HMSA Federal Plan 87 is the plan for employees who are eligible to participate in the Federal Employees Health Benefits (FEHB) Program. Please visit the U.S. Office of Personnel Management webpage for more information on the FEHB Program.
Learn more about the services your plan pays for.
2025 Plan Rate [PDF]
See a summary of rates for the 2025 plan year.
2025 Member Booklet [PDF]
Member booklet for open season.
2025 Plan Brochure [PDF]
View benefits and services included in your plan.
View on opm.gov
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High Option Plan |
Standard Option Plan |
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| Plan Documents 2025 Summary of Benefits and Coverage [PDF] |
Plan Documents 2025 Summary of Benefits and Coverage [PDF] |
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Annual Deductible |
Annual Deductible |
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Annual Out-of-pocket Maximum $3,000 per person |
Annual Out-of-pocket Maximum $5,000 per person |
Medical BenefitsPhysician visit $15 No charge
20% of eligible charges
$15 copayment
$200 copayment
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Medical BenefitsPhysician visit* $20 30% of eligible charges
$20 copayment
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Drug BenefitsTier 1 (preferred generic drugs) $7 copayment Tier 2 (non-preferred generic and preferred brand drugs) $35 copayment Tier 3 (other brand drugs) $70 copayment Tier 4 (specialty drugs) $80 copayment Tier 5 (non-preferred specialty drugs) $200 copayment |
Drug BenefitsTier 1 (preferred generic drugs)* $7 copayment Tier 2 (non-preferred generic and preferred brand drugs) 40% of eligible charge up to $100 Tier 3 (other brand drugs) 40% of eligible charge up to $600 Tier 4 (specialty drugs) $200 copayment Tier 5 (non-preferred specialty drugs) 40% of eligible charge up to $1,200 |
Dental BenefitsNo charge
30% of eligible charges
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Dental Benefits30% of eligible charges for Accidental Injury benefits only |
Vision Benefits220% of eligible charges
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Vision Benefits230% of eligible charges
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Infertility BenefitsPlan Provider 20% of eligible charges Non-Plan Provider 30% of eligible charges and any difference between our eligible charge and the actual charge |
Infertility BenefitsPlan Provider 30% of eligible charges (deductible applies) Non-Plan Provider 40% of eligible charges and any difference between our eligible charge and the actual charge (deductible applies) |
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Infertility definition Infertility is the failure to achieve a successful pregnancy after regular, unprotected intercourse or artificial insemination for 12 months or more (6 months for individuals over age 35). Infertility may also be established through an evaluation based on medical history and diagnostic testing. Diagnosis and treatment of infertility specific to:
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More resources
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Annual deductible
None
Annual Out-of-pocket Maximum
$3,000 per person
$9,000 per family
(Some costs can’t be applied to your maximum.)
Annual deductible
$150 per person
Annual Out-of-pocket Maximum
$5,000 per person
$10,000 per family
(Some costs can’t be applied to your maximum.)
Infertility defintion
Infertility is the failure to achieve a successful pregnancy after regular, unprotected intercourse or artificial insemination for 12 months or more (6 months for individuals over age 35). Infertility may also be established through an evaluation based on medical history and diagnostic testing.
Diagnosis and treatment of infertility specific to:
More resources
In-network emergency room visit and follow up care
Services included in example event
EXAMPLE Simple fracture cost: $2,800
| Plan | High Plan | Standard Plan |
|---|---|---|
| You pay deductible: | $0 | $150 |
| Copayments: | $80 | $100 |
| Coinsurance: | $200 | $600 |
| What isn’t covered (Limits or exclusions): | $0 | $0 |
| Your total out-of-pocket: | $280 | $850 |
| Plan | High Plan |
|---|---|
| You pay deductible: | $0 |
| Copayments: | $80 |
| Coinsurance: | $200 |
| What isn't covered (Limits or exclusions): | $0 |
| Your total out-of-pocket: | $280 |
| Plan | Standard Plan |
|---|---|
| You pay deductible: | $150 |
| Copayments: | $100 |
| Coinsurance: | $600 |
| What isn't covered (Limits or exclusions): | $0 |
| Your total out-of-pocket: | $850 |
This is not a cost estimator. Treatments shown are just examples of how this plan might cover medical care. Your actual costs will be different depending on the actual care you receive, the prices your providers charge, and many other factors.
A year of routine in-network care of a well-controlled condition
Services included in example event
EXAMPLE Managing type 2 diabetes cost: $5,600
| Plan | High Plan | Standard Plan |
|---|---|---|
| You pay deductible: | $0 | $150 |
| Copayments: | $400 | $400 |
| Coinsurance: | $200 | $200 |
| What isn’t covered (Limits or exclusions): | $20 | $20 |
| Your total out-of-pocket: | $620 | $770 |
| Plan | High Plan |
|---|---|
| You pay deductible: | $0 |
| Copayments: | $400 |
| Coinsurance: | $200 |
| What isn't covered (Limits or exclusions): | $20 |
| Your total out-of-pocket: | $620 |
| Plan | Standard Plan |
|---|---|
| You pay deductible: | $150 |
| Copayments: | $400 |
| Coinsurance: | $200 |
| What isn't covered (Limits or exclusions): | $20 |
| Your total out-of-pocket: | $770 |
This is not a cost estimator. Treatments shown are just examples of how this plan might cover medical care. Your actual costs will be different depending on the actual care you receive, the prices your providers charge, and many other factors.
9 months of in-network pre-natal care and a routine hospital delivery
Services included in example event
EXAMPLE Maternity Care cost: $12,700
| Plan | High Plan | Standard Plan |
|---|---|---|
| You pay deductible: | $0 | $150 |
| Copayments: | $200 | $30 |
| Coinsurance: | $70 | $2,500 |
| What isn’t covered (Limits or exclusions): | $60 | $60 |
| Your total out-of-pocket: | $330 | $2,740 |
| Plan | High Plan |
|---|---|
| You pay deductible: | $0 |
| Copayments: | $200 |
| Coinsurance: | $70 |
| What isn't covered (Limits or exclusions): | $60 |
| Your total out-of-pocket: | $330 |
| Plan | Standard Plan |
|---|---|
| You pay deductible: | $150 |
| Copayments: | $30 |
| Coinsurance: | $2,500 |
| What isn't covered (Limits or exclusions): | $60 |
| Your total out-of-pocket: | $2,740 |
This is not a cost estimator. Treatments shown are just examples of how this plan might cover medical care. Your actual costs will be different depending on the actual care you receive, the prices your providers charge, and many other factors.
A deductible is the fixed dollar amount you must pay each calendar year for certain services and products before your health plan pays.
The out-of-pocket maximum is the most you'll have to pay per calendar year for covered health care services. Once you reach this amount, your plan pays 100 percent of the allowed amount for covered services excluding taxes.
There's a maximum for each person on the plan and a maximum for everyone on the plan.
