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2025 Plans 2026 Plans

PSHB High Option 2025

Self Only
Overall Deductible
$300
No deductible for PPO provider visits
Out-of-Pocket Limit
Not specified in SBC
Excludes premiums, balance-billed amounts

Office Visits

Primary care $25/visit
Specialist $25/visit
Preventive care No Charge

No deductible when services are rendered by a PPO provider

Tests & Imaging

Diagnostic (x-ray, blood work) 15% coinsurance
Imaging (CT/PET scans, MRIs) 15% coinsurance*

*Precertification required. LabCorp/Quest: You pay nothing

Prescription Drugs

Generic (retail) 20% coinsurance
Generic (mail order) $15/90-day
Preferred brand (retail) 30% coinsurance
Preferred brand (mail) $90/90-day
Non-preferred brand 50% coinsurance
Specialty drugs $200/30-day

Lower copays for hypertension, diabetes, asthma

Hospital stay
$350 copay + 15%
Emergency room
15% coinsurance
Urgent care
$25 copay
Ambulance
15% coinsurance

Mental Health/Substance Abuse

Outpatient 15% coinsurance
Inpatient $350 copay + 15%*

*Precertification required, $500 penalty

Coverage Examples (Self Only):
Peg (Baby): $4
Joe (Diabetes): $750
Mia (Fracture): $400

FEHB CDHP 2025

Self Only
Overall Deductible
$2,000
Self Only
Out-of-Pocket Limit
$6,600
Self Only
Self Plus One: $4,000 deductible / $12,000 OOP | Self & Family: $4,000 deductible / $12,000 OOP

Office Visits

Primary care 20% coinsurance
Specialist 20% coinsurance
Preventive care No Charge

Deductible does not apply to preventive care

Prescription Drugs

Generic (retail) 20% coinsurance
Generic (mail order) 20% coinsurance ($450 max)
Preferred brand (retail) 30% coinsurance
Preferred brand (mail) 30% coinsurance ($450 max)
Non-preferred brand 50% coinsurance
Hospital stay
20% coinsurance*
Emergency room
20% coinsurance
Urgent care
20% coinsurance
Ambulance
20% coinsurance

Service Limitations

  • Home health: 2 hrs/day, 25 days/year
  • Rehab/Habilitation: 50 visits/year combined
  • Skilled nursing: Not covered
  • Hospice: Not covered
Coverage Examples (Self Only):
Peg (Baby): $2,850
Joe (Diabetes): $1,470
Mia (Fracture): $1,000

PSHB High Option 2026

Self Only
Overall Deductible
$350
No deductible for PPO provider visits
Out-of-Pocket Limit
Not specified in SBC

Office Visits

Primary care $25/visit
Specialist $25/visit
Preventive care No Charge

Prescription Drugs (2026)

Generic (retail) 20% coinsurance
Generic (mail order) 20% coinsurance ($250 max)
Preferred brand (mail) 30% coinsurance ($350 max)
Non-preferred (mail) 50% coinsurance ($450 max)
Specialty $200-500/30-90 days
Coverage Examples (2026):
Peg: $3
Joe: $540
Mia: $450

FEHB CDHP 2026

Self Only
Overall Deductible
$2,000
Self Only
Out-of-Pocket Limit
$6,600
Self Only
Self Plus One/Family: $4,000 deductible / $12,000 OOP
Coverage Examples (2026):
Peg: $2,960
Joe: $1,270
Mia: $1,040

Limitations (2026)

  • Home health: 2 hrs/day, 25 days/year
  • Rehab/Habilitation: 50 visits/year combined
  • Skilled nursing: Not covered
  • Hospice: Not covered

2025 Plans - Your Rights to Continue Coverage

You can get help if you want to continue your coverage after it ends. See the FEHB Plan brochure, contact your HR office/retirement system, contact your plan at 877-814-6252 or visit www.opm.gov.insure/health. Generally, if you lose coverage under the plan, then, depending on the circumstances, you may be eligible for a 31-day free extension of coverage, a conversion policy (a non-FEHB individual policy), spouse equity coverage, or temporary continuation of coverage (TCC).

Grievance and Appeals: If you are dissatisfied with a denial of coverage for claims under your plan, you may be able to appeal. Call 877-814-6252 for assistance.

2026 Plans - Your Rights to Continue Coverage

You can get help if you want to continue your coverage after it ends. See the PSHB Plan brochure, contact your HR office/retirement system, contact your plan at 888-626-6252 or visit https://health-benefits.opm.gov/PSHB/. Generally, if you lose coverage under the plan, then, depending on the circumstances, you may be eligible for a 31-day free extension of coverage, a conversion policy (a non-PSHB individual policy), spouse equity coverage, or temporary continuation of coverage (TCC).

Grievance and Appeals: If you are dissatisfied with a denial of coverage, you may be able to appeal. Call 888-636-6252 for assistance.

Language Access (2025): Español: 800-594-6252 | Tagalog: 800-594-6252 | 中文: 800-594-6252 | Navajo: 800-594-6252
Language Access (2026): Español: 888-636-6252 | Tagalog: 888-636-6252 | 中文: 888-636-6252 | Navajo: 888-636-6252
Minimum Essential Coverage: Yes Minimum Value Standards: Yes

Services Generally NOT Covered (2025)

Cosmetic surgery Dental care Hospice Care Long-term care Routine eye/foot care Skilled nursing

Services Generally NOT Covered (2026)

Cosmetic surgery Dental care Routine eye care Routine foot care