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
Page 174

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

Go to page 173.