Group Health Cooperative of South Central Wisconsin, Standard: 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 WJ4 | $118.86 gov $352.04 | $257.53 | $257.53 | $-7.66 biweekly | $3,090 |
| Self Plus One code WJ6 | $268.45 gov $767.53 | $581.64 | $581.64 | $-13.20 biweekly | $6,980 |
| Self and Family code WJ5 | $380.50 gov $843.82 | $824.41 | $824.41 | $-14.78 biweekly | $9,893 |
Traditional, HMO network. Offered in Wisconsin (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 | $1,000 out of network Not applicable | $2,000 out of network Not applicable | $2,000 out of network Not applicable |
| Out-of-pocket maximum | $7,150 out of network Not applicable | $14,300 out of network Not applicable | $14,300 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 | $20 Copayment | Member Pays All Charges |
| Specialist visit | $40 Copayment | Member Pays All Charges |
| Urgent care | $40 Copayment | $40 Copayment |
| Emergency room | $100 Copayment | $100 Copayment |
| Labs and X-rays | 20% Coinsurance after deductible | Member Pays All Charges |
| CT, MRI, PET | 20% Coinsurance after deductible | Member Pays All Charges |
| Hospital stay, per admission | 20% Coinsurance after deductible | Member Pays All Charges |
| Hospital room | 20% Coinsurance after deductible | Member Pays All Charges |
| Surgeon, inpatient | 20% Coinsurance after deductible | Member Pays All Charges |
| Outpatient surgery | 20% Coinsurance after deductible | Member Pays All Charges |
| Mental health, office | $20 Copayment Your cost-sharing responsibilities are no greater than for other illness or conditions. | Member Pays All Charges |
| Mental health, inpatient | 20% Coinsurance after deductible | Member Pays All Charges |
| Physical therapy | 20% Coinsurance after deductible | Member Pays All Charges |
| Chiropractic | $20 Copayment | Member Pays All Charges |
| Acupuncture | Member Pays All Charges | Member Pays All Charges |
| Maternity care | Member Pays Nothing Nothing for prenatal care or for the first postpartum care visit; $20 per office visit for all postpartum care visits thereafter. 20% coinsurance for Inpatient professional and facility delivery services. | Member Pays All Charges No |
| Maternity hospital stay | 20% Coinsurance 20% coinsurance for Inpatient professional and facility delivery services | Member Pays All Charges |
| Infertility diagnosis and treatment | 50% Coinsurance | Member Pays All Charges |
| IVF and assisted reproduction | Member Pays All Charges | Member Pays All Charges |
| Hearing aids | Covered 20% Coinsurance for models specifically designated by GHCSCW. | Not Covered |
| Durable medical equipment | 20% Coinsurance | Member Pays All Charges |
| Home health | 20% Coinsurance after deductible | Member Pays All Charges |
| Adult dental exams | Covered Nothing if you use a GHCSCW Plan dentist. All charges for services provided by a non-plan dentist. | Not Covered |
| Children's dental exams | Covered Nothing if you use a GHCSCW Plan dentist. All charges for services provided by a non-plan dentist. | Not Covered |
| Routine eye exam | Covered $40 per office visit | Not Covered |
| Eyeglasses | Not Covered One eyeglass lens (frame not covered) or one contact lens to correct the affected eye for impairment directly caused by ocular injury or intraocular surgery (such as for cataracts). | Not Covered |
| PRESCRIPTIONS | ||
| Tier 1 (usually generic) | $5 Copayment | Not applicable |
| Tier 2 | $20 Copayment | Not applicable |
| Tier 3 | 20% Coinsurance | Not applicable |
| Tier 4 | $50 Copayment | Not applicable |
| Mail order | Yes | Yes |
| Prescription out-of-pocket maximum, Self | $7,150 | Not listed |
| Prescription out-of-pocket maximum, family | $14,300 | 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
Group Health Cooperative of South Central Wisconsin plan site · Summary of Benefits and Coverage · OPM plan comparison and brochure RI 73-061 · 800-605-4327
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.
