SAMB
SAMBA — Standard
FEHB Offered in 2027|SAMBA|Traditional|PPO
Also listed as: SAMBA Health Benefit Plan
Premium
biweekly · employee paysSelf Only
$135.87biweekly · employee pays
vs 2026+$13.01 +10.6%
Lowest$60.79 (2013)
Highest$135.87 (2027)
Since 2013+123.5%
Self Plus One
$264.64biweekly · employee pays
vs 2026+$27.91 +11.8%
Lowest$139.57 (2016)
Highest$264.64 (2027)
Since 2016+89.6%
Self & Family
$280.66biweekly · employee pays
vs 2026+$23.18 +9.0%
Lowest$138.84 (2013)
Highest$280.66 (2027)
Since 2013+102.1%
Premium history
SharePeriodRate type
Year by year
follows the chart's share, period and rate-type selection| Year | Self Only | Δ | Self Plus One | Δ | Self & Family | Δ | Listed as |
|---|
Changelog
- 2012Tracked since 2012Earliest plan year in the data set.
- 2016Self Plus One enrollment addedOPM introduced the Self Plus One enrollment type government-wide in 2016.
- 2018Largest increase: +33.8%Self Only employee share went from $72.95 to $97.59.
- 2019Largest decrease: -11.0%Self Only employee share went from $97.59 to $86.85.
- 2020Renamed“SAMBA” → “SAMBA Health Benefit Plan”
- 2026Renamed“SAMBA Health Benefit Plan” → “SAMBA”
Full rate schedule
Plan yearIn-network
2027 plan benefits file| Self Only | Self Plus One | Self & Family | |
|---|---|---|---|
| Annual deductible | $350 | $700 | $900 |
| Medical account contribution | Not applicable | Not applicable | Not applicable |
| Net deductible | $350 | $700 | $900 |
| Annual out-of-pocket maximum | $6,000 | $12,000 | $12,000 |
| Prescription out-of-pocket maximum | $6,000 | $12,000 | $12,000 |
- Type of accountNot Applicable
- Medicare Part D EGWP Prescription Drug Out-of-Pocket Maximum per enrollee$6,000
- Total Annual Part B Premium Reimbursement Amount Per Enrollee (MAPD)$900
- Tier 0$0 Copayment
- Tier 1$12 Copayment
- Tier 235% Coinsurance
- Tier 350% Coinsurance
- Tier 4$999 Copayment
- Tier 5$999 Copayment
- Mail Order PharmacyYes
- Deductible waiver (with Medicare Part A as Primary)No
- Deductible waiver (with Medicare Part B as Primary)Deductible waived
- Deductible Waiver with Parts A & BDeductible waived
- Out-of-Pocket Maximum with Parts A & BNot applicable
- Primary Care Physician Office Visit with Medicare A & B PrimaryMember Pays Nothing
- Specialty Physician Office Visit with Parts A & BMember Pays Nothing
- Inpatient Hospital Services with Parts A & BMember Pays Nothing
- Outpatient Hospital Services with Part A20% Coinsurance
- Outpatient physician services (with Medicare Part B as Primary)Member Pays Nothing
- Part B Premium Reimbursement with Parts A & BNo
- Requirement for Part B ReimbursementNot applicable
- Deductible Waiver with Part CDeductible waived
- Out-of-Pocket Maximum with Part C$0
- Primary Care Physician Office Visit with Medicare Advantage (Part C) PrimaryMember Pays Nothing
- Specialty Physician Office Visit with Part CMember Pays Nothing
- Inpatient Hospital Services with Part CMember Pays Nothing
- Outpatient Hospital Services with Part CMember Pays Nothing
- Outpatient physician services (with Medicare Advantage Part C as Primary)Member Pays Nothing
- Part B Premium Reimbursement with Part C$900 Maximum
- Preventive CareMember Pays Nothing
- Primary Care Office Visit$20 Copayment
- Specialist Office Visit$30 Copayment
- Emergency Care20% Coinsurance
- Urgent Care$20 Copayment
- Doctor Costs for Inpatient Surgery20% Coinsurance
- Hospital Inpatient Cost Per Admission$250 Copayment
- Hospital Room CostsMember Pays Nothing
- Other Inpatient Hospital Costs20% Coinsurance
- Doctor Costs for Outpatient Surgery20% Coinsurance
- Other Outpatient Surgery Costs20% Coinsurance
- Diagnostic Tests or Procedures (e.g., Blood Tests, X-rays, Urinalysis, Ultrasounds)20% Coinsurance
- Diagnostic Tests or Procedures (e.g., CT scans, MRIs, PET Scans)20% Coinsurance
- Enhanced Lab NetworkMember Pays Nothing
- Applied Behavioral Analysis (ABA)20% Coinsurance
- Chiropractic20% Coinsurance
- Occupational Therapy20% Coinsurance
- Physical Therapy20% Coinsurance
- Speech Therapy20% Coinsurance
- Professional Services (Mental Health and Substance Use Disorder)$20 Copayment
- Inpatient Hospital (Mental Health and Substance Use Disorder Services)$250 Copayment
- Outpatient Hospital (Mental Health and Substance Use Disorder Services)20% Coinsurance
- Diagnosis and Treatment (Infertility Services)20% Coinsurance
- Fertility Preservation Procedures (e.g., iatrogenic infertility) (Infertility Services)20% Coinsurance
- Artificial Insemination Services (e.g. ICI, IVI, IUI)20% Coinsurance
- Assisted Reproductive Technology (ART) (e.g., IVF, GIFT, ZIFT) (Infertility Services)Member Pays All Charges
- Surgical Procedures20% Coinsurance
- Reconstructive Surgery20% Coinsurance
- Hearing Services20% Coinsurance
- Hearing Aids (external)Covered
- Prenatal Care, Screening for Gestational Diabetes, Delivery, and Postpartum Care (Maternity Care)Member Pays Nothing
- Hospital Stay--Vaginal Birth, Cesarean Birth (Maternity Care)Member Pays Nothing
- Hospice Care20% Coinsurance
- Home Health Services (Skilled Nursing Care)20% Coinsurance
- Durable Medical Equipment20% Coinsurance
- Outpatient Rehabilitation (Skilled Nursing Care Facility)20% Coinsurance
- Diabetes Education20% Coinsurance
- Nutritional Counseling20% Coinsurance
- Routine Dental Exams and Cleaning for AdultsNot Covered
- Routine Dental Exams and Cleaning for ChildrenNot Covered
- Routine Eye ExamsNot Covered
- Eye Exams for Medical Condition or Non-Surgical TreatmentCovered
- EyeglassesNot Covered
- Contact LensesNot Covered
- Acupuncture20% Coinsurance
- Chronic Disease Management: Heart DiseaseCovered
- Chronic Disease Management: ObesityCovered
- Chronic Disease Management: HypertensionCovered
- Chronic Disease Management: AsthmaCovered
Out-of-network
2027 plan benefits file| Self Only | Self Plus One | Self & Family | |
|---|---|---|---|
| Annual deductible | $350 | $700 | $900 |
| Medical account contribution | Not applicable | Not applicable | Not applicable |
| Net deductible | $350 | $700 | $900 |
| Annual out-of-pocket maximum | $8,500 | $14,000 | $14,000 |
- Type of accountNot Applicable
- Tier 0$0 Copayment
- Tier 1$12 Copayment
- Tier 235% Coinsurance
- Tier 350% Coinsurance
- Tier 4$999 Copayment
- Tier 5$999 Copayment
- Mail Order PharmacyYes
- Deductible waiver (with Medicare Part A as Primary)No
- Deductible waiver (with Medicare Part B as Primary)Deductible waived
- Deductible Waiver with Parts A & BDeductible waived
- Out-of-Pocket Maximum with Parts A & BNot applicable
- Primary Care Physician Office Visit with Medicare A & B PrimaryMember Pays Nothing
- Specialty Physician Office Visit with Parts A & BMember Pays Nothing
- Inpatient Hospital Services with Parts A & BMember Pays Nothing
- Outpatient Hospital Services with Part A45% Coinsurance
- Outpatient physician services (with Medicare Part B as Primary)Member Pays Nothing
- Part B Premium Reimbursement with Parts A & BNo
- Requirement for Part B ReimbursementNot applicable
- Deductible Waiver with Part CDeductible waived
- Out-of-Pocket Maximum with Part C$0
- Primary Care Physician Office Visit with Medicare Advantage (Part C) PrimaryMember Pays Nothing
- Specialty Physician Office Visit with Part CMember Pays Nothing
- Inpatient Hospital Services with Part CMember Pays Nothing
- Outpatient Hospital Services with Part CMember Pays Nothing
- Outpatient physician services (with Medicare Advantage Part C as Primary)Member Pays Nothing
- Part B Premium Reimbursement with Part C$900 Maximum
- Preventive Care45% Coinsurance
- Primary Care Office Visit45% Coinsurance
- Specialist Office Visit45% Coinsurance
- Emergency Care20% Coinsurance
- Urgent Care45% Coinsurance
- Doctor Costs for Inpatient Surgery45% Coinsurance
- Hospital Inpatient Cost Per Admission$450 Copayment
- Hospital Room Costs45% Coinsurance
- Other Inpatient Hospital Costs45% Coinsurance
- Doctor Costs for Outpatient Surgery45% Coinsurance
- Other Outpatient Surgery Costs45% Coinsurance
- Diagnostic Tests or Procedures (e.g., Blood Tests, X-rays, Urinalysis, Ultrasounds)45% Coinsurance
- Diagnostic Tests or Procedures (e.g., CT scans, MRIs, PET Scans)45% Coinsurance
- Enhanced Lab NetworkNot applicable
- Applied Behavioral Analysis (ABA)45% Coinsurance
- Chiropractic45% Coinsurance
- Occupational Therapy50% Coinsurance
- Physical Therapy50% Coinsurance
- Speech Therapy45% Coinsurance
- Professional Services (Mental Health and Substance Use Disorder)45% Coinsurance
- Inpatient Hospital (Mental Health and Substance Use Disorder Services)$450 Copayment
- Outpatient Hospital (Mental Health and Substance Use Disorder Services)45% Coinsurance
- Diagnosis and Treatment (Infertility Services)45% Coinsurance
- Fertility Preservation Procedures (e.g., iatrogenic infertility) (Infertility Services)45% Coinsurance
- Artificial Insemination Services (e.g. ICI, IVI, IUI)45% Coinsurance
- Assisted Reproductive Technology (ART) (e.g., IVF, GIFT, ZIFT) (Infertility Services)Member Pays All Charges
- Surgical Procedures45% Coinsurance
- Reconstructive Surgery45% Coinsurance
- Hearing Services45% Coinsurance
- Hearing Aids (external)Covered
- Prenatal Care, Screening for Gestational Diabetes, Delivery, and Postpartum Care (Maternity Care)45% Coinsurance
- Hospital Stay--Vaginal Birth, Cesarean Birth (Maternity Care)$450 Copayment
- Hospice Care45% Coinsurance
- Home Health Services (Skilled Nursing Care)50% Coinsurance
- Durable Medical Equipment50% Coinsurance
- Outpatient Rehabilitation (Skilled Nursing Care Facility)45% Coinsurance
- Diabetes Education45% Coinsurance
- Nutritional Counseling45% Coinsurance
- Routine Dental Exams and Cleaning for AdultsNot Covered
- Routine Dental Exams and Cleaning for ChildrenNot Covered
- Routine Eye ExamsNot Covered
- Eye Exams for Medical Condition or Non-Surgical TreatmentCovered
- EyeglassesNot Covered
- Contact LensesNot Covered
- Acupuncture45% Coinsurance
- Chronic Disease Management: Heart DiseaseCovered
- Chronic Disease Management: ObesityCovered
- Chronic Disease Management: HypertensionCovered
- Chronic Disease Management: AsthmaCovered
Offered nationwide.
Service area description
| State | Description |
|---|---|
| Nationwide | Nationwide |
Service area over time
| Year | States / areas listed |
|---|---|
| 2027 | Nationwide |
| 2026 | Nationwide |
| 2025 | Nationwide |
| 2024 | Nationwide |
| 2023 | Nationwide |
| 2022 | Nationwide |
| 2021 | Nationwide |
| 2020 | Nationwide |
| 2019 | Nationwide |
| 2018 | Nationwide |
| 2017 | Nationwide |
| 2016 | Nationwide |