This brochure is the official statement of benefits that are available to Federal Employees. It explains how the plan works, your benefits and out-of-pocket costs.

2023 Benefits Brochure

2024 Benefits Brochure

2025 Benefits Brochure

An overview of the plan and the associated rates.

2024 Resource Guide

Use this summary to compare costs and coverage between health plans based on price, benefits, network providers and other features. The Summary of Benefits and Coverage (SBC) is helpful to understand new coverage, renewals or change in coverage.

2024 Standard Option Plan Summary of Benefits & Coverage (SBC) Subscriber/Family

2024 High Option Plan Summary of Benefits & Coverage (SBC) Subscriber/Family

2024 Wellness Option Plan Summary of Benefits & Coverage (SBC) Subscriber/Family

2025 Resource Guide

2025 Standard Option Plan Summary of Benefits & Coverage (SBC) Subscriber/Family

2025 High Option Plan Summary of Benefits & Coverage (SBC) Subscriber/Family

2025 Wellness Option Plan Summary of Benefits & Coverage (SBC) Subscriber/Family 

An overview of Infertility Diagnosis and Treatment 

Infertility Diagnosis and Treatment Overview

Learn more about the Fitness Pass

List of the prescription drugs - by drug class - that are covered by your plan. Explains if Prior Authorizations are needed, what the Quantity Limits are, and other conditions to have the drug.

Commercial 4-Tier Drug Formulary - by Drug Class

Drug Formulary Changes

List of preventative medications and products that may be available to you with no cost-sharing (copay, coinsurance and/or deductible) depending on your plan.

2024 Preventive Medication List

Specialty Pharmacy & Medical Drugs Coverage 

Form for a member, prescriber or a pharmacy to request authorization for  a drug listed on the Drugs Requiring Prior Authorization List.

Prior Authorization Request Form

List of all the Pharmacies available on Presbyterian Health Plans. Note that some drugs are required to be obtained through a specialty pharmacy provider. 

Pharmacy Locations

Contraception Exception Form

Form to register for 3 months of prescriptions to be mailed to you. This service is available for most drugs.