2025 Blue Cross and Blue Shield Service Benefit Plan - FEP Blue Focus
Section 5. FEP Blue Focus Benefits
Section 5. FEP Blue Focus Benefits
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
Section 5(d). Emergency Services/Accidents - 76
Non-PSHB Benefits Available to Plan Members - 110
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
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
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
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
Section 5(e). Mental Health and Substance Use Disorder Benefits - 80Professional 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 - 84Inpatient Hospital or Other Covered Facility - 82
Residential Treatment Center - 82
Outpatient Hospital or Other Covered Facility - 82
Covered Medications and Supplies - 88
Section 5(f)(a). FEP Medicare Prescription Drug Program - 90
Covered Medications and Supplies - 94
Section 5(g). Dental Benefits - 101
Accidental Injury Benefit - 101
Inpatient and Outpatient Facility Care - 102
Section 5(h). Wellness and Other Special Features - 103 Health Tools - 103
Services for the Deaf and Hearing Impaired - 103
Web Accessibility for the Visually Impaired - 103
Travel Benefit/Services Overseas - 103
Healthy Families - 103
Blue Health Assessment - 103
Hypertension Management Program - 103
MyBlue® Customer eService - 104
National Doctor & Hospital Finder - 104
Care Management Programs - 104
Flexible Benefits Option - 105
Telehealth Services - 105
Routine Annual Physical Incentive Program - 106
Services for the Deaf and Hearing Impaired - 103
Web Accessibility for the Visually Impaired - 103
Travel Benefit/Services Overseas - 103
Healthy Families - 103
Blue Health Assessment - 103
Hypertension Management Program - 103
MyBlue® Customer eService - 104
National Doctor & Hospital Finder - 104
Care Management Programs - 104
Flexible Benefits Option - 105
Telehealth Services - 105
Routine Annual Physical Incentive Program - 106
The fepblue Mobile Application - 106
Section 5(i). Services, Drugs, and Supplies Provided Overseas - 107 Non-PSHB Benefits Available to Plan Members - 110