Charges |
| Acupuncture | Member Pays All Charges Member pays all charges above $25 | Member Pays All Charges |
| Maternity care | Member Pays Nothing | 30% Coinsurance After $500 deductible plus the difference between billed charges and eligible charges |
| Maternity hospital stay | $200 Copayment | 30% Coinsurance After $500 deductible plus the difference between billed charges and eligible charges |
| Infertility diagnosis and treatment | $40 Copayment specialty office visit copayment | 30% Coinsurance After $500 deductible plus the difference between billed charges and eligible charges |
| IVF and assisted reproduction | $40 Copayment specialty office visit copayment, other copayments apply for inpatient and outpatient facility services | 30% Coinsurance After $500 deductible plus the difference between billed charges and eligible charges |
| Hearing aids | Covered Coverage is limited to $300 per ear every two years | Covered After $500 deductible plus the difference between billed charges and eligible charges |
| Durable medical equipment | 20% Coinsurance | Member Pays All Charges After $500 deductible plus the difference between billed charges and eligible charges |
| Home health | Member Pays Nothing coverage limited to 100 days | 30% Coinsurance After $500 deductible plus the difference between billed charges and eligible charges |
| Adult dental exams | Covered | Not Covered |
| Children's dental exams | Covered | Not Covered |
| Routine eye exam | Covered | Covered After $500 deductible plus the difference between billed charges and eligible charges |
| Eyeglasses | Covered Coverage limited to $100 per benefit year for eyeglasses and contact lenses combined. | Not Covered |
| PRESCRIPTIONS | ||
| Tier 1 (usually generic) | $10 Copayment | 100% Coinsurance |
| Tier 2 | $25 Copayment | 100% Coinsurance |
| Tier 3 | 50% Coinsurance | 100% Coinsurance |
| Tier 4 | $100 Copayment | 100% Coinsurance |
| Mail order | Yes | Yes |
| Prescription out-of-pocket maximum, Self | $2,000 | Not listed |
| Prescription out-of-pocket maximum, family | $4,000 | 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
Calvo's SelectCare plan site · Summary of Benefits and Coverage · OPM plan comparison and brochure RI 73-874 · 6714779808
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.
