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
Orthopedic and Prosthetic Devices

 

Note: We state whether or not the calendar year deductible applies for each benefit listed in this section.

Benefit Description

Orthopedic and Prosthetic Devices
Orthopedic braces and prosthetic appliances such as:
 
  • Artificial limbs and eyes
     
  • Functional foot orthotics when prescribed by a physician
     
  • Rigid devices attached to the foot or a brace, or placed in a shoe
     
  • Replacement, repair, and adjustment of covered devices
     
  • Following a mastectomy, breast prostheses and surgical bras, including necessary replacements
     
  • Surgically implanted penile prostheses limited to treatment of erectile dysfunction or as part of an approved plan for gender affirming surgery
     
  • Surgical implants

Note: A prosthetic appliance is a device that is surgically inserted or physically attached to the body to restore a bodily function or replace a physical portion of the body.

We provide hospital benefits for internal prosthetic devices, such as artificial joints, pacemakers, cochlear implants, and surgically implanted breast implants following mastectomy; see Section 5(c) for payment information. Insertion of the device is paid as surgery; see Section 5(b).


You Pay
Preferred: 30% of the Plan allowance (deductible applies)

Non-preferred (Participating/Non-participating): You pay all charges

 

Benefit Description

Not covered:
 
  • Shoes (including diabetic shoes)
     
  • Over-the-counter orthotics
     
  • Arch supports
     
  • Heel pads and heel cups
     
  • Wigs (including cranial prostheses)
     
  • Hearing aids, including bone anchored hearing aids, accessories or supplies (including remote controls and warranty packages) and all associated services


You Pay
All charges