Skip to main content
Previous
List
Next
HOME
Cover Page and Inside Cover
Table of Contents
Introduction/Plain Language/Advisory
PSHB Facts
Section 1
Section 2
Section 3
Section 4
Section 5
5(a). Medical Services and Supplies Provided by Physicians and Other Healthcare Professionals
5(b). Surgical and Anesthesia Services Provided by Physicians and Other Healthcare Professionals
5(c). Services Provided by a Hospital or Other Facility, and Ambulance Services
5(d). Emergency Services/Accidents
5(e). Mental Health and Substance Use Disorder Benefits
5(f). Prescription Drug Benefits
5(f)(a). FEP Medicare Prescription Drug Plan
5(g). Dental Benefits
5(h). Wellness and Other Special Features
5(i). Services, Drugs, and Supplies Provided Overseas
Non-PSHB Benefits Available to Plan Members
Section 6
Section 7
Section 8
Section 8(a)
Section 9
Section 10
Index
Summary of Benefits – Standard Option
Summary of Benefits – Basic Option
2025 Rate Information
 
Blue Cross Blue Shield Federal Employee Program logo
 
 

 

2025 Blue Cross and Blue Shield Service Benefit Plan - Standard and Basic Option
2025 Rate Information for the Blue Cross and Blue Shield Service Benefit Plan

 

2025 Rate Information for the Blue Cross and Blue Shield Service Benefit Plan

 

To compare your PSHB health plan options please go to https://health-benefits.opm.gov/PSHB/.

To review premium rates for all PSHB health plan options please go to https://www.opm.gov/healthcare-insurance/pshb/premiums/.

 

 

Standard Option, Self Only, Enrollment Code 33D:
Premium Rate
Biweekly government share: $286.09
Biweekly your share: $174.13
Monthly government share: $619.86
Monthly your share: $377.28

Standard Option, Self Plus One, Enrollment Code 33F:
Premium Rate
Biweekly government share: $618.40
Biweekly your share: $388.04
Monthly government share: $1,339.87
Monthly your share: $840.75

Standard Option, Self and Family, Enrollment Code 33E:
Premium Rate
Biweekly government share: $672.95
Biweekly your share: $435.43
Monthly government share: $1,458.06
Monthly your share: $943.43

Basic Option, Self Only, Enrollment Code 33A:
Premium Rate
Biweekly government share: $286.09
Biweekly your share: $114.12
Monthly government share: $619.86
Monthly your share: $247.26

Basic Option, Self Plus One, Enrollment Code 33C:
Premium Rate
Biweekly government share: $618.40
Biweekly your share: $280.99
Monthly government share: $1,339.87
Monthly your share: $608.81

Basic Option, Self and Family, Enrollment Code 33B:
Premium Rate
Biweekly government share: $672.95
Biweekly your share: $317.62
Monthly government share: $1,458.06
Monthly your share: $688.18
 

© 2024 Blue Cross Blue Shield Association. All rights reserved.

Back to Top