The information contained in this comparison tool is not the official statement of benefits. Before making your final enrollment decision, always refer to the individual FEHB brochure which is the official statement of benefits. The amounts shown below indicate what you will pay for each class of service. When you see a plus sign (+), it means you must pay the stated coinsurance AND any difference between your Plan’s allowance and the provider’s billed amount. When a “yes” appears indicating that there is coverage for a specific service, you must check the plan brochure for your cost share. NOTE: HDHP plans require that the combined medical and pharmacy deductible be met before traditional coverage begins. traditional coverage begins.
Costs & Network
Disclaimer: In some cases, the enrollee share of premiums for the Self Plus One enrollment type will be higher than for the Self and Family enrollment type. Enrollees who wish to cover one eligible family member are free to elect either the Self and Family or Self Plus One enrollment type. Check premiums on our website at www.opm.gov/fehbpremiums.
Self Plus One Self & Family| Plans - Networks | Aetna HealthFund HDHP and Aetna Direct Plan (HDHP) - In-Network 1 | Aetna HealthFund HDHP and Aetna Direct Plan (HDHP) - Out-of-Network | Blue Cross and Blue Shield Service Benefit Plan (Basic) - In-Network 1 | Blue Cross and Blue Shield Service Benefit Plan (Basic) - Out-of-Network | GEHA Benefit Plan (HDHP) - In-Network 1 | GEHA Benefit Plan (HDHP) - Out-of-Network | MHBP Consumer Option (HDHP) - In-Network 1 | MHBP Consumer Option (HDHP) - Out-of-Network |
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| Annual Deductible |
Annual Deductible: The amount you may have to pay for covered health care services before the plan begins to pay. Some plans have both an overall deductible for all or most covered items/services, but some also have separate deductibles for specific types of services (e.g. prescription services).
Annual Deductible: The amount you may have to pay for covered health care services before the plan begins to pay. Some plans have both an overall deductible for all or most covered items/services, but some also have separate deductibles for specific types of services (e.g. prescription services).
Annual Deductible: The amount you may have to pay for covered health care services before the plan begins to pay. Some plans have both an overall deductible for all or most covered items/services, but some also have separate deductibles for specific types of services (e.g. prescription services).
The amount of funds available to you for paying your out-of-pocket qualified medical expenses through a premium pass-through contribution or a virtual account.
The amount of funds available to you for paying your out-of-pocket qualified medical expenses through a premium pass-through contribution or a virtual account.
The amount of funds available to you for paying your out-of-pocket qualified medical expenses through a premium pass-through contribution or a virtual account.
A net deductible is the sum of your deductible minus any medical account fund. A net deductible is the sum of your deductible minus any medical account fund. A net deductible is the sum of your deductible minus any medical account fund.Annual Maximum Out of Pocket: Yearly amount the Federal government sets as the most each individual or family is required to pay in cost sharing (e.g. copayments, deductibles and coinsurance) during the plan year for covered, in-network services. This amount may be higher than the out of pocket limits the plan sets.
Annual Maximum Out of Pocket: Yearly amount the Federal government sets as the most each individual or family is required to pay in cost sharing (e.g. copayments, deductibles and coinsurance) during the plan year for covered, in-network services. This amount may be higher than the out of pocket limits the plan sets.
Annual Maximum Out of Pocket: Yearly amount the Federal government sets as the most each individual or family is required to pay in cost sharing (e.g. copayments, deductibles and coinsurance) during the plan year for covered, in-network services. This amount may be higher than the out of pocket limits the plan sets.
Member Cost with Medicare A & B Primary - This field will indicate either the amount of your annual deductible or that the deductible has been waived (forgiven) when Medicare A and B is the primary coverage.
Member Cost with Medicare A & B Primary - This is the most you have to pay annually in cost-sharing (deductibles, copayments and coinsurance) for covered, in-network services in your FEHB plan when Medicare A and B is your primary coverage.
Member Cost with Medicare A & B Primary - This is the amount you pay for a primary care visit. When you have Medicare A and B, some plans will waive the copay.
Member Cost with Medicare A & B Primary - This is the amount you pay for a Specialty care visit. When you have Medicare A and B, some plans will waive the copay.
Member Cost with Medicare A & B Primary - This is the amount you pay for an inpatient hospital stay. When you have Medicare A and B, some plans waive this amount.
Member Cost with Medicare A & B Primary - This is the amount you pay for an outpatient hospital visit when you have Medicare Parts A & B as your primary coverage.What is the amount a member with Medicare A and B pays for an outpatient hospital visit?
Member Cost with Medicare A & B Primary - If a plan reimburses you for your Part B premiums, this displays the maximum amount that you will be annually reimbursed. A ‘No” means that the premium will not be reimbursed.
Member Cost with Medicare Advantage (Part C) Primary - This field will indicate either the amount of your annual deductible or that the deductible has been waived (forgiven) when Medicare C is the primary coverage.
Member Cost with Medicare Advantage (Part C) Primary - This is the most you have to pay annually in cost-sharing (deductibles, copayments and coinsurance) for covered, in-network services in your FEHB plan when Medicare C is your primary coverage.
Member Cost with Medicare Advantage (Part C) Primary - This is the amount you pay for a primary care visit. When you have Medicare C, some plans will waive the copay.
Member Cost with Medicare Advantage (Part C) Primary - This is the amount you pay for a Specialty care visit. When you have Medicare C, some plans will waive the copay.
Member Cost with Medicare Advantage (Part C) Primary - This is the amount you pay for an inpatient hospital stay. When you have Medicare C, some plans waive this amount.
Member Cost with Medicare Advantage (Part C) Primary - This is the amount you pay for an outpatient hospital visit when you have Medicare Parts C as your primary coverage.What is the amount a member with Medicare C pays for an outpatient hospital visit?
Member Cost with Medicare Advantage (Part C) Primary - If a plan reimburses you for your Part B premiums, this displays the maximum amount that you will be annually reimbursed. A ‘No” means that the premium will not be reimbursed.
Primary/Specialty Care - What is the member cost share for Preventive Care, as defined by the U.S. Preventive Services Task Force with a rating of A or B?
Primary/Specialty Care - The amount you pay for a visit to a primary care practitioner (typically an M.D. or D.O., but can include other licensed providers).
Primary/Specialty Care - The amount you pay for a visit to a provider focusing on a specific area of medicine. Some plans require a referral from your primary care provider for you to see a specialist. You must get a referral, if required, or your plan may not pay for the services.
Primary/Specialty Care - A written order from your primary care provider for you to see a specialist or get certain health care services. Some plans may require you need to get a referral before you can get health care services from anyone other than your primary care provider. In those plans, if you don’t get a referral first, the plan may not pay for the services
Emergency & Urgent Care - What is the member cost share for Emergency Care? Emergency & Urgent Care - What is the member cost share for Urgent Care?Emergency & Urgent Care - Is a member's Out-of-Pocket cost waived when the member is admitted to the hospital following ER treatment? Select "NA" if a member pays nothing for any medical emergency.
Surgery & Hospital Charges - The amount you will pay for a doctor to perform inpatient surgery.Surgery & Hospital Charges - This is the amount you pay before the Plan pays benefits when you are admitted as an inpatient to a hospital.
Surgery & Hospital Charges - This is the amount you pay for covered Room & Board charges while an inpatient in a hospital.
Surgery & Hospital Charges - This is the amount you pay for other costs associated with inpatient surgery.
Surgery & Hospital Charges - This is the amount you pay for a doctor to perform surgery in an outpatient hospital setting or ambulatory surgery center.
Surgery & Hospital Charges - This is the amount you pay for other outpatient care at a hospital (not surgery or emergency room services).
Lab, X-Ray & Other Diagnostic Tests - What is the member cost share for Simple Diagnostic Tests/Procedures (e.g., blood tests, urinalysis, ultrasounds)?
Lab, X-Ray & Other Diagnostic Tests - What is the member cost share for Complex Diagnostic Tests/Procedures (e.g., CT scans, MRIs, PET scans, sleep labs)?