2024 Blue Cross and Blue Shield Service Benefit Plan - FEP Blue Focus
Section 5(d). Emergency Services/Accidents
Page 80
Section 5(d). Emergency Services/Accidents
Page 80
Benefit Description
Medical Emergency (cont.)
Note: Benefits for crutches, splints, braces, etc. when billed by a provider other than the urgent care center are stated in Section 5(a), DME.
You Pay
Preferred urgent care center: $25 copayment per visit (no deductible)
Non-preferred (Participating/Non-participating): You pay all charges
Medical Emergency (cont.)
- Urgent care centers, not licensed as or permitted to provide emergency services and supplies, including professional providers’ services, diagnostic studies, radiology services, laboratory tests and pathology services, when billed by the provider
Note: Benefits for crutches, splints, braces, etc. when billed by a provider other than the urgent care center are stated in Section 5(a), DME.
You Pay
Preferred urgent care center: $25 copayment per visit (no deductible)
Non-preferred (Participating/Non-participating): You pay all charges
Benefit Description
Not covered: Emergency room professional charges for shift differentials
You Pay
All charges
Not covered: Emergency room professional charges for shift differentials
You Pay
All charges
Benefit Description
Ambulance
See Section 5(c) for complete ambulance benefit and coverage information.
You Pay
See Section 5(c)
Ambulance
See Section 5(c) for complete ambulance benefit and coverage information.
You Pay
See Section 5(c)