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Cover Page and Inside Cover
Table of Contents
Introduction/Plain Language/Advisory
PSHB Facts
Section 1
Section 2
Section 3
Section 4
Section 5
5(a). Medical Services and Supplies Provided by Physicians and Other Healthcare Professionals
5(b). Surgical and Anesthesia Services Provided by Physicians and Other Healthcare Professionals
5(c). Services Provided by a Hospital or Other Facility, and Ambulance Services
5(d). Emergency Services/Accidents
5(e). Mental Health and Substance Use Disorder Benefits
5(f). Prescription Drug Benefits
5(f)(a). FEP Medicare Prescription Drug Plan
5(g). Dental Benefits
5(h). Wellness and Other Special Features
5(i). Services, Drugs, and Supplies Provided Overseas
Non-PSHB Benefits Available to Plan Members
Section 6
Section 7
Section 8
Section 8(a)
Section 9
Section 10
Index
Summary of Benefits – FEP Blue Focus
2025 Rate Information
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
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2025 Blue Cross and Blue Shield Service Benefit Plan - FEP Blue Focus
Index

Page 141

 

National Doctor & Hospital Finder - 104
Neurological testing - 38, 68-71
Never Events - 6-8, 135
Newborn care - 27, 37-38, 43-44, 66-68
No Surprises Act (NSA) - 30-31
NON-CORE benefits - 35, 135
Non-member facilities - 14-15, 17-18
Non-participating providers - 30, 136-137
Non-preferred providers - 14-15, 17, 30
Non-PSHB benefits - 110
Nurse - 52-53, 72-74, 103
Nutritional counseling - 37-43, 65-66, 105
Observation care - 135
Obstetrical care - 43-44, 66-68
Occupational therapy - 48, 68-72
Office visits - 37-38, 80-81
Oral surgery - 58
Organ/tissue transplants - 54-63
Orthopedic devices - 50, 68-71
Osteoporosis screening - 138
Ostomy and catheter supplies - 52 
Out-of-pocket expenses - 31-32
Outpatient facility services - 68-71, 102
Outpatient professional services - 37-38, 80-81
Overpayments - 32
Overseas Assistance Center - 107
Overseas services, drugs, supplies and claims - 107-109
Oxygen - 51-52, 72-74
Pap tests - 39-43 
Participating providers - 30, 136-137
Patient Safety and Quality Monitoring (PSQM) program - 86-87
Personal Health Record - 103
PET scans - 38, 68-71
Pharmacotherapy - 37-38, 47 
Physical examinations - 39-43, 68-71, 111-112
Physical therapy - 48, 68-74
Physician - 14-15, 124, 128-129, 133
Plan allowance - 136-137
PPO - 14-15, 17-18, 137
Pre-admission testing - 65-66
Precertification - 20, 137
Preferred providers - 14-15, 17, 104 
Pregnancy (see: Maternity care)
Prescription drugs
Brand-name drugs - 84-86, 88-89, 91-92, 94-95
Drugs from other sources - 100 
Generic drugs - 84-89, 91-92, 94-95
Preferred retail pharmacies - 84-86, 88-89, 114
Retail Pharmacy Program - 84-86, 108-109
Self-injectable drugs - 84
Specialty Drug Pharmacy Program - 84-86, 88-89, 114
Specialty drugs - 84-86, 88-89, 91-92, 94-95, 138
Preventive care
Adult - 39-41, 138
Child - 41-43
Primary care provider (PCP) - 35
Prior approval - 20-23, 25-26, 138
Professional providers - 14-15, 17
Prostate cancer - 39-41
Prosthetic devices - 50,  65-66, 68-71
Psychotherapy - 80-83
Pulmonary rehabilitation - 47, 68-71
Radiation therapy - 47, 68-71
Reconsiderations - 27-28, 116-118
Replacement coverage - 13 
Reproductive services - 45-46, 131
Assisted reproductive technology (ART) - 45-46, 96-99, 131
Residential treatment center (RTC) - 17-18, 71-72, 82
Rights and responsibilities - 14-15
Room and board - 65-68, 71-72, 82
Routine Annual Physical Incentive Program - 106
Screening services - 39-41, 138
Second surgical opinion - 37-38
Self-injectable drugs - 84
Skilled nursing facility (SNF) care - 72
Smoking cessation - 53, 96-99
Social worker - 104-105 
Specialty Drug Pharmacy Program - 84-89, 114
Specialty drugs - 84-86, 88-89, 94-95, 138
Speech therapy - 48, 68-74
Speech-generating devices - 51-52
Stem cell transplants - 59-62
Sterilization procedures - 44-45
Subrogation - 121-122, 138 
Substance use disorder - 80-83, 139
Surgery - 54-63
Assistant surgeon - 19, 36, 55-56
Eye: cataract, amblyopia, strabismus - 49, 55-56
Gender affirming - 54-57
Multiple procedures - 54-56
Oral and maxillofacial - 58
Outpatient - 68-71
Reconstructive - 56-57
Sterilization, reversal of voluntary - 44-45, 55-56
Surgical implants - 50, 68-71
Surgical treatment of morbid obesity - 20-23
Transplants - 20-23, 58-62
Syringes - 88-89, 94-95
Telehealth
Dermatology - 37-38, 139
Mental health/substance use disorder - 105
Minor acute conditions - 17, 37-38, 105, 135
Nutritional counseling - 105
Temporary Continuation of Coverage (TCC) - 12-13
Tobacco cessation - 53, 96-99
Transplants - 54-63
Travel benefit - 62, 103
Treatment therapies - 47
TRICARE - 120-121
Ultrasounds - 38, 68-71
Urgent care center - 76-79
Urgent care claims - 26, 139
VA facility - 32, 129
Vaccines - 39-43, 96-99
Verbal statements - 28, 104-105
Vision services - 49, 122
Waivers - 30
Weight control - 20-23, 103
Wheelchairs - 51-52
Wigs - 50
WRAP benefits - 35, 139
X-rays - 38, 68-71

 

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