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PLANS & SERVICES FOR FEDERAL EMPLOYEES

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
$4/$12/$50/$80/10% up to $150/10% up to $250

Home Delivery or Extended Supply Retail - 90 Day Supply
$8/$24/$125/$240

Retail Pharmacy - 30 Day Supply
$6/$15/$85/$120/10% up to $400/10% up to $600

Home Delivery or Extended Supply Retail - 90 Day Supply
$12/$30/$170/$240

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
(A range of voluntary family planning servies limited to: Annual contraceptive counseling, Voluntary sterilization (e.g., tubal ligation, vasectomy), Surgically implanted contraceptives, Injectable contraceptive drugs (such as Depo provera), Intrauterine devices (IUDs), Diaphragms and contraceptive rings)

$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.