Document Number:
FBF24-054
Revision #:
v1.0
Date Published:
1/1/2024
2024 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 54
Section 5(a). Medical Services and Supplies Provided by Physicians and Other Healthcare Professionals
Page 54
Benefit Description
Alternative/Manipulative Treatment (cont.)
See Section 5(c) for facility benefits.
You Pay
Preferred: $25 copayment per visit (no deductible)
Non-preferred (Participating/Non-participating): You pay all charges
Note: You pay 30% of the Plan allowance (deductible applies) for agents, drugs, and/or supplies administered or obtained in connection with your care.
Alternative/Manipulative Treatment (cont.)
- Manipulative treatment limited to:
- Osteopathic manipulative treatment to any body region
- Chiropractic spinal and/or extraspinal manipulative treatment
- Osteopathic manipulative treatment to any body region
See Section 5(c) for facility benefits.
You Pay
Preferred: $25 copayment per visit (no deductible)
Non-preferred (Participating/Non-participating): You pay all charges
Note: You pay 30% of the Plan allowance (deductible applies) for agents, drugs, and/or supplies administered or obtained in connection with your care.
Benefit Description
Not covered:
You Pay
All charges
Not covered:
- Biofeedback
- Self-care or self-help training
You Pay
All charges
Benefit Description
Educational Classes and Programs
You Pay
Preferred: Nothing (no deductible)
Non-preferred (Participating/Non-participating): You pay all charges
Educational Classes and Programs
- Smoking and tobacco cessation treatment including:
- Counseling for smoking and tobacco use cessation
- Smoking and tobacco cessation classes
Note: See Section 5(f) for our coverage of smoking and tobacco cessation drugs.
- Counseling for smoking and tobacco use cessation
You Pay
Preferred: Nothing (no deductible)
Non-preferred (Participating/Non-participating): You pay all charges
Benefit Description
You Pay
Preferred: 30% of the Plan allowance (deductible applies)
Non-preferred (Participating/Non-participating): You pay all charges
- Diabetic education
Note: See previous information in this section for our coverage of nutritional counseling services that are not part of a diabetic education program.
You Pay
Preferred: 30% of the Plan allowance (deductible applies)
Non-preferred (Participating/Non-participating): You pay all charges
Benefit Description
Not covered:
You Pay
All charges
Not covered:
- Educational or other counseling or training services, or applied behavior analysis (ABA), when performed as part of an educational class or program
- Premenstrual syndrome (PMS), lactation, headache, eating disorder, and other educational clinics unless described earlier in this section as being covered
- Recreational or educational therapy, and any related diagnostic testing except as provided by a hospital as part of a covered inpatient stay
- Services performed or billed by a school or halfway house or a member of its staff
You Pay
All charges