Altius Health Plans (Aetna Health of Utah, Inc.), 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 DK4 | $268.28 gov $352.04 | $581.28 | $581.28 | +$12.68 biweekly | $6,975 |
| Self Plus One code DK6 | $588.79 gov $767.53 | $1,275.71 | $1,275.71 | +$31.00 biweekly | $15,309 |
| Self and Family code DK5 | $526.07 gov $843.82 | $1,139.82 | $1,139.82 | +$22.45 biweekly | $13,678 |
Traditional, HMO network. Offered in Idaho (32 counties); Utah (27 counties); Wyoming (3 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 | $100 out of network Not applicable | $200 out of network Not applicable | $200 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 | Member Pays All Charges |
| Primary care visit | $25 Copayment per visit | Member Pays All Charges |
| Specialist visit | $45 Copayment per visit | Member Pays All Charges |
| Urgent care | $40 Copayment per visit | Member Pays All Charges |
| Emergency room | $250 Copayment per visit | Member Pays All Charges |
| Labs and X-rays | $25 Copayment $25 PCP/$45 Specialist cost share | Member Pays All Charges |
| CT, MRI, PET | $250 Copayment per test | Member Pays All Charges |
| Hospital stay, per admission | 15% Coinsurance of our plan allowance | Member Pays All Charges |
| Hospital room | 15% Coinsurance of our plan allowance (see Inpatient Admission) If a private room is requested when it is not medically necessary, members pay the additional charge above the semiprivate room rate. | Member Pays All Charges |
| Surgeon, inpatient | 15% Coinsurance of our plan allowance (see Inpatient admission) | Member Pays All Charges |
| Outpatient surgery | $650 Copayment per visit | Member Pays All Charges |
| Mental health, office | $25 Copayment | Member Pays All Charges |
| Mental health, inpatient | 15% Coinsurance of our plan allowance | Member Pays All Charges |
| Physical therapy | $45 Copayment 60 visits per person, per calendar year for physical or occupational therapy | Member Pays All Charges |
| Chiropractic | $45 Copayment 20 visits per member per calendar year | Member Pays All Charges |
| Acupuncture | $25 Copayment 10 visits per member per calendar year | Member Pays All Charges |
| Maternity care | Member Pays Nothing | Member Pays All Charges |
| Maternity hospital stay | 15% Coinsurance of our plan allowance | Member Pays All Charges |
| Infertility diagnosis and treatment | $650 Copayment per visit | Member Pays All Charges |
| IVF and assisted reproduction | $650 Copayment of our Plan allowance, up to 3 cycles per calendar year (combined limit with Ovulation Induction and Advanced Reproductive Technology) | Member Pays All Charges |
| Hearing aids | Covered 50% of our plan allowance | Not Covered |
| Durable medical equipment | 50% Coinsurance of our plan allowance | Member Pays All Charges |
| Home health | $45 Copayment 60 visits per member per calendar year | Member Pays All Charges |
| Adult dental exams | Not Covered | Not Covered |
| Children's dental exams | Not Covered | Not Covered |
| Routine eye exam | Covered | Not Covered |
| Eyeglasses | Covered Up to $100 per 24 months, children through age 18, members pay 90% of charges after $100 | Covered Up to $100 per 24 months, children through age 18, members pay 90% of charges after $100 |
| PRESCRIPTIONS | ||
| Tier 1 (usually generic) | $7 Copayment | 100% Coinsurance |
| Tier 2 | $50 Copayment | 100% Coinsurance |
| Tier 3 | 50% Coinsurance | 100% Coinsurance |
| Tier 4 | 30% Coinsurance | 100% Coinsurance |
| 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
Altius Health Plans (Aetna Health of Utah, Inc.) plan site · Summary of Benefits and Coverage · OPM plan comparison and brochure RI 73-564 · 800-537-9384
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.
