2018 Rates and Benefits

Kaiser Foundation Health Plan of Washington Options, Inc. FEHB Rates


Standard Option

Enrollment TypeCode Non-Postal Biweekly PremiumPostal Category 1 Biweekly PremiumPostal Category 2 Biweekly PremiumAnnuitant Premium
Self Only L11 $77.47 $71.10 $64.74 $167.85
Self Plus One L13 $189.91 $176.27 $162.63 $411.48
Self and Family L12 $170.23 $154.91 $141.29 $368.83

High Deductible Health Plan (HDHP)

Enrollment Type Code Non-Postal Biweekly Premium Postal Category 1 Biweekly Premium Postal Category 2 Biweekly Premium Annuitant Premium
Self Only L14 $60.67 $55.21 $50.35 $131.45
Self Plus One L16 $134.68 $122.56 $111.79 $291.81
Self and Family L15 $134.68 $122.56 $111.79 $291.81

Postal rates apply to Postal Service employees.

Postal Category 1 rates apply to career bargaining unit employees who are covered by the following agreements: APWU, IT/AS, NALC, NPMHU, NPPN and NRLCA.

Postal Category 2 rates apply to career bargaining unit employees who are covered by the following agreement: PPOA.

Postal Category 3 rates apply to career bargaining unit employees who are covered by the following agreements: PPOA. (Please see liteblue.usps.gov/open season for rates.).

Non-Postal rates apply to all career non-bargaining unit Postal Service employees.

For further assistance, Postal Service employees should call:

Human Resources Shared Service Center, 877-477-3273, option 5, TTY: 866-260-7507

Postal rates do not apply to non-career Postal employees, Postal retirees, or associate members of any Postal employee organization who are not career postal employees.

Premiums for Tribal employees are shown under the monthly non-Postal column. The amount shown under employee contribution is the maximum you will pay. Your Tribal employer may choose to contribute a higher portion of your premium. Please contact your Tribal Benefits Officer for exact rates.

These rates do not apply to all enrollees. If you are in a special enrollment category, please refer to the FEHBP Program website or contact the agency or Tribal Employer which maintains your health benefits enrollment.

Kaiser Foundation Health Plan of Washington Options, Inc. FEHB Benefits

Coverage Standard Option Plan You Pay

Deductible applies, except where indicated
High Deductible Health Plan You Pay

Deductible must be met before benefits apply, except where indicated
Annual Deductible $350 individual / $700 family

Plan providers: $1,500 individual / $3,000 family

Non-Plan Providers: $1,500 Individual/$3,000 Family

Annual Out-of-Pocket Maximum

Plan Providers: $5,000 Individual/$10,000 Family (Includes deductible, copays, RX copays, and coinsurance)

Non-Plan Providers: Unlimited

Plan Providers: $5,000 Individual/$10,000 Family (Includes deductible, RX copays, and coinsurance)

Non-Plan Providers: Non-Plan Providers: $5,000 Individual/$10,000 Family (Includes deductible, RX copays, and coinsurance)

Preventive Care Visit

Adult routine physical exams & screenings, mammograms, PSA testing, immunizations, routine screening eye exams.

Child routine physical exams & immunizations, routine eye and hearing exams.

Nothing, no deductible

 

 

 

Nothing, no deductible

Nothing, no deductible

 

 

 

Nothing, no deductible

Professional Services
Office, Home, Naturopath or Urgent Care Visits

No deductible, $25 primary / $35 specialty copay per office visit 20% coinsurance
Lab and X-ray 20% coinsurance 20% coinsurance

Facility/Hospital
Inpatient & Outpatient
Inpatient requires preauthorization

20% coinsurance 20% coinsurance
Emergency Room & Supplies $150 copay per visit (waived if admitted) 20% coinsurance
Maternity Nothing, no deductible 20% coinsurance
(Prenatal care covered at 100%, no deductible)

Ambulance
Ground & Air

20% coinsurance 20% coinsurance

Alternative Care - Acupuncture, Chiropractic, Massage Therapy
20 treatments max per provider type per year

No deductible
$25 primary / $35 specialty copay per office visit
20% coinsurance
Mental Health

Inpatient requires preauthorization

Outpatient: No deductible $25 primary / $35 specialty copay per office visit
Inpatient 20% coinsurance

Outpatient: 20% coinsurance
Inpatient 20% coinsurance

Prescription Drugs
90-day supply of any Tier 1, Tier 2, or Tier 3 medications with two copays (some exceptions)

No deductible
Tier 1 - $20 copay
Tier 2 - $40 copay
Tier 3 - $60 copay
Tier 4 - 25% up to $200 per 30 day supply
Tier 5 - 35% up to $300 per 30 day supply

Tier 1 - $20 copay
Tier 2 - $40 copay
Tier 3 - $60 copay
Tier 4 - 25% up to $200 per 30 day supply
Tier 5 - 35% up to $300 per 30 day supply

Worldwide Travel Benefit
(Outside WA State)

Applicable Benefit Cost Shares

Applicable Benefit Cost Shares

2018 Enrollment Guide PDF Standard Option High Deductible Health Plan
Summary of Benefits and Coverage PDF Standard Option High Deductible Health Plan
2018 Federal Brochure PDF Standard Option High Deductible Health Plan

Dental Benefits (Included in Medical Premium)

Coverage Standard Option Plan You Pay
High Deductible Health Plan You Pay

Preventive
No Deductible

All charges in excess of scheduled allowance All charges in excess of scheduled allowance

Vision Benefits (Included in Medical Premium)

Coverage Standard Option Plan You Pay
High Deductible Health Plan You Pay

Annual routine eye exam

Nothing. No deductible Nothing. No deductible

Diagnostic exams

$25 primary / $35 specialty copay per exam
No deductible
Deductible and 20% coinsurance

Eyeglasses or contact lenses
(Accident or surgery related)

Deductible and 20% coinsurance Deductible and 20% coinsurance

Other services & hardware

All charges less 20% discount All charges less 20% discount

Note: The above information is a summary of benefits. It is not a contract. For complete information, and before making a final decision, please read the Federal brochure (RI 73-051). All benefits are subject to the definitions, limitations and exclusions set forth in the brochure.


Looking for 2017 Rates and Benefits?

See our 2017 Rates and Benefits


Please note that the above information is a summary of the Kaiser Permanente Washington Options Federal benefits. Before making a final decision, please read the Plan’s Federal brochure (RI 73-051). All benefits are subject to the definitions, limitations, and exclusions set forth in the Federal brochure. Please refer to the Kaiser Permanente Washington Options Federal (formerly Group Health Options, Inc.) brochure posted at kp.org/wa/fehb-options.