2024 FEHB Plan Comparison Details

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

Self Plus One

Self & Family

Plan Selection Comparison Tool

Plans	Blue Cross and Blue Shield Service Benefit Plan (Standard)		Blue Cross and Blue Shield Service Benefit Plan (Basic)
Plan Links	[Website] Brochure Link [Summary of Benefits] [Provider Directory] [RX Pricing Tool]		[Website] Brochure Link [Summary of Benefits] [Provider Directory] [RX Pricing Tool]
General Information - State	District Of Columbia		District Of Columbia
General Information - Enrollment Code - Self	104		111
General Information - Enrollment Code - Self & Family	105		112
General Information - Enrollment Code - Self Plus One	106		113
General Information - Carrier Code	10		11
General Information - Telephone Number	1-800-411-2583		1-800-411-2583
Biweekly Premium	$150.79		$95.74
Biweekly Premium	$336.84		$238.63
Biweekly Premium	$370.68		$262.60

Plans - Networks	Blue Cross and Blue Shield Service Benefit Plan (Standard) - In-Network 1	Blue Cross and Blue Shield Service Benefit Plan (Standard) - 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
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).	$350.00	None	None	None
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).	$700.00	None	None	None
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).	$700.00	None	None	None
Type of Account	None	None	None	None
Medical Account Contribution 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.	N/A	N/A	N/A	N/A
Medical Account Contribution 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.	N/A	N/A	N/A	N/A
Medical Account Contribution 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.	N/A	N/A	N/A	N/A
Net Deductible A net deductible is the sum of your deductible minus any medical account fund.	$350.00	None	None	None
Net Deductible A net deductible is the sum of your deductible minus any medical account fund.	$700.00	None	None	None
Net Deductible A net deductible is the sum of your deductible minus any medical account fund.	$700.00	None	None	None
Annual Out-of-Pocket Maximum 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.	$6,000.00	$8,000.00	$6,500.00	None
Annual Out-of-Pocket Maximum 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.	$12,000.00	$16,000.00	$13,000.00	None
Annual Out-of-Pocket Maximum 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.	$12,000.00	$16,000.00	$13,000.00	None
Member Cost with Medicare A & B Primary - Deductible Waiver with Parts A & B 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.	Deductible Waived	Deductible Waived	N/A	N/A
Member Cost with Medicare A & B Primary - Out-of-Pocket Maximum with Parts A & B 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.	$6000 $12000	$8000 $16000	$6500 $13000	N/A
Member Cost with Medicare A & B Primary - Primary Care Office Visit with Medicare A & B Primary 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 Pays Nothing	Member Pays Nothing	Member Pays Nothing	N/A
Member Cost with Medicare A & B Primary - Specialty Office Visit with Parts A & B 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 Pays Nothing	Member Pays Nothing	Member Pays Nothing	N/A
Member Cost with Medicare A & B Primary - Inpatient Hospital with Parts A & B 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 Pays Nothing	Member Pays Nothing	Member Pays Nothing	N/A
Member Cost with Medicare A & B Primary - Outpatient Hospital with Parts A & B 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 Pays Nothing	Member Pays Nothing	Member Pays Nothing	N/A
Member Cost with Medicare A & B Primary - Part B Premium Reimbursement with Parts A & B 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.	No	No	$800 Max	N/A
Member Cost with Medicare Advantage (Part C) Primary - Deductible Waiver with Part C 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.	Deductible Waived	Deductible Waived	N/A	N/A
Member Cost with Medicare Advantage (Part C) Primary - Out-of-Pocket Maximum with Part C 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.	$6000 $12000	$8000 $16000	$6500 $13000	N/A
Member Cost with Medicare Advantage (Part C) Primary - Primary Care Office Visit with Medicare Advantage (Part C) Primary 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 Pays Nothing	Member Pays Nothing	Member Pays Nothing	N/A
Member Cost with Medicare Advantage (Part C) Primary - Specialty Office Visit with Part C 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 Pays Nothing	Member Pays Nothing	Member Pays Nothing	N/A
Member Cost with Medicare Advantage (Part C) Primary - Inpatient Hospital with Part C 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 Pays Nothing	Member Pays Nothing	Member Pays Nothing	N/A
Member Cost with Medicare Advantage (Part C) Primary - Outpatient Hospital with Part C 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 Pays Nothing	Member Pays Nothing	Member Pays Nothing	N/A
Member Cost with Medicare Advantage (Part C) Primary - Part B Premium Reimbursement with Part C 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.	No	No	No	N/A
Primary/Specialty Care - Preventive Care 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?	Member Pays Nothing	35% + Difference Between Plan Allowance and Billed Amount	Member Pays Nothing	N/A
Primary/Specialty Care - Primary Care Office Visit 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).	$30	35% + Difference Between Plan Allowance and Billed Amount	$35	N/A
Primary/Specialty Care - Specialist Office Visit 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.	$40	35% + Difference Between Plan Allowance and Billed Amount	$45	N/A
Primary/Specialty Care - Plan Requires Referral to See Certain Specialists 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	No	No	No	N/A
Emergency & Urgent Care - Emergency Care Emergency & Urgent Care - What is the member cost share for Emergency Care?	15%	15%	$0 + $250	$0 + $250
Emergency & Urgent Care - Urgent Care Emergency & Urgent Care - What is the member cost share for Urgent Care?	$0 Or $30	$0 Or $0 + Difference Between Plan Allowance and Billed Amount Or $30 Or 35% Or 35% + Difference Between Plan Allowance and Billed Amount	$35	$35 Or Member Pays All Charges
Emergency & Urgent Care - Out-of-Pocket Waived 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.	No	No	Yes	N/A
Surgery & Hospital Charges - Doctor Costs Inpatient Surgery Surgery & Hospital Charges - The amount you will pay for a doctor to perform inpatient surgery.	15%	35% + Difference Between Plan Allowance and Billed Amount	$200	N/A
Surgery & Hospital Charges - Hospital Inpatient Cost Per Admission Surgery & Hospital Charges - This is the amount you pay before the Plan pays benefits when you are admitted as an inpatient to a hospital.	$350	$450 + 35% + Difference Between Plan Allowance and Billed Amount	$250 Per Day Up To $1500 Per Admission	N/A
Surgery & Hospital Charges - Room & Board Charges Surgery & Hospital Charges - This is the amount you pay for covered Room & Board charges while an inpatient in a hospital.	Member Pays Nothing	Member Pays Nothing	Member Pays Nothing	N/A
Surgery & Hospital Charges - Other Inpatient Costs Surgery & Hospital Charges - This is the amount you pay for other costs associated with inpatient surgery.	Member Pays Nothing	Member Pays Nothing	Member Pays Nothing	N/A
Surgery & Hospital Charges - Doctor Costs Outpatient 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.	15%	35% + Difference Between Plan Allowance and Billed Amount	$150 Or $200	N/A
Surgery & Hospital Charges - Other Outpatient Costs Surgery & Hospital Charges - This is the amount you pay for other outpatient care at a hospital (not surgery or emergency room services).	15%	35% + Difference Between Plan Allowance and Billed Amount	$150 Per Day Or $200 Per Day	N/A
Lab, X-Ray & Other Diagnostic Tests - Simple Diagnostic Tests/Procedures Lab, X-Ray & Other Diagnostic Tests - What is the member cost share for Simple Diagnostic Tests/Procedures (e.g., blood tests, urinalysis, ultrasounds)?	15%	35% + Difference Between Plan Allowance and Billed Amount	15% Or $40 Or $100	N/A
Lab, X-Ray & Other Diagnostic Tests - Complex Diagnostic Tests/Procedures 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)?	15%	35% + Difference Between Plan Allowance and Billed Amount	$40 Or $100	N/A
Lab, X-Ray & Other Diagnostic Tests - Enhanced Lab Network Lab, X-Ray & Other Diagnostic Tests - What is the member cost share for Enhanced lab Network?	N/A	N/A	N/A	N/A
Prescription Drugs - Separate Annual Out-of-Pocket Maximum	None	None	None	None
Prescription Drugs - Separate Annual Deductible	None	None	None	None
Prescription Drugs - Separate Annual Deductible	None	None	None	None
Prescription Drugs - Separate Annual Deductible	None	None	None	None
Prescription Drugs - Retail Generic Prescription Drugs - The amount you will pay to fill a prescription for retail generic drugs.	Tier 1: $7.50	45% + Difference Between Plan Allowance and Billed Amount	Tier 1: $15	N/A
Prescription Drugs - Retail Brand Prescription Drugs - The amount you will pay to fill a prescription for retail brand name drugs.	Tier 2: 30% Tier 3: 50%	45% + Difference Between Plan Allowance and Billed Amount	Tier 2: $60 Tier 3: 60% $90 Min	N/A
Prescription Drugs - Specialty Prescription Drugs - Your cost share for specialty prescription drugs. Specialty prescription drugs are high cost, complex drugs placed on a specialty tier of the formulary and/or dispensed from a designated specialty pharmacy.	Tier 4: $65 Tier 5: $85 Or Tier 5: 30%	45% + Difference Between Plan Allowance and Billed Amount	Tier 4: $85 Or Tier 5: $110 Or Tier 5: $100	N/A
Prescription Drugs - Mail Service Pharmacy Benefit Prescription Drugs - This is the amount you pay for a mail order prescription. These are medications sent via mail for maintenance prescriptions, typically greater than a 30-day supply.	Yes	No	No	N/A
Prescription Drugs - Mail Order Pharmacy Restriction Prescription Drugs - Mail order drug dispensing may be restricted to a specific mail order pharmacy. For more details, refer to the medication pricing tool.	Yes	N/A	N/A	N/A
Prescription Drugs - Specialty Pharmacy Restriction Prescription Drugs - Specialty drug dispensing may be restricted to a specific specialty pharmacy. For more details, refer to the medication pricing tool.	Yes	N/A	Yes	N/A
Treatment Therapies - Applied Behavioral Analysis (ABA) Treatment Therapies - This is the amount you pay for Applied Behavior Analysis (ABA) coverage.	15%	35% + Difference Between Plan Allowance and Billed Amount	$35 Or $45	N/A
Treatment Therapies - Chiropractic Treatment Therapies - Your cost share for chiropractic care.	$30	35% + Difference Between Plan Allowance and Billed Amount	$35	N/A
Treatment Therapies - Occupational Therapy Treatment Therapies - Your cost share for occupational therapy.	$30 Or $40	35% +	$35 Or $45	N/A
Treatment Therapies - Physical Therapy Treatment Therapies - Your cost share for physical therapy.	$30 Or $40	35% + Difference Between Plan Allowance and Billed Amount	$35 Or $45	N/A
Treatment Therapies - Speech Therapy Treatment Therapies - Your cost share for speech therapy.	$30 Or $40	35% + Difference Between Plan Allowance and Billed Amount	$35 Or $45	N/A
Dental - Preventive Dental for Adults Dental - Does the plan cover Preventive Dental for Adults?	Yes	Yes	Yes	N/A
Dental - Preventive for Children Dental - Does the plan cover Preventive Dental for Children?	Yes	Yes	Yes	N/A
Dental - Minor Restorative for Adults Dental - Does the plan cover Minor Restorative for Adults (e.g., fillings, local anesthesia)?	No	No	No	N/A
Dental - Minor Restorative for Children Dental - Does the plan cover Minor Restorative for Children (e.g., fillings, local anesthesia)?	No	No	No	N/A
Dental - Major Restorative for Adults Dental - Does the plan cover Major Restorative for Adults (e.g., endodontics, crowns, prosthodontics)?	No	No	No	N/A
Dental - Major Restorative for Children Dental - Does the plan cover Major Restorative for Children (e.g., endodontics, crowns, prosthodontics)?	No	No	No	N/A
Dental - Orthodontic Dental - Does the plan cover Orthodontics?	No	No	No	N/A
Vision - Routine Eye Exams Vision - Does the plan cover Routine Eye Exams?	No	No	No	N/A
Vision - Eye Exams for Medical Condition or Non-Surgical Treatment Vision - Does the plan cover Eye Exams for Medical Condition or Non-Surgical Treatment?	Yes	Yes	Yes	N/A
Vision - Eyeglass Frames & Lenses Vision - Does the plan cover Eyeglass Frames and Lenses?	No	No	No	N/A
Vision - Contacts Vision - Does the plan cover Contacts?	No	No	No	N/A
Alternative Care - Alternative Care Alternative Care - Your plan may cover some type of alternative care such as: acupuncture, massage therapy, hypnotherapy, holistic medicine, Yoga, herbal treatments, or naturopathic services. Please consult the plan brochure for more information.	Yes	Yes	Yes	N/A

Key:  Excellent  Very Good  Good  Fair  Poor         NA  (NA is displayed if a plan did not report or is unable to report a result in this coverage area.)

Plans	Blue Cross and Blue Shield Service Benefit Plan (Standard)		Blue Cross and Blue Shield Service Benefit Plan (Basic)
Quality - Controlling High Blood Pressure People with high blood pressure receive effective treatment.
Quality - Hemoglobin A1c Control for Patients with Diabetes Do people with diabetes have their condition under control?
Quality - Timeliness of Prenatal Care Pregnant women receive care in the first trimester.
Quality - Avoidance of Antibiotic Treatment for Acute Bronchitis/Bronchiolitis Ages 18 to 64 Appropriate use of antibiotics for acute bronchitis.
Quality - Asthma Medication Ratio Appropriate ratio of controller medications to total asthma medications.
Quality - Breast Cancer Screening Do women who need screening mammograms get them?
Quality - Follow Up After Emergency Department Visit for Alcohol and Other Drug Abuse or Dependence 30 day Follow-up appointment within 30 days of discharge.
Quality - Follow Up After Emergency Department Visit for Mental Illness 30 day Follow-up appointment within 30 days of discharge.
Quality - Well Child Visits in First 30 Months of Life, First 15 Months Recommended well-child visits completed.
Quality - Use of Imaging Studies for Low Back Pain Appropriate treatment of lower back pain.
CustomerService - Overall Plan Satisfaction How pleased are customers with the plan overall?
CustomerService - Claims Processing How quickly do customers say the plan handles claims?			NA
CustomerService - Getting Needed Care Members report getting the care they need.
CustomerService - Coordination of Care Members say that their doctors know about care from other providers.