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33

 
 
Document Number:
PFBF25-033
Revision #:
v1.0
Date Published:
1/1/2025
 

 

2025 Blue Cross and Blue Shield Service Benefit Plan - FEP Blue Focus
Section 5. FEP Blue Focus Benefits
Page 33

 

Section 5. FEP Blue Focus Benefits

 

See near the end of the brochure for a summary of benefits for this plan and Section 5 provides an overview of FEP Blue Focus.

 

Section 5. FEP Blue Focus Overview - 35
Section 5(a). Medical Services and Supplies Provided by Physicians and Other Healthcare Professionals - 36
Diagnostic and Treatment Services - 37
Lab, X-ray and Other Diagnostic Tests - 38
Preventive Care, Adult - 39
Preventive Care, Child - 41
Maternity Care - 43
Family Planning - 44
Reproductive Services - 45 
Allergy Care - 46
Treatment Therapies - 47
Physical Therapy, Occupational Therapy, Speech Therapy, and Cognitive Rehabilitation Therapy - 48
Hearing Services - 48
Vision Services (Testing, Treatment, and Supplies) - 49 
Foot Care - 50 
Orthopedic and Prosthetic Devices - 50
Durable Medical Equipment (DME) - 51
Medical Supplies - 52 
Home Health Services - 52 
Alternative/Manipulative Treatment - 53
Educational Classes and Programs - 53
Section 5(b). Surgical and Anesthesia Services Provided by Physicians and Other Healthcare Professionals - 54 
Surgical Procedures - 55
Reconstructive Surgery - 56 
Oral and Maxillofacial Surgery - 58
Organ/Tissue Transplants - 59 
Anesthesia - 63
Section 5(c). Services Provided by a Hospital or Other Facility, and Ambulance Services - 64 
Inpatient Hospital - 65
Maternity – Facility - 66 
Outpatient Hospital or Ambulatory Surgical Center - 68 
Residential Treatment Center - 71 
Extended Care Benefits/Skilled Nursing Care Facility Benefits - 72 
Hospice Care - 72
Ambulance - 75
Section 5(d). Emergency Services/Accidents - 76 
Accidental Injury - 77
Medical Emergency -78
Ambulance - 79
Section 5(e). Mental Health and Substance Use Disorder Benefits - 80
Professional Services - 80
Inpatient Hospital or Other Covered Facility - 82 
Residential Treatment Center - 82
Outpatient Hospital or Other Covered Facility - 82 
Section 5(f). Prescription Drug Benefits - 84
Covered Medications and Supplies - 88

 

Go to page 32.  Go to page 34.
 

Blue Cross Blue Shield Federal Employee Program
Confidential - Internal Plan use only

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