Federal Employees Health Benefits Program Benefits and Coverage
PLANS & SERVICES FOR FEDERAL EMPLOYEES
Benefits at a Glance (2021)
This is a summary of the features of the GlobalHealth Plan. Before making a final decision, please read the Plan’s Federal Brochure, RI 73-834. All benefits are subject to the definitions, limitations, and exclusions set forth in the Federal brochure.
| BENEFIT | FEHB High Option Plan | FEHB Standard Option Plan |
|---|---|---|
| Annual Deductible* | This plan doesn’t have an annual deductible. | Self Only - $500 Self Plus One - $1,000 Self and Family - $1,000 |
| Annual out-of-pocket maximum | Self Only - $5,000 Self Plus One - $7,000 Self Plus Family - $7,000 |
Self Only - $6,500 Self Plus One - $7,500 Self and Family - $7,500 |
| Primary Care Physician Visits | $0 copay per visit | $0 copay per visit |
| Specialist Physician Visits | $35 copay per visit | $50 copay per visit |
| Preventive Care | $0 copay | $0 copay |
| X-Rays & Labs | $0 copay | $0 copay |
| Specialized Scans, Imaging & Diagnostic Exams | $250 copay per scan in a preferred facility; $500 copay per scan in a non-preferred facility | $350 copay per scan in a preferred facility; $700 copay per scan in a non-preferred facility |
| Inpatient Hospital Stay | $250 copay per day with $750 maximum per admission | $750 copay per day with $1,500 maximum per admission |
| Outpatient Surgery | $250 copay in a preferred facility; $750 copay in a non-preferred facility | $500 copay in a preferred facility; $1,000 copay in a non-preferred facility |
| Emergency Room Service | $250 copay, waived if admitted to hospital inpatient | $300 copay, waived if admitted to hospital inpatient |
| Urgent Care | $25 copay in urgent care facility | $45 copay in urgent care facility |
|
Prescription Drugs (Chickasaw Nation Refill Center is a home delivery option for Native American members. Click here for more information.) |
Retail Pharmacy - 30 Day Supply Home Delivery or Extended Supply Retail - 90 Day Supply |
Retail Pharmacy - 30 Day Supply Home Delivery or Extended Supply Retail - 90 Day Supply |
| Maternity Care | $0 copay for prenatal care and postnatal care; $250 copay per admission for delivery | $0 copay for prenatal care and postnatal care; $500 copay per admission for delivery |
|
Family Planning |
$0 copay | $0 copay |
| Allergy Care | $0 copay per PCP visit; $35 copay per specialist visit; $0 copay for antigen and administration | $0 copay per PCP visit; $25 copay per specialist visit; $0 copay for antigen and administration |
| Physical, Occupational, Speech Therapy (Limited to 60** combined visits per calendar year) | Inpatient: $0 copay Outpatient: $20 copay per visit |
Inpatient: $0 copay Outpatient: $25 copay per visit |
| Chiropractic Care (20 visits per year) | $20 copay per visit | $15 copay per visit |
| Mental Health Services, Chemical Dependency & Substance Abuse | $0 copay per outpatient office visit; $250 copay/day with $750/admission maximum | $0 copay per outpatient office visit; $750 copay/day with $1,500/admission maximum |
GlobalHealth, Inc., an NCQA Accredited Health Plan, was rated 3.5 out of 5 in NCQA's Private Health Insurance Plan Ratings 2019-2020, the only HMO plan in Oklahoma to receive this rating
*No deductible on high option plan. Standard option plan deductible does not apply to PCP, specialist and behavioral health office visits, lab/x-ray, urgent care, preventive care and prescription drugs.
**60 visits for rehabilitation and 60 visits for habilitation.
Benefits at a Glance (2020)
This is a summary of the features of the GlobalHealth Plan. Before making a final decision, please read the Plan’s Federal Brochure, RI 73-834. All benefits are subject to the definitions, limitations, and exclusions set forth in the Federal brochure.
| BENEFIT | FEHB High Option Plan | FEHB Standard Option Plan |
|---|---|---|
| Annual Deductible* | This plan doesn’t have an annual deductible. | Self Only - $500 Self Plus One - $1,000 Self and Family - $1,000 |
| Annual out-of-pocket maximum | Self Only - $5,000 Self Plus One - $7,000 Self Plus Family - $7,000 |
Self Only - $6,500 Self Plus One - $7,500 Self and Family - $7,500 |
| Primary Care Physician Visits | $0 copay per visit | $0 copay per visit |
| Specialist Physician Visits | $35 copay per visit | $50 copay per visit |
| Preventive Care | $0 copay | $0 copay |
| X-Rays & Labs | $0 copay | $0 copay |
| Specialized Scans, Imaging & Diagnostic Exams | $250 copay per scan in a preferred facility; $500 copay per scan in a non-preferred facility | $350 copay per scan in a preferred facility; $700 copay per scan in a non-preferred facility |
| Inpatient Hospital Stay | $250 copay per day with $750 maximum per admission | $750 copay per day with $1,500 maximum per admission |
| Outpatient Surgery | $250 copay in a preferred facility; $750 copay in a non-preferred facility | $500 copay in a preferred facility; $1,000 copay in a non-preferred facility |
| Emergency Room Service | $250 copay, waived if admitted to hospital inpatient | $300 copay, waived if admitted to hospital inpatient |
| Urgent Care | $25 copay in urgent care facility | $45 copay in urgent care facility |
|
Prescription Drugs (Chickasaw Nation Refill Center is a home delivery option for Native American members. Click here for more information.) |
Retail Pharmacy - 30 Day Supply Home Delivery or Extended Supply Retail - 90 Day Supply |
Retail Pharmacy - 30 Day Supply Home Delivery or Extended Supply Retail - 90 Day Supply |
| Maternity Care | $0 copay for prenatal care and postnatal care; $250 copay per admission for delivery | $0 copay for prenatal care and postnatal care; $500 copay per admission for delivery |
|
Family Planning |
$0 copay | $0 copay |
| Allergy Care | $0 copay per PCP visit; $35 copay per specialist visit; $0 copay for antigen and administration | $0 copay per PCP visit; $25 copay per specialist visit; $0 copay for antigen and administration |
| Physical, Occupational, Speech Therapy (Limited to 60** combined visits per calendar year) | Inpatient: $0 copay Outpatient: $20 copay per visit |
Inpatient: $0 copay Outpatient: $25 copay per visit |
| Chiropractic Care (20 visits per year) | $20 copay per visit | $15 copay per visit |
| Mental Health Services, Chemical Dependency & Substance Abuse | $0 copay per outpatient office visit; $250 copay/day with $750/admission maximum | $0 copay per outpatient office visit; $750 copay/day with $1,500/admission maximum |
GlobalHealth, Inc., an NCQA Accredited Health Plan, was rated 3.5 out of 5 in NCQA's Private Health Insurance Plan Ratings 2019-2020, the only HMO plan in Oklahoma to receive this rating
*No deductible on high option plan. Standard option plan deductible does not apply to PCP, specialist and behavioral health office visits, lab/x-ray, urgent care, preventive care and prescription drugs.
**60 visits for rehabilitation and 60 visits for habilitation.