2025 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) | GEHA Benefit Plan (HDHP) | |||
|---|---|---|---|---|---|
| Plan Links | |||||
| General Information - State | South Carolina | South Carolina | |||
| General Information - Enrollment Code - Self |
104
|
341
|
|||
| General Information - Enrollment Code - Self & Family |
105 
|
342
|
|||
| General Information - Enrollment Code - Self Plus One |
106
|
343
|
|||
| General Information - Carrier Code | 10 | 34 | |||
| General Information - Telephone Number | 1-800-411-2583 | 800-821-6136 | |||
|
Biweekly Premium
|
|
|
|||
|
Biweekly Premium
|
|
|
|||
|
Biweekly Premium
|
|
|
|||
| Plans - Networks |
Blue Cross and Blue Shield Service Benefit Plan (Standard) -
In-Network 1 |
Blue Cross and Blue Shield Service Benefit Plan (Standard) -
In-Network 2 |
Blue Cross and Blue Shield Service Benefit Plan (Standard) -
Out-of-Network |
GEHA Benefit Plan (HDHP) -
In-Network 1 |
GEHA Benefit Plan (HDHP) -
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
|
$1,650.00
|
$3,300.00
|
|
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
|
$3,300.00
|
$6,600.00
|
|
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
|
$3,300.00
|
$6,600.00
|
|
Type of Account |
None | None | None | HSA/HRA | HSA/HRA |
|
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 |
$1,000.00
|
$1,000.00
|
|
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 |
$2,000.00
|
$2,000.00
|
|
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 |
$2,000.00
|
$2,000.00
|
|
Net Deductible
A net deductible is the sum of your deductible minus any medical account fund.
|
$350.00
|
None
|
None
|
$650.00
|
$2,300.00
|
|
Net Deductible
A net deductible is the sum of your deductible minus any medical account fund.
|
$700.00
|
None
|
None
|
$1,300.00
|
$4,600.00
|
|
Net Deductible
A net deductible is the sum of your deductible minus any medical account fund.
|
$700.00
|
None
|
None
|
$1,300.00
|
$4,600.00
|
|
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
|
None
|
$8,000.00
|
$6,000.00
|
$8,500.00
|
|
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
|
None
|
$16,000.00
|
$12,000.00
|
$17,000.00
|
|
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
|
None
|
$16,000.00
|
$12,000.00
|
$17,000.00
|
|
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 | N/A | Deductible Waived | $1650 $3300 | $3300 $6600 |
|
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 | N/A | $8000 $16000 | $6000 $12000 | $8500 $17000 |
|
Member Cost with Medicare A & B Primary - Primary Care Physician 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 | N/A | Member Pays Nothing | 5% | 35% + Difference Between Plan Allowance and Billed Amount |
|
Member Cost with Medicare A & B Primary - Specialty Office Physician 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 | N/A | Member Pays Nothing | 5% | 35% + Difference Between Plan Allowance and Billed Amount |
|
Member Cost with Medicare A & B Primary - Inpatient Hospital Services 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 | N/A | Member Pays Nothing | 5% Coinsurance | 35% Coinsurance + Difference Between Plan Allowance and Billed Amount |
|
Member Cost with Medicare A & B Primary - Outpatient Hospital Services 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 | N/A | Member Pays Nothing | 5% Coinsurance | 35% Coinsurance + Difference Between Plan Allowance and Billed Amount |
|
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 | N/A | No | $1000 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 | N/A | 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 | N/A | $8000 $16000 | N/A | N/A |
|
Member Cost with Medicare Advantage (Part C) Primary - Primary Care Physician 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 | N/A | Member Pays Nothing | N/A | N/A |
|
Member Cost with Medicare Advantage (Part C) Primary - Specialty Physician 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 | N/A | Member Pays Nothing | N/A | N/A |
|
Member Cost with Medicare Advantage (Part C) Primary - Inpatient Hospital Services 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 | N/A | Member Pays Nothing | N/A | N/A |
|
Member Cost with Medicare Advantage (Part C) Primary - Outpatient Hospital Services 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 | N/A | Member Pays Nothing | N/A | 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 | N/A | No | N/A | N/A |
|
Member Cost with Medicare Part D EGWP - Prescription Drug Deductible
Member Cost with Medicare Part D EGWP - Is the deductible waived for prescription drugs with Medicare Part D EGWP?
|
N/A | N/A | N/A | N/A | N/A |
|
Member Cost with Medicare Part D EGWP - Out-of-Pocket Maximum
Member Cost with Medicare Part D EGWP - What is the maximum a member with Medicare Part D pays out-of-pocket for covered prescriptions?
|
$2000 | N/A | N/A | N/A | N/A |
|
Member Cost with Medicare Part D EGWP - EGWP Tier 0
Member Cost with Medicare Part D EGWP - What is the member cost of Tier 0 prescriptions with Medicare Part D EGWP?
|
N/A | N/A | N/A | N/A | N/A |
|
Member Cost with Medicare Part D EGWP - EGWP Tier 1
Member Cost with Medicare Part D EGWP - What is the member cost of Tier 1 prescriptions with Medicare Pard D EGWP?
|
$5 Copayment | N/A | Member Pays All Charges | N/A | N/A |
|
Member Cost with Medicare Part D EGWP - EGWP Tier 2
Member Cost with Medicare Part D EGWP - What is the member cost of Tier 0 prescriptions with Medicare Part D EGWP?
|
$35 | N/A | Member Pays All Charges | N/A | N/A |
|
Member Cost with Medicare Part D EGWP - EGWP Tier 3
Member Cost with Medicare Part D EGWP - What is the member cost of Tier 3 prescriptions with Medicare Part D EGWP?
|
50% | N/A | Member Pays All Charges | N/A | N/A |
|
Member Cost with Medicare Part D EGWP - EGWP Tier 4
Member Cost with Medicare Part D EGWP - What is the member cost of Tier 4 prescriptions with Medicare Pard D EGWP?
|
$60 Copayment | N/A | Member Pays All Charges | N/A | N/A |
|
Member Cost with Medicare Part D EGWP - EGWP Tier 5
Member Cost with Medicare Part D EGWP - What is the member cost of Tier 5 prescriptions with Medicare Part D EGWP?
|
N/A | N/A | N/A | N/A | N/A |
|
Member Cost with Medicare Part D EGWP - EGWP Tier 6
Member Cost with Medicare Part D EGWP - What is the member cost of Tier 6 prescriptions with Medicare Part D EGWP?
|
N/A | N/A | N/A | N/A | 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 | N/A | 35% + Difference Between Plan Allowance and Billed Amount | Member Pays Nothing | 35% + Difference Between Plan Allowance and Billed Amount |
|
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 Copayment | N/A | 35% + Difference Between Plan Allowance and Billed Amount | 5% | 35% + Difference Between Plan Allowance and Billed Amount |
|
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 Copayment | N/A | 35% + Difference Between Plan Allowance and Billed Amount | 5% | 35% + Difference Between Plan Allowance and Billed Amount |
|
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 | N/A | No | No | No |
|
Emergency & Urgent Care - Emergency Care
Emergency & Urgent Care - What is the member cost share for Emergency Care?
|
15% | N/A | 15% | 5% | 5% |
|
Emergency & Urgent Care - Urgent Care
Emergency & Urgent Care - What is the member cost share for Urgent Care?
|
$0 Copayment Or $30 Copayment | N/A | $0 Or $0 + Difference Between Plan Allowance and Billed Amount Or $30 Or 35% Or 35% + Difference Between Plan Allowance and Billed Amount | 5% | 35% + Difference Between Plan Allowance and Billed Amount |
|
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 | N/A | No | No | No |
|
Surgery & Hospital Charges - Doctor Costs Inpatient Surgery
Surgery & Hospital Charges - The amount you will pay for a doctor to perform inpatient surgery.
|
15% | N/A | 35% + Difference Between Plan Allowance and Billed Amount | 5% | 35% + Difference Between Plan Allowance and Billed Amount |
|
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 Copayment | N/A | $450 + 35% + Difference Between Plan Allowance and Billed Amount | 5% | 35% + Difference Between Plan Allowance and Billed Amount |
|
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 | N/A | Member Pays Nothing | 5% | 35% + Difference Between Plan Allowance and Billed Amount |
|
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 | N/A | Member Pays Nothing | 5% | 35% + Difference Between Plan Allowance and Billed Amount |
|
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% | N/A | 35% + Difference Between Plan Allowance and Billed Amount | 5% | 35% + Difference Between Plan Allowance and Billed Amount |
|
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% | N/A | 35% + Difference Between Plan Allowance and Billed Amount | 5% | 35% + Difference Between Plan Allowance and Billed Amount |
|
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% | N/A | 35% + Difference Between Plan Allowance and Billed Amount | 5% | 35% + Difference Between Plan Allowance and Billed Amount |
|
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% | N/A | 35% + Difference Between Plan Allowance and Billed Amount | 5% | 35% + Difference Between Plan Allowance and Billed Amount |
|
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 | 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 | N/A | No | Yes | 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 | Yes | 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 | N/A | Yes | N/A |
|
Prescription Drugs - Hormone Therapy
Prescription Drugs - Does the plan cover Hormone Therapy for the treatment of gender dysphoria?
|
Covered | Not Covered | Covered | Covered | Covered |
|
Prescription Drugs - Tier 0 Prescription
Prescription Drugs - Specifies formulary tier description and cost sharing for Tier 0
|
N/A | N/A | N/A | Member Pays Nothing | $0 + Difference Between Plan Allowance and Billed Amount |
|
Prescription Drugs - Tier 1 Prescriptions
Prescription Drugs - Specifies formulary tier description and cost sharing for Tier 1
|
$7.50 Copayment | N/A | 45% + Difference Between Plan Allowance and Billed Amount | 25% | 25% + Difference Between Plan Allowance and Billed Amount |
|
Prescription Drugs - Tier 2 Prescriptions
Prescription Drugs - Specifies formulary tier description and cost sharing for Tier 2
|
30% | N/A | 45% + Difference Between Plan Allowance and Billed Amount | 25% | 25% + Difference Between Plan Allowance and Billed Amount |
|
Prescription Drugs - Tier 3 Prescriptions
Prescription Drugs - Specifies formulary tier description and cost sharing for Tier 3
|
50% | N/A | 45% + Difference Between Plan Allowance and Billed Amount | 40% | 40% + Difference Between Plan Allowance and Billed Amount |
|
Prescription Drugs - Tier 4 Prescriptions
Prescription Drugs - Specifies formulary tier description and cost sharing for Tier 4
|
30% | N/A | 45% + Difference Between Plan Allowance and Billed Amount | 25% | N/A |
|
Prescription Drugs - Tier 5 Prescriptions
Prescription Drugs - Specifies formulary tier description and cost sharing for Tier 5
|
30% | N/A | 45% + Difference Between Plan Allowance and Billed Amount | 40% | N/A |
|
Prescription Drugs - Tier 6 Prescriptions
Prescription Drugs - Specifies formulary tier description and cost sharing for Tier 6
|
N/A | N/A | N/A | N/A | N/A |
|
Treatment, Devices, and Services - Applied Behavioral Analysis (ABA)
Treatment, Devices, and Services - This is the amount you pay for Applied Behavior Analysis (ABA) coverage.
|
15% | N/A | 35% + Difference Between Plan Allowance and Billed Amount | 5% | 35% + Difference Between Plan Allowance and Billed Amount |
|
Treatment, Devices, and Services - Chiropractic
Treatment, Devices, and Services - Your cost share for chiropractic care.
|
$30 Copayment | N/A | 35% + Difference Between Plan Allowance and Billed Amount | 5% | 35% + Difference Between Plan Allowance and Billed Amount |
|
Treatment, Devices, and Services - Occupational Therapy
Treatment, Devices, and Services - Your cost share for occupational therapy.
|
$30 Copayment Or $40 Copayment | N/A | 35% + Difference Between Plan Allowance and Billed Amount | 5% | 35% + Difference Between Plan Allowance and Billed Amount |
|
Treatment, Devices, and Services - Physical Therapy
Treatment, Devices, and Services - Your cost share for physical therapy.
|
$30 Copayment Or $40 Copayment | N/A | 35% + Difference Between Plan Allowance and Billed Amount | 5% | 35% + Difference Between Plan Allowance and Billed Amount |
|
Treatment, Devices, and Services - Speech Therapy
Treatment, Devices, and Services - Your cost share for speech therapy.
|
$30 Copayment Or $40 Copayment | N/A | 35% + Difference Between Plan Allowance and Billed Amount | 5% | 35% + Difference Between Plan Allowance and Billed Amount |
|
Treatment, Devices, and Services - Professional Services (Mental Health and Substance Use Disorder)
Treatment, Devices, and Services - This is the member copayment for Professional Services Mental Health and Substance Use Disorder treatment
|
$30 Copayment | Member Pays All Charges | 35% + Difference Between Plan Allowance and Billed Amount | 5% | 35% + Difference Between Plan Allowance and Billed Amount |
|
Treatment, Devices, and Services - Inpatient Hospital (Mental Health and Substance Use Disorder Services)
Treatment, Devices, and Services - This is the member copayment for Inpatient Hospital Mental Health and Substance Use Disorder Services
|
$350 Copayment | Member Pays All Charges | 35% + Difference Between Plan Allowance and Billed Amount | 5% | 35% + Difference Between Plan Allowance and Billed Amount |
|
Treatment, Devices, and Services - Outpatient Hospital (Mental Health and Substance Use Disorder Services)
Treatment, Devices, and Services - This is the member copayment for Outpatient Hospital Mental Health and Substance Use Disorder Services
|
15% | Member Pays All Charges | 35% + Difference Between Plan Allowance and Billed Amount | 5% | 35% + Difference Between Plan Allowance and Billed Amount |
|
Treatment, Devices, and Services - Infertility Services
Treatment, Devices, and Services - Member cost for Diagnosis and Treatment Infertility Services
|
15% | Member Pays All Charges | 35% + Difference Between Plan Allowance and Billed Amount | 5% | 35% + Difference Between Plan Allowance and Billed Amount |
|
Treatment, Devices, and Services - Fertility Preservation Procedures (e.g., iatrogenic infertility) (Infertility Services)
Treatment, Devices, and Services - Member Cost of Fertility Preservation Procedures (e.g., iatrogenic infertility) (Infertility Services)
|
15% | Member Pays All Charges | 35% + Difference Between Plan Allowance and Billed Amount | 5% | 35% + Difference Between Plan Allowance and Billed Amount |
|
Treatment, Devices, and Services - Artificial Insemination Services (e.g. ICI, IVI, IUI)
Treatment, Devices, and Services - Specifies what coverage Carrier provides for artificial insemination procedures and services
|
15% | Member Pays All Charges | 35% + Difference Between Plan Allowance and Billed Amount | 5% | 35% + Difference Between Plan Allowance and Billed Amount |
|
Treatment, Devices, and Services - Assisted Reproductive Technology (ART) (e.g., IVF, GIFT, ZIFT) (Infertility Services)
Treatment, Devices, and Services - Specifies what portion of the ART medical and pharmacy services the plan pays vs what portion of the medical services the member pays
|
15% | Member Pays All Charges | 35% + Difference Between Plan Allowance and Billed Amount | Member Pays All Charges | Member Pays All Charges |
|
Treatment, Devices, and Services - Surgical Procedures
Treatment, Devices, and Services - Member cost associated with Surgical Procedures
|
15% | Member Pays All Charges | 35% + Difference Between Plan Allowance and Billed Amount | 5% | 35% + Difference Between Plan Allowance and Billed Amount |
|
Treatment, Devices, and Services - Reconstructive Surgery
Treatment, Devices, and Services - Member cost associated with Reconstructive Surgery
|
15% | Member Pays All Charges | 35% + Difference Between Plan Allowance and Billed Amount | 5% | 35% + Difference Between Plan Allowance and Billed Amount |
|
Treatment, Devices, and Services - Gender Affirming Surgery
Treatment, Devices, and Services - Member cost associated with Gender Affirming Surgery
|
15% | Member Pays All Charges | 35% + Difference Between Plan Allowance and Billed Amount | 5% | 35% + Difference Between Plan Allowance and Billed Amount |
|
Treatment, Devices, and Services - Hearing Services
Treatment, Devices, and Services - Member cost Associated with Hearing Services
|
15% | Member Pays All Charges | 35% + Difference Between Plan Allowance and Billed Amount | 5% | 35% + Difference Between Plan Allowance and Billed Amount |
|
Treatment, Devices, and Services - Hearing Aids (External)
Treatment, Devices, and Services - Member cost Associated with Hearing Aids (External)
|
Covered | Not Covered | Covered | Not Covered | Not Covered |
|
Treatment, Devices, and Services - Maternity Care
Treatment, Devices, and Services - Member cost associated with Prenatal Care, Screening for Gestational Diabetes, Delivery, and Postpartum Care (Maternity Care)
|
Member Pays Nothing | Member Pays All Charges | 35% + Difference Between Plan Allowance and Billed Amount | 0% | 35% + Difference Between Plan Allowance and Billed Amount |
|
Treatment, Devices, and Services - Maternity Care - Hospital Stay
Treatment, Devices, and Services - Member cost Associated with Hospital Stay--Vaginal Birth, Cesarean Birth (Maternity Care)
|
Member Pays Nothing | Member Pays All Charges | $450 Copayment 35% + Difference Between Plan Allowance and Billed Amount | 0% | 35% + Difference Between Plan Allowance and Billed Amount |
|
Treatment, Devices, and Services - Hospice Care
Treatment, Devices, and Services - Member cost Associated with Hospice Care
|
Member Pays Nothing | Member Pays All Charges | Member Pays Nothing | 5% $30000 Max | 35% + Difference Between Plan Allowance and Billed Amount $30000 Max |
|
Treatment, Devices, and Services - Home Health Services (Skilled Nursing Care)
Treatment, Devices, and Services - Member Cost Associated with Home Health Services (Skilled Nursing Care)
|
$175 Copayment | Member Pays All Charges | $275 Copayment 35% + Difference Between Plan Allowance and Billed Amount | 5% | 35% + Difference Between Plan Allowance and Billed Amount |
|
Treatment, Devices, and Services - Durable Medical Equipment
Treatment, Devices, and Services - Member cost Associated with Durable medical Equipment
|
15% | Member Pays All Charges | 35% + Difference Between Plan Allowance and Billed Amount | 5% | 35% + Difference Between Plan Allowance and Billed Amount |
|
Treatment, Devices, and Services - Outpatient Rehabilitation (Skilled Nursing Care Facility)
Treatment, Devices, and Services - Member Cost Associated with Outpatient Rehabilitation (Skilled Nursing Care Facility)
|
$30 Copayment | Member Pays All Charges | 35% + Difference Between Plan Allowance and Billed Amount | 5% | 35% + Difference Between Plan Allowance and Billed Amount |
|
Treatment, Devices, and Services - Diabetes Education
Treatment, Devices, and Services - Member Cost Associated with Diabetes Education
|
15% | Member Pays All Charges | 35% + Difference Between Plan Allowance and Billed Amount | Member Pays Nothing | Member Pays Nothing |
|
Treatment, Devices, and Services - Nutritional Counseling
Treatment, Devices, and Services - Member Cost Associated with Nutritional Counseling
|
Member Pays Nothing | Member Pays All Charges | 35% + Difference Between Plan Allowance and Billed Amount | 0% | 35% + Difference Between Plan Allowance and Billed Amount |
|
Dental - Routine Dental Exams and Cleaning for Adults
Dental - Does the plan cover Preventive Dental for Adults?
|
Yes | N/A | Yes | Yes | Yes |
|
Dental - Routine Dental Exams and Cleaning for Children
Dental - Does the plan cover Preventive Dental for Children?
|
Yes | N/A | Yes | Yes | Yes |
|
Dental - Minor Restorative for Adults
Dental - Does the plan cover Minor Restorative for Adults (e.g., fillings, local anesthesia)?
|
No | N/A | No | Yes | Yes |
|
Dental - Minor Restorative for Children
Dental - Does the plan cover Minor Restorative for Children (e.g., fillings, local anesthesia)?
|
No | N/A | No | Yes | Yes |
|
Dental - Major Restorative for Adults
Dental - Does the plan cover Major Restorative for Adults (e.g., endodontics, crowns, prosthodontics)?
|
No | N/A | No | No | No |
|
Dental - Major Restorative for Children
Dental - Does the plan cover Major Restorative for Children (e.g., endodontics, crowns, prosthodontics)?
|
No | N/A | No | No | No |
|
Dental - Orthodontic
Dental - Does the plan cover Orthodontics?
|
No | N/A | No | No | No |
|
Vision - Routine Eye Exams
Vision - Does the plan cover Routine Eye Exams?
|
No | N/A | No | Yes | Yes |
|
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 | N/A | Yes | Yes | Yes |
|
Vision - Eyeglass Frames & Lenses
Vision - Does the plan cover Eyeglass Frames and Lenses?
|
No | N/A | No | Yes | Yes |
|
Vision - Contacts
Vision - Does the plan cover Contacts?
|
No | N/A | No | Yes | Yes |
|
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 | N/A | Yes | Yes | Yes |
|
Alternative Care - Chronic Disease Management: Asthma
Alternative Care - Is Chronic Disease Management of Asthma covered?
|
Covered | Not Covered | Not Covered | Covered | Covered |
|
Alternative Care - Chronic Disease Management: Heart Disease
Alternative Care - Is Chronic Disease Management of Heart Disease covered?
|
Covered | Not Covered | Not Covered | Covered | Covered |
|
Alternative Care - Chronic Disease Management: Hypertension
Alternative Care - Is Chronic Disease Management of Hypertension covered?
|
Covered | Not Covered | Not Covered | Covered | Covered |
|
Alternative Care - Chronic Disease Management: Obesity
Alternative Care - Is Chronic Disease Management of Obesity covered?
|
Covered | Not Covered | Not Covered | Covered | Covered |
Key:
Outstanding
Excellent
Good
Fair
Poor
NA
(NA is displayed if a plan did not report or is unable to report a result in this coverage area.)
Outstanding
Excellent
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) | GEHA Benefit Plan (HDHP) | |||
|---|---|---|---|---|---|
|
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
- Childhood Immunization Status—Combination 10
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?
|
|
|
|||
|
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.
|
|
|
|||