2025 Blue Cross and Blue Shield Service Benefit Plan - FEP Blue Focus
Section 5(a). Medical Services and Supplies Provided by Physicians and Other Healthcare Professionals
Page 46
Section 5(a). Medical Services and Supplies Provided by Physicians and Other Healthcare Professionals
Page 46
Benefit Description
Reproductive Services (cont.)
Note: See other sections in this brochure for benefits associated with other service performed to diagnose and treat the cause of infertility.
You Pay
Preferred: 30% of the Plan allowance (deductible applies)
Non-preferred (Participating/Non-participating): You pay all charges
Reproductive Services (cont.)
Note: See other sections in this brochure for benefits associated with other service performed to diagnose and treat the cause of infertility.
You Pay
Preferred: 30% of the Plan allowance (deductible applies)
Non-preferred (Participating/Non-participating): You pay all charges
Benefit Description
Not covered: The services listed below are not covered as treatments for infertility or as alternatives to conventional conception:
You Pay
All charge
Not covered: The services listed below are not covered as treatments for infertility or as alternatives to conventional conception:
- Assisted reproductive technology (ART), including but not limited to:
- In vitro fertilization (IVF)
- Embryo transfer and gamete intrafallopian transfer (GIFT) and zygote intrafallopian transfer (ZIFT)
- In vitro fertilization (IVF)
- Intracytoplasmic sperm injection (ICSI)
- Services, procedures, and/or supplies that are related to ART and assisted insemination procedures except as described above
- Cryopreservation or storage of sperm (sperm banking), eggs, or embryos except as described above
- Preimplantation diagnosis, testing, and/or screening, including the testing or screening of eggs, sperm, or embryos
- Drugs used in conjunction with ART and assisted insemination procedures except as described above and in Section 5(f) Prescription Drug Benefits
- Services, supplies, or drugs provided to individuals not enrolled in this Plan including surrogates
You Pay
All charge
Benefit Description
Allergy Care
Note: See earlier in this section for applicable office visit copayment.
You Pay
Preferred: 30% of the Plan allowance (deductible applies)
Non-preferred (Participating/Non-participating): You pay all charges
Note: When care is provided by a Non-preferred laboratory and/or radiologist, as stated in Section 3 for an exception, you pay:
Allergy Care
- Allergy testing
- Allergy treatment
- Allergy injections
- Sublingual allergy desensitization drugs as licensed by the U.S. FDA
- Preparation of each multi-dose vial of antigen
- Agents, drugs, and/or supplies administered or obtained in connection with your care
Note: See earlier in this section for applicable office visit copayment.
You Pay
Preferred: 30% of the Plan allowance (deductible applies)
Non-preferred (Participating/Non-participating): You pay all charges
Note: When care is provided by a Non-preferred laboratory and/or radiologist, as stated in Section 3 for an exception, you pay:
- Participating laboratories or radiologists: 30% of the Plan allowance (deductible applies)
- Non-participating laboratories or radiologists: 30% of the Plan allowance, plus any difference between our allowance and the billed amount (deductible applies)
Benefit Description
Not covered: Provocative food testing
You Pay
All charges
Not covered: Provocative food testing
You Pay
All charges