Western Health Advantage, High 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 W51 | $148.58 gov $352.04 | $321.93 | $321.93 | +$27.63 biweekly | $3,863 |
| Self Plus One code W53 | $333.84 gov $767.53 | $723.32 | $723.32 | +$64.45 biweekly | $8,680 |
| Self and Family code W52 | $357.67 gov $843.82 | $774.95 | $774.95 | +$66.00 biweekly | $9,299 |
Traditional, HMO network. Offered in California (6 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 | $2,500 out of network Not applicable | $5,000 out of network Not applicable | $5,000 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 | Member Pays All Charges |
| Specialist visit | $25 Copayment | Member Pays All Charges |
| Urgent care | $35 Copayment $25 per visit for virtual urgent care visit. | $35 Copayment |
| Emergency room | $100 Copayment Copay waived if admitted. Follow-up care for an out-of-area emergency and/or urgent care service needs to be obtained by a WHA in-network provider. | $100 Copayment Copay waived if admitted. Follow-up care for an out-of-area emergency and/or urgent care service needs to be obtained by a WHA in-network provider. |
| Labs and X-rays | $0 Copayment Prior authorization required. | Member Pays All Charges |
| CT, MRI, PET | $0 Copayment Prior authorization required. | Member Pays All Charges |
| Hospital stay, per admission | $500 Copayment $500 per admission is based on inpatient surgery; $100 per visit if performed on an outpatient basis. | Member Pays All Charges |
| Hospital room | $500 Copayment Prior authorization required. | Member Pays All Charges |
| Surgeon, inpatient | $500 Copayment $500 per admission is based on inpatient surgery; $100 per visit if performed on an outpatient basis. | Member Pays All Charges |
| Outpatient surgery | $100 Copayment Prior authorization required. | Member Pays All Charges |
| Mental health, office | $25 Copayment Copay applicable to office or virtual visit. | Member Pays All Charges |
| Mental health, inpatient | $500 Copayment $500 copay for services provided at a participating acute care facility; $250 per admission copay applies for residential treatment center. | Member Pays All Charges |
| Physical therapy | $25 Copayment Prior authorizaton required; covered as medically necessary | Member Pays All Charges |
| Chiropractic | $15 Copayment Up to 20 visits per year for chiropractic care; copayments do not contribute to the medical out-of-pocket. | Member Pays All Charges |
| Acupuncture | $15 Copayment Up to 20 visits per year for acupuncture. | Member Pays All Charges |
| Maternity care | Member Pays Nothing Routine prenatal care and lab tests. | Member Pays All Charges |
| Maternity hospital stay | $500 Copayment $0 copay for first post-natal visit only | Member Pays All Charges |
| Infertility diagnosis and treatment | $25 Copayment $25 per visit in office setting $100 per visit in Facility setting | Member Pays All Charges |
| IVF and assisted reproduction | $25 Copayment $25 per visit in office setting $100 per visit in Facility setting | Member Pays All Charges |
| Hearing aids | Covered | Not Covered |
| Durable medical equipment | $20 Copayment Durable medical equipment when determined by a participating physician to be medically necessary and when authorized in advance by WHA | Member Pays All Charges |
| Home health | Member Pays Nothing Prior authorization required. | Member Pays All Charges |
| Adult dental exams | Not Covered | Not Covered |
| Children's dental exams | Not Covered | Not Covered |
| Routine eye exam | Covered Routine annual exam with WHA provider; coverage for the exam includes dilated exam, refraction exam with prescription if needed, med history and routine medical eye exam testing components. Excludes exams for contact fittings. Copays for adult exams do not contribute to the out-of-pocket maximum. Pr | Not Covered |
| Eyeglasses | Not Covered | Not Covered |
| PRESCRIPTIONS | ||
| Tier 1 (usually generic) | $15 Copayment | Not applicable |
| Tier 2 | $50 Copayment | Not applicable |
| Tier 3 | $75 Copayment | Not applicable |
| Tier 4 | $250 Copayment | Not applicable |
| Mail order | Yes | Yes |
| Prescription out-of-pocket maximum, Self | $2,500 | Not listed |
| Prescription out-of-pocket maximum, family | $5,000 | 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
Western Health Advantage plan site · Summary of Benefits and Coverage · OPM plan comparison and brochure RI 73-936 · 888.563.2250
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.
