Kaiser Permanente - Mid-Atlantic States, Prosper: 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 T71 | $62.33 gov $186.98 | $135.04 | $135.04 | +$4.50 biweekly | $1,621 |
| Self Plus One code T73 | $148.90 gov $446.72 | $322.63 | $322.63 | +$10.74 biweekly | $3,871 |
| Self and Family code T72 | $168.13 gov $504.38 | $364.28 | $364.28 | +$5.43 biweekly | $4,371 |
Traditional, HMO network. Offered in District of Columbia (statewide); Maryland (8 counties); Virginia (13 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 | $150 out of network Not applicable | $300 out of network Not applicable | $300 out of network Not applicable |
| Out-of-pocket maximum | $5,300 out of network Not applicable | $10,600 out of network Not applicable | $10,600 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 | $30 Copayment nothing from infancy through age 4 | Member Pays All Charges |
| Specialist visit | $40 Copayment | Member Pays All Charges |
| Urgent care | $40 Copayment | $40 Copayment |
| Emergency room | $200 Copayment $200 per visit after the deductible | $200 Copayment $200 per visit after the deductible |
| Labs and X-rays | $0 Copayment $40 per procedure for X-rays | Member Pays All Charges |
| CT, MRI, PET | $100 Copayment $100 per procedure after the deductible. Nothing for Breast MRIs. | Member Pays All Charges |
| Hospital stay, per admission | $750 Copayment per aper admission after the deductible | Member Pays All Charges |
| Hospital room | Member Pays Nothing | Member Pays All Charges |
| Surgeon, inpatient | Member Pays Nothing | Member Pays All Charges |
| Outpatient surgery | $300 Copayment per surgery or procedure after deductible | Member Pays All Charges |
| Mental health, office | $30 Copayment $30 per individual therapy visit; $15 per group therapy visit. Nothing from infancy through age 4. | Member Pays All Charges |
| Mental health, inpatient | $750 Copayment $750 per inpatient admission after the deductible | Member Pays All Charges |
| Physical therapy | $40 Copayment per specialty care office visit | Member Pays All Charges |
| Chiropractic | $40 Copayment | Member Pays All Charges |
| Acupuncture | $40 Copayment | Member Pays All Charges |
| Maternity care | Member Pays Nothing | Member Pays All Charges |
| Maternity hospital stay | $750 Copayment per admission after the deductible | Member Pays All Charges |
| Infertility diagnosis and treatment | 50% Coinsurance of our allowance after the deductible. | Member Pays All Charges |
| IVF and assisted reproduction | 50% Coinsurance of our allowance after the deductible. Limited to 3 attempts per live birth per calendar year not to exceed $50,000 annual maximum benefit. | Member Pays All Charges |
| Hearing aids | Covered Limited to one device every 36 months. No annual or lifetime dollar limits. | Not Covered Member pays all charges |
| Durable medical equipment | 50% Coinsurance of our allowance after the deductible. Covers breastfeeding pump, supplies, and home UV light box. | Member Pays All Charges |
| Home health | Member Pays Nothing Nothing after the deductible | 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 $100 for eyeglasses every 12 months | Not Covered |
| PRESCRIPTIONS | ||
| Tier 1 (usually generic) | $10 Copayment | 100% Coinsurance |
| Tier 2 | $45 Copayment | 100% Coinsurance |
| Tier 3 | $65 Copayment | 100% Coinsurance |
| Tier 4 | $200 Copayment | 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 | ||
| Part B premium reimbursement (Medicare Advantage option) | None | Not listed |
| 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
Kaiser Permanente - Mid-Atlantic States plan site · Summary of Benefits and Coverage · OPM plan comparison and brochure RI 73-047 · 877-574-3337
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.
