Capital Health Plan, 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 EA1 | $126.89 gov $352.04 | $274.93 | $274.93 | +$6.49 biweekly | $3,299 |
| Self Plus One code EA3 | $279.79 gov $767.53 | $606.21 | $606.21 | +$17.43 biweekly | $7,275 |
| Self and Family code EA2 | $298.67 gov $843.82 | $647.12 | $647.12 | +$14.70 biweekly | $7,765 |
Traditional, HMO network. Offered in Florida (9 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 | None out of network Not applicable | None out of network Not applicable | None out of network Not applicable |
| Out-of-pocket maximum | $3,500 out of network Not applicable | $7,000 out of network Not applicable | $7,000 out of network Not applicable |
What you pay for care, in and out of network
| Service | In network | Out of network |
|---|---|---|
| VISITS | ||
| Preventive care | $0 Copayment You may have to pay for services that aren't preventive. Ask your provider if the services you need are preventive. Then check what your plan will pay for. | Member Pays All Charges |
| Primary care visit | $10 Copayment Cost share applies regardless of place of service, including office, telehealth, school, etc. Telehealth - Services are provided by network providers through remote access technology including the web and mobile devices. | Member Pays All Charges |
| Specialist visit | $60 Copayment Cost share applies regardless of place of service, including office, telehealth, school, etc. Telehealth - Services are provided by network providers through remote access technology including the web and mobile devices. | Member Pays All Charges |
| Urgent care | $50 Copayment Telehealth Services are provided by network providers through remote access technology including the web and mobile devices. | Member Pays All Charges |
| Emergency room | $500 Copayment Copayment is waived if inpatient admission occurs. | $500 Copayment |
| Labs and X-rays | Member Pays Nothing | Member Pays All Charges |
| CT, MRI, PET | $250 Copayment Prior authorization may be required. Your benefits/services may be denied. Cost share applies to all outpatient services. | Member Pays All Charges |
| Hospital stay, per admission | $250 Copayment Per day for days 1-6 | Member Pays All Charges |
| Hospital room | Member Pays Nothing Prior authorization required. | Member Pays All Charges |
| Surgeon, inpatient | Member Pays Nothing Prior authorization required. | Member Pays All Charges |
| Outpatient surgery | $225 Copayment Prior authorization may be required. Your benefits/services may be denied. Cost share applies to all outpatient services. | Member Pays All Charges |
| Mental health, office | $60 Copayment Limited per member per condition to the number of medically necessary rehabilitation services received by the member within the consecutive 62-day period immediately following the first date that the member begins such services | Member Pays All Charges |
| Mental health, inpatient | $250 Copayment $250 per day; days 1-6. Cost share applies regardless of place of service, including office, telehealth, school, etc. | Member Pays All Charges |
| Physical therapy | $60 Copayment Limited per member per condition to the number of medically necessary rehabilitation, habilitative, and speech services which are received by the member within the consecutive 62-day period immediately following the first date that the member begins such services. | Member Pays All Charges |
| Chiropractic | $60 Copayment Prior authorization and/or quantity limits may apply. Your benefits/services may be denied. | Member Pays All Charges |
| Acupuncture | Member Pays All Charges | Member Pays All Charges |
| Maternity care | $60 Copayment Copayment for initial visit to specialist | Member Pays All Charges |
| Maternity hospital stay | $250 Copayment $250 per day, days 1-6. Prior authorization required. Your benefits/services may be denied. | Member Pays All Charges |
| Infertility diagnosis and treatment | $60 Copayment Infertility services for a Member who meets the criteria established by Capital Health Plan for diagnostic procedures to determine the cause of infertility. Limited to endometrial biopsy, sperm count and hysterosalpingography. | Member Pays All Charges |
| IVF and assisted reproduction | Member Pays All Charges Not covered | Member Pays All Charges |
| Hearing aids | Not Covered | Not Covered |
| Durable medical equipment | 20% Coinsurance Durable Medical Equipment must be prescribed by your plan physician and authorized by CHP. CHP reserves the right to rent or purchase the most cost-effective DME that meets the member's needs. | Member Pays All Charges |
| Home health | Member Pays Nothing Extended care/skilled nursing facility (SNF): The Plan provides a comprehensive range of benefits for up to 60 days per admission with subsequent admission following 180 days from discharge date of previous admission. | Member Pays All Charges |
| Adult dental exams | Not Covered | Not Covered |
| Children's dental exams | Not Covered | Not Covered |
| Routine eye exam | Covered $15 PCP/$60 Specialist Routine Annual Eye Exam | Not Covered |
| Eyeglasses | Not Covered | Not Covered |
| PRESCRIPTIONS | ||
| Tier 1 (usually generic) | $15 Copayment | Not applicable |
| Tier 2 | $15 Copayment | Not applicable |
| Tier 3 | $40 Copayment | Not applicable |
| Tier 4 | $100 Copayment | Not applicable |
| Mail order | Yes | Yes |
| Prescription out-of-pocket maximum, Self | $4,600 | Not listed |
| Prescription out-of-pocket maximum, family | $8,700 | 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
Capital Health Plan plan site · Summary of Benefits and Coverage · OPM plan comparison and brochure RI 73-197 · 8503833311
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.
