TakeCare Insurance Company, Inc., HDHP 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 KX1 | $20.37 gov $61.10 | $44.13 | $44.13 | +$2.57 biweekly | $530 |
| Self Plus One code KX3 | $49.17 gov $147.53 | $106.54 | $106.54 | +$6.20 biweekly | $1,278 |
| Self and Family code KX2 | $54.61 gov $163.82 | $118.32 | $118.32 | +$6.89 biweekly | $1,420 |
HDHP, HMO/POS 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 | $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 | $3,000 out of network Not applicable | $6,000 out of network Not applicable | $6,000 out of network Not applicable |
| Health Savings Account contribution | $42.43 | $102.45 | $113.77 |
| Deductible after the account | $1,957.57 | $3,897.55 | $3,886.23 |
What you pay for care, in and out of network
| Service | In network | Out of network |
|---|---|---|
| VISITS | ||
| Preventive care | Member Pays Nothing Plan deductible is waived. | 30% Coinsurance of our allowance plus any difference between our allowance and billed charges, after meeting plan deductible |
| Primary care visit | 20% Coinsurance after plan deductible is met. | 30% Coinsurance of our allowance plus any difference between our allowance and billed charges, after meeting plan deductible |
| Specialist visit | 2% Coinsurance after plan deductible is met. | 30% Coinsurance of our allowance plus any difference between our allowance and billed charges, after meeting plan deductible |
| Urgent care | $75 Copayment after plan deductible is met. | $75 Copayment plus any difference between our allowance and billed charges, after meeting deductible. |
| Emergency room | $100 Copayment after plan deductible is met. | $100 Copayment after plan deductible is met. |
| Labs and X-rays | Member Pays Nothing after plan deductible is met. | 30% Coinsurance of our allowance plus any difference between our allowance and billed charges, after meeting plan deductible |
| CT, MRI, PET | 20% Coinsurance after plan deductible is met. | 30% Coinsurance of our allowance plus any difference between our allowance and billed charges, after meeting plan deductible |
| Hospital stay, per admission | 20% Coinsurance after plan deductible is met. | 30% Coinsurance of our allowance plus any difference between our allowance and billed charges, after meeting plan deductible |
| Hospital room | 20% Coinsurance after plan deductible is met. | 30% Coinsurance of our allowance plus any difference between our allowance and billed charges, after meeting plan deductible |
| Surgeon, inpatient | 20% Coinsurance after plan deductible is met. | 30% Coinsurance of our allowance plus any difference between our allowance and billed charges, after meeting plan deductible |
| Outpatient surgery | 20% Coinsurance after plan deductible is met. | 30% Coinsurance of our allowance plus any difference between our allowance and billed charges, after meeting plan deductible |
| Mental health, office | 20% Coinsurance of our allowance after deductible is met | 30% Coinsurance of our allowance plus difference between our allowance and billed charges, after meeting ded |
| Mental health, inpatient | 20% Coinsurance of our allowance after deductible is met | 30% Coinsurance of our allowance plus difference between our allowance and billed charges, after meeting ded |
| Physical therapy | 20% Coinsurance of our allowance after deductible is met, up to 2 consecutive months | 30% Coinsurance of our allowance plus difference between our allowance and billed charges, after meeting ded |
| Chiropractic | Member Pays All Charges After deductible is met, any amount over $25 - 20 Visit/Year Limit | Member Pays All Charges |
| Acupuncture | Member Pays All Charges After deductible is met, any amount over $25 - 20 Visit/ Year Limit | Member Pays All Charges |
| Maternity care | Member Pays Nothing after deductible is met | 30% Coinsurance of our allowance plus difference between our allowance and billed charges, after meeting ded |
| Maternity hospital stay | 20% Coinsurance of our allowance after deductible is met | 30% Coinsurance of our allowance plus difference between our allowance and billed charges, after meeting ded |
| Infertility diagnosis and treatment | 20% Coinsurance of our allowance after deductible is met | 30% Coinsurance of our allowance plus difference between our allowance and billed charges, after meeting ded |
| IVF and assisted reproduction | Member Pays All Charges | Member Pays All Charges |
| Hearing aids | Covered after ded is met, 80% covered, up to $300/ear, every 2 years. Adults only | Covered after ded is met, 80% of our allowance is covered, up to $300/ear, every 2 years. Adults only. |
| Durable medical equipment | Member Pays Nothing after deductible is met | 30% Coinsurance of our allowance plus difference between our allowance and billed charges, after meeting ded |
| Home health | 20% Coinsurance of our allowance after deductible is met. | 30% Coinsurance of our allowance plus difference between our allowance and billed charges, after meeting ded |
| Adult dental exams | Covered 100% of allowance, ded waived | Covered 100% of allowance, ded waived |
| Children's dental exams | Covered 100% of allowance, ded waived | Covered 100% of allowance, ded waived |
| Routine eye exam | Covered 100% through age 17. Over age 17, 80% of allowance, after deductible is met | Covered 70% of allowance |
| Eyeglasses | Covered for prescription eyeglasses, up to $100/year after ded is met. Benefit combined with contact lenses | Not Covered |
| PRESCRIPTIONS | ||
| Tier 1 (usually generic) | $10 Copayment | 30% Coinsurance |
| Tier 2 | $40 Copayment | 30% Coinsurance |
| Tier 3 | $100 Copayment | 30% Coinsurance |
| Tier 4 | $100 Copayment | 30% Coinsurance |
| Mail order | Yes | Yes |
| Prescription out-of-pocket maximum, Self | $3,000 Combined In and Out of Network | Not listed |
| Prescription out-of-pocket maximum, family | $6,000 Combined In and Out of Network | Not listed |
| WITH MEDICARE | ||
| Part B premium reimbursement (prescription drug plan) | None | Not listed |
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
TakeCare Insurance Company, Inc. plan site · Summary of Benefits and Coverage · OPM plan comparison and brochure RI 73-776 · 1-671-647-3526
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.
