2025 Blue Cross and Blue Shield Service Benefit Plan - FEP Blue Focus
Index
Index
Index
Do not rely only on this page; it is for your convenience and may not show all pages where the terms appear. This Index is not an official statement of benefits.
Abortion - 111-112
Accidental injury - 77-78, 101, 131
Acupuncture - 53, 63, 68-71
Affordable Care Act (ACA) - 13, 96-99
Allergy care - 46
Allogeneic transplants - 60-62
Alternative treatments - 53
Ambulance - 75
Ambulatory surgical center - 17-18, 68-71
Anesthesia - 63
Angiographies - 38, 68-71
Appeals - 28, 116-118
Applied behavior analysis (ABA) - 20-23, 47, 68-71
Assistant surgeon - 19, 55-56
Autism spectrum disorder - 47, 68-71
Autologous transplants - 59-62
Biopsies - 39-41, 55-56, 68-71
Birthing centers - 17-18
Blood and blood plasma - 52, 68-71
Blood or marrow stem cell - 59-62
Blue Distinction Centers - 17-18, 59-60
for Transplants - 58-60, 62
Blue Distinction Specialty Care - 17-18
Blue Health Assessment - 103-104
Bone density tests - 38, 68-71
Brand-name drugs - 84-86, 88-89, 91-92, 94-95
Breast pump and supplies - 43-44
Breast reconstruction -56-57
Cardiac rehabilitation - 47, 68-71
Cardiovascular monitoring - 38, 68-71
Care Management Programs - 104-105
Case management - 72-74, 104-105
Casts - 54-55, 65-66, 68-71
Catastrophic protection - 31-32, 93-94
Cervical cancer screening - 39-43
CHAMPVA - 120-121
Changes for 2025 - 16
Chemotherapy - 47, 68-71
Children’s Equity Act - 11
Chiropractic manipulative treatment - 53, 68-71
Cholesterol tests - 38-41
Circumcision - 55-56
Claims and claims filingClinical trials - 60-62, 123, 132
Cognitive rehabilitation - 48, 68-72
Coinsurance - 29, 31-32
Colonoscopy - 39-41, 55-56, 68-71
Colorectal cancer testsCongenital anomalies - 55-56, 132
Consultations - 37-38, 80-81
Contact lenses - 49
Contraceptives - 44-45, 68-71, 88-89, 94-99
Coordination of benefits - 24-25, 120-130
Copayments - 29, 31-32
CORE benefits - 35, 132
Cosmetic surgery - 55-57, 132
Cost-share/cost-sharing - 29
Costs for covered services - 29-32
Coverage information - 9
Covered facility providers - 17-18
Covered professional providers - 17
CT scans - 38, 68-71
Custodial or long term care - 111-112, 132
Daily Habits - 103
Deductible - 29
Definitions - 131-139
Dental care - 101-102
Diabetic education - 53, 68-71
Diabetic supplies
Dialysis - 47, 51-52, 68-52, 71
Disease Management - 104-105
Disputed claims - 116-118
Divorce - 12
DNA analysis of stool samples - 39-41
Donor expenses - 62
Drugs (see: Prescription drugs)
Durable medical equipment - 51-52, 68-71, 132-133Educational classes and programs - 53
EEGs - 38, 68-71
EKGs - 38, 68-71
Emergency - 27, 76-79
Enrollment - Inside cover, 9-10
Exception situations - 19-20
Exclusions - 111-112
Experimental or investigational - 133
Extended care benefits - 72
Eyeglasses - 49
Facility providers - 17-18
Family planning - 44-45
Fecal occult blood test - 39-41
FEDVIP - 101, 122
fepblue mobile application - 106
fepblue.org - 4
Flexible benefits option - 105
Foot care - 50
Formulary/Preferred drug list - 84 -86, 90-92
Fraud - 4
Gender affirming care - 56-57
Generic drugs - 86-89, 94-95
Generic equivalents - 86-87, 92-93
Genetic screening/testing - 38, 68-71
Health Insurance Marketplace - 13
Health tools - 103
Healthy Families - 103
Hearing aids and hearing services - 48, 50, 111-112
Home health services - 52-53
Home nursing care (maternity) - 52-53
Hospice care - 72-74
Hospital - Human papillomavirus (HPV) tests - 39-43
Hypertension Management Program - 103-104
Identification cards - 17
Immunizations - 39-43, 96-99
Inpatient hospital benefits - 65-66
Inpatient professional services - 37-38, 80-81
Insulin - 88-89, 94-95
Insulin pumps - 51-52
Laboratory and pathology services - 38, 65-66, 68-71, 77-79
Low-dose CT screening - 138
Mammograms - 39-41
Manipulative treatment - 53, 68-71
Maternity care - 25, 27, 43-44, 66-68
Maxillofacial surgery - 58
Medicaid - 121
Medical emergency - 76-79
Medical foods - 52, 87-88, 93-94, 134
Medical supplies - 52, 65-66, 72-74
Medically necessary - 20, 27, 51-52, 71-72, 75
Medicare - Inside cover, 24-25, 120-130
Medications and supplies - 88-89, 94-99
Medications to promote better health - 96-99
Member facilities - 14-15
Mental health/substance use disorder - 80-83, 105
MRIs - 38, 68-71
Multiple procedures - 54 -55
MyBlue Customer eService - 104
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
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, 131Residential 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
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
Abortion - 111-112
Accidental injury - 77-78, 101, 131
Acupuncture - 53, 63, 68-71
Affordable Care Act (ACA) - 13, 96-99
Allergy care - 46
Allogeneic transplants - 60-62
Alternative treatments - 53
Ambulance - 75
Ambulatory surgical center - 17-18, 68-71
Anesthesia - 63
Angiographies - 38, 68-71
Appeals - 28, 116-118
Applied behavior analysis (ABA) - 20-23, 47, 68-71
Assistant surgeon - 19, 55-56
Autism spectrum disorder - 47, 68-71
Autologous transplants - 59-62
Biopsies - 39-41, 55-56, 68-71
Birthing centers - 17-18
Blood and blood plasma - 52, 68-71
Blood or marrow stem cell - 59-62
Blue Distinction Centers - 17-18, 59-60
for Transplants - 58-60, 62
Blue Distinction Specialty Care - 17-18
Blue Health Assessment - 103-104
Bone density tests - 38, 68-71
Brand-name drugs - 84-86, 88-89, 91-92, 94-95
Breast pump and supplies - 43-44
Breast reconstruction -56-57
Breast prostheses and surgical bras - 50
Cancer tests - 39-41Cardiac rehabilitation - 47, 68-71
Cardiovascular monitoring - 38, 68-71
Care Management Programs - 104-105
Case management - 72-74, 104-105
Casts - 54-55, 65-66, 68-71
Catastrophic protection - 31-32, 93-94
Cervical cancer screening - 39-43
CHAMPVA - 120-121
Changes for 2025 - 16
Chemotherapy - 47, 68-71
Children’s Equity Act - 11
Chiropractic manipulative treatment - 53, 68-71
Cholesterol tests - 38-41
Circumcision - 55-56
Claims and claims filingClinical trials - 60-62, 123, 132
Cognitive rehabilitation - 48, 68-72
Coinsurance - 29, 31-32
Colonoscopy - 39-41, 55-56, 68-71
Colorectal cancer testsCongenital anomalies - 55-56, 132
Consultations - 37-38, 80-81
Contact lenses - 49
Contraceptives - 44-45, 68-71, 88-89, 94-99
Coordination of benefits - 24-25, 120-130
Copayments - 29, 31-32
CORE benefits - 35, 132
Cosmetic surgery - 55-57, 132
Cost-share/cost-sharing - 29
Costs for covered services - 29-32
Coverage information - 9
Covered facility providers - 17-18
Covered professional providers - 17
CT scans - 38, 68-71
Custodial or long term care - 111-112, 132
Daily Habits - 103
Deductible - 29
Definitions - 131-139
Dental care - 101-102
Diabetic education - 53, 68-71
Diabetic supplies
Diabetic Meter Program - 96-99
Insulin pumps - 51-52
Insulin, test strips, and lancets - 88-89, 94-99
Needles and disposable syringes - 88-89, 94-95
Diagnostic tests - 38, 43-44, 49, 80-83Insulin pumps - 51-52
Insulin, test strips, and lancets - 88-89, 94-99
Needles and disposable syringes - 88-89, 94-95
Dialysis - 47, 51-52, 68-52, 71
Disease Management - 104-105
Disputed claims - 116-118
Divorce - 12
DNA analysis of stool samples - 39-41
Donor expenses - 62
Drugs (see: Prescription drugs)
Durable medical equipment - 51-52, 68-71, 132-133Educational classes and programs - 53
EEGs - 38, 68-71
EKGs - 38, 68-71
Emergency - 27, 76-79
Enrollment - Inside cover, 9-10
Exception situations - 19-20
Exclusions - 111-112
Experimental or investigational - 133
Extended care benefits - 72
Eyeglasses - 49
Facility providers - 17-18
Family planning - 44-45
Fecal occult blood test - 39-41
FEDVIP - 101, 122
fepblue mobile application - 106
fepblue.org - 4
Flexible benefits option - 105
Foot care - 50
Formulary/Preferred drug list - 84 -86, 90-92
Fraud - 4
Gender affirming care - 56-57
Generic drugs - 86-89, 94-95
Generic equivalents - 86-87, 92-93
Genetic screening/testing - 38, 68-71
Health Insurance Marketplace - 13
Health tools - 103
Healthy Families - 103
Hearing aids and hearing services - 48, 50, 111-112
Home health services - 52-53
Home nursing care (maternity) - 52-53
Hospice care - 72-74
Hospital - Human papillomavirus (HPV) tests - 39-43
Hypertension Management Program - 103-104
Identification cards - 17
Immunizations - 39-43, 96-99
Inpatient hospital benefits - 65-66
Inpatient professional services - 37-38, 80-81
Insulin - 88-89, 94-95
Insulin pumps - 51-52
Laboratory and pathology services - 38, 65-66, 68-71, 77-79
Low-dose CT screening - 138
Mammograms - 39-41
Manipulative treatment - 53, 68-71
Maternity care - 25, 27, 43-44, 66-68
Maxillofacial surgery - 58
Medicaid - 121
Medical emergency - 76-79
Medical foods - 52, 87-88, 93-94, 134
Medical supplies - 52, 65-66, 72-74
Medically necessary - 20, 27, 51-52, 71-72, 75
Medicare - Inside cover, 24-25, 120-130
Medications and supplies - 88-89, 94-99
Medications to promote better health - 96-99
Member facilities - 14-15
Mental health/substance use disorder - 80-83, 105
MRIs - 38, 68-71
Multiple procedures - 54 -55
MyBlue Customer eService - 104
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
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
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
Primary care provider (PCP) - 35Prior 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, 131Residential 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
TelehealthEye: 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
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) - 12-13Mental health/substance use disorder - 105
Minor acute conditions - 17, 37-38, 105, 135
Nutritional counseling - 105
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