Document Number:
PFBF25-001
Revision #:
v1.0
Date Published:
1/1/2025
 

 

2025 Blue Cross and Blue Shield Service Benefit Plan - FEP Blue Focus
Table of Contents
Page 1

 

Table of Contents

 

Introduction - 4
Plain Language - 4
Stop Healthcare Fraud! - 4
Discrimination is Against the Law - 5 
Preventing Medical Mistakes - 6 
PSHB Facts - 9 
Coverage information - 9 
• No pre-existing condition limitation - 9 
• Minimum essential coverage (MEC) - 9 
• Minimum value standard - 9 
• Where you can get information about enrolling in the PSHB Program - 9 
• Enrollment types available for you and your family - 9
• Family member coverage - 10 
• Children’s Equity Act - 11 
• Medicare Prescription Drug Plan (PDP) Employer Group Waiver Plan (EGWP) - 11
• When benefits and premiums start - 11
• When you retire - 12
When you lose benefits - 12
• When PSHB coverage ends - 12
• Upon divorce - 12
• Medicare PDP EGWP - 12
• Temporary Continuation of Coverage (TCC) - 12
• Finding replacement coverage - 13
• Health Insurance Marketplace - 13
Section 1. How This Plan Works - 14 
General features of FEP Blue Focus - 14
We have a Preferred Provider Organization (PPO) - 14
How we pay professional and facility providers - 14
Your rights and responsibilities - 15
Your medical and claims records are confidential - 15
Section 2. New for 2025 - 16
Section 3. How You Get Care - 17 
Identification cards - 17
Where you get covered care - 17
Balance Billing Protection - 17
• Covered professional providers - 17
• Covered facility providers - 17
What you must do to get covered care - 19
•Transitional care - 19
• If you are hospitalized when your enrollment begins - 19
You need prior Plan approval for certain services - 20
• Inpatient hospital admission, inpatient residential treatment center admission - 20
• Other services - 20
• Special prior authorization situations related to coordination of benefits (COB) - 24
• Prior notification – Maternity care - 25 
How to request precertification for an admission or get prior approval for Other services - 25 
• Non-urgent care claims - 26
• Urgent care claims - 26
• Concurrent care claims - 26

 

Go to Inside cover.  Go to page 2.