Baylor Scott and White Health Plan, Value: 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 YZ1 | $67.41 gov $202.23 | $146.05 | $146.05 | $-0.25 biweekly | $1,753 |
| Self Plus One code YZ3 | $149.65 gov $448.95 | $324.24 | $324.24 | $-0.56 biweekly | $3,891 |
| Self and Family code YZ2 | $158.41 gov $475.25 | $343.23 | $343.23 | $-0.59 biweekly | $4,119 |
Traditional, HMO network. Offered in Texas (52 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 | $2,000 out of network Not applicable | $4,000 out of network Not applicable | $4,000 out of network Not applicable |
| Out-of-pocket maximum | $9,000 out of network Not applicable | $18,000 out of network Not applicable | $18,000 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 | Member Pays All Charges We don't offer out of network benefits |
| Primary care visit | $30 | Member Pays All Charges We don't offer out of network benefits |
| Specialist visit | $75 | Member Pays All Charges We don't offer out of network benefits |
| Urgent care | $75 | Member Pays All Charges We don't offer out of network benefits |
| Emergency room | 30% | Member Pays All Charges We don't offer out of network benefits |
| Labs and X-rays | Member Pays Nothing | Member Pays All Charges We don't offer out of network benefits |
| CT, MRI, PET | 30% After deductible | Member Pays All Charges We don't offer out of network benefits |
| Hospital stay, per admission | 30% After deductible | Member Pays All Charges We don't offer out of network benefits |
| Hospital room | 30% After deductible | Member Pays All Charges We don't offer out of network benefits |
| Surgeon, inpatient | 30% After deductible | Member Pays All Charges We don't offer out of network benefits |
| Outpatient surgery | 30% After deductible | Member Pays All Charges We don't offer out of network benefits |
| Mental health, office | $30 | Member Pays All Charges SWHP does not offer any out of network benefits except for urgent or emergent services |
| Mental health, inpatient | 30% Coinsurance after deductible | Member Pays All Charges SWHP does not offer any out of network benefits except for urgent or emergent services |
| Physical therapy | $75 | Member Pays All Charges SWHP does not offer any out of network benefits except for urgent or emergent services |
| Chiropractic | $75 | Member Pays All Charges SWHP does not offer any out of network benefits except for urgent or emergent services |
| Acupuncture | Member Pays All Charges | Member Pays All Charges We don't offer out of network benefits |
| Maternity care | $30 delivery is 30% after ded, postpartum and others are $30/$75 (PCP/specialist office visit)) | Member Pays All Charges SWHP does not offer any out of network benefits except for urgent or emergent services |
| Maternity hospital stay | 30% Coinsurance after ded | Member Pays All Charges SWHP does not offer any out of network benefits except for urgent or emergent services |
| Infertility diagnosis and treatment | $30 30/75 (PCP/specialist office visit) | Member Pays All Charges SWHP does not offer any out of network benefits except for urgent or emergent services |
| IVF and assisted reproduction | 50% Coinsurance $15000 max benefit | Member Pays All Charges SWHP does not offer any out of network benefits except for urgent or emergent services |
| Hearing aids | Covered | Not Covered SWHP does not offer any out of network benefits except for urgent or emergent services |
| Durable medical equipment | 30% Coinsurance after ded | Member Pays All Charges SWHP does not offer any out of network benefits except for urgent or emergent services |
| Home health | 30% Coinsurance after ded | Member Pays All Charges SWHP does not offer any out of network benefits except for urgent or emergent services |
| Adult dental exams | Not Covered | Not Covered We don't offer out of network benefits |
| Children's dental exams | Not Covered | Not Covered We don't offer out of network benefits |
| Routine eye exam | Not Covered | Not Covered We don't offer out of network benefits |
| Eyeglasses | Not Covered | Not Covered We don't offer out of network benefits |
| PRESCRIPTIONS | ||
| Tier 1 (usually generic) | $10 Copayment | 0% Coinsurance |
| Tier 2 | $25 Copayment | 0% Coinsurance |
| Tier 3 | $90 Copayment | 0% Coinsurance |
| Tier 4 | $200 Copayment | 0% 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 | ||
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
Baylor Scott and White Health Plan plan site · Summary of Benefits and Coverage · OPM plan comparison and brochure RI 73-881 · 254.298.3000
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.
