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Blue Cross and Blue Shield Service Benefit Plan Brochure - 2024

FEP Blue Focus

 

Document list

Document Number Document Name
FBF24.00.1.1 Cover Page
FBF24.00.1.2 Inside cover
FBF24.00.1.3 Table of Contents
FBF24.00.2.1 Introduction
FBF24.00.2.2 Plain Language
FBF24.00.2.3 Stop Healthcare Fraud
FBF24.00.2.4 Discrimination is Against the Law
FBF24.00.2.5 Preventing Medical Mistakes
FBF24.00.3.1.1 No pre-existing condition limitation
FBF24.00.3.1.2 Minimum essential coverage (MEC)
FBF24.00.3.1.3 Minimum value standard
FBF24.00.3.1.4 Where you can get information about enrolling in the FEHB Program
FBF24.00.3.1.5 Enrollment types available for you and your family
FBF24.00.3.1.6 Family member coverage
FBF24.00.3.1.7 Children's Equity Act
FBF24.00.3.1.8 When benefits and premiums start
FBF24.00.3.1.9 When you retire
FBF24.00.3.2.1 When FEHB coverage ends
FBF24.00.3.2.2 Upon divorce
FBF24.00.3.2.3 Temporary Continuation of Coverage (TCC)
FBF24.00.3.2.4 Finding replacement coverage
FBF24.00.3.2.5 Health Insurance Marketplace
FBF24.01.0 Section 1. How This Plan Works
FBF24.01.1 General features of FEP Blue Focus/We have a Preferred Provider Organization (PPO)
FBF24.01.2 How we pay professional and facility providers
FBF24.01.3 Your rights and responsibilities
FBF24.01.4 Your medical and claims records are confidential
FBF24.02 Section 2. Changes for 2024
FBF24.03.1 Identification cards
FBF24.03.2.0 Where you get covered care
FBF24.03.2.01 Balance Billing Protection
FBF24.03.2.1 Covered professional providers
FBF24.03.2.2 Covered facility providers
FBF24.03.3.0 What you must do to get covered care
FBF24.03.3.1 Transitional care
FBF24.03.3.2 If you are hospitalized when your enrollment begins
FBF24.03.4.00 You need prior Plan approval for certain services
FBF24.03.4.01 Inpatient hospital admission, inpatient residential treatment center admission
FBF24.03.4.02 Other services
FBF24.03.4.03 Special prior authorization situations related to coordination of benefits (COB)
FBF24.03.4.04 Prior notification - Maternity care
FBF24.03.4.05 How to request precertification for an admission or get approval for Other services
FBF24.03.4.06 Non-urgent care claims
FBF24.03.4.07 Urgent care claims
FBF24.03.4.08 Concurrent care claims
FBF24.03.4.09 Emergency inpatient admission
FBF24.03.4.10 Maternity care
FBF24.03.4.11 If your facility stay needs to be extended
FBF24.03.4.12 If your treatment needs to be extended
FBF24.03.5.0 If you disagree with our pre-service claim decision
FBF24.03.5.1 To reconsider a non-urgent care claim
FBF24.03.5.2 To reconsider an urgent care claim
FBF24.03.5.3 To file an appeal with OPM
FBF24.04.01 Cost-share/Cost-sharing
FBF24.04.02 Copayment
FBF24.04.03 Deductible
FBF24.04.04 Coinsurance
FBF24.04.05 If your provider routinely waives your cost
FBF24.04.06 Waivers
FBF24.04.07 Differences between our allowance and the bill
FBF24.04.08 Important Notice About Surprise Billing – Know Your Rights
FBF24.04.09 Your costs for other care
FBF24.04.10 Your catastrophic protection out-of-pocket maximum for deductibles, coinsurance, and copayments
FBF24.04.11 Carryover
FBF24.04.12 If we overpay you
FBF24.04.13 When Government facilities bill us
FBF24.04.14 The Federal Flexible Spending Account Program – FSAFEDS
FBF24.05.01 Section 5. Benefits - Table of Contents
FBF24.05.02 Section 5. FEP Blue Focus Overview
FBF24.05a.0 Section 5(a). Overview
FBF24.05a.01 Diagnostic and Treatment Services
FBF24.05a.02 Lab, X-ray and Other Diagnostic Tests
FBF24.05a.03 Preventive Care, Adult
FBF24.05a.04 Preventive Care, Child
FBF24.05a.05 Maternity Care
FBF24.05a.06 Family Planning
FBF24.05a.07 Reproductive Services
FBF24.05a.08 Allergy Care
FBF24.05a.09 Treatment Therapies
FBF24.05a.10 Physical Therapy, Occupational Therapy, Speech Therapy, and Cognitive Rehabilitation Therapy
FBF24.05a.11 Hearing Services
FBF24.05a.12 Vision Services (Testing, Treatment, and Supplies)
FBF24.05a.13 Foot Care
FBF24.05a.14 Orthopedic and Prosthetic Devices
FBF24.05a.15 Durable Medical Equipment (DME)
FBF24.05a.16 Medical Supplies
FBF24.05a.17 Home Health Services
FBF24.05a.18 Alternative/Manipulative Treatment
FBF24.05a.19 Educational Classes and Programs
FBF24.05b.0 Section 5(b). Overview
FBF24.05b.1 Surgical Procedures
FBF24.05b.2 Reconstructive Surgery
FBF24.05b.3 Oral and Maxillofacial Surgery
FBF24.05b.4 Organ/Tissue Transplants
FBF24.05b.5 Anesthesia
FBF24.05c.0 Section 5(c). Overview
FBF24.05c.1 Inpatient Hospital
FBF24.05c.2 Maternity - Facility
FBF24.05c.3 Outpatient Hospital or Ambulatory Surgical Center
FBF24.05c.4 Residential Treatment Center
FBF24.05c.5 Extended Care Benefits/Skilled Nursing Care Facility Benefits
FBF24.05c.6 Hospice Care
FBF24.05c.7 Ambulance
FBF24.05d.0 Section 5(d). Overview
FBF24.05d.1 Accidental Injury
FBF24.05d.2 Medical Emergency
FBF24.05d.3 Ambulance
FBF24.05e.0 Section 5(e). Overview
FBF24.05e.1 Professional Services
FBF24.05e.2 Inpatient Hospital or Other Covered Facility
FBF24.05e.3 Residential Treatment Center
FBF24.05e.4 Outpatient Hospital or Other Covered Facility
FBF24.05f.0 Section 5(f). Overview
FBF24.05f.01 There are important features you should be aware of
FBF24.05f.02 Who can write your prescriptions
FBF24.05f.03 Where you can obtain them
FBF24.05f.04 What is covered
FBF24.05f.05 Generic equivalents
FBF24.05f.06 Disclosure of information
FBF24.05f.07 These are the dispensing limitations
FBF24.05f.08 Patient Safety and Quality Monitoring (PSQM)
FBF24.05f.09 Prior Approval
FBF24.05f.10 Medical Foods
FBF24.05f.11 Here is how to obtain your prescription drugs and supplies
FBF24.05f.12 Preferred retail pharmacies
FBF24.05f.13 Section 5(f). MPDP Overview
FBF24.05f.14 MPDP There are important features you should be aware of
FBF24.05f.15 MPDP Who can write your prescriptions
FBF24.05f.16 MPDP Where you can obtain them
FBF24.05f.17 MPDP What is covered
FBF24.05f.18 MPDP Generic equivalents
FBF24.05f.19 MPDP Disclosure of information
FBF24.05f.20 MPDP These are the dispensing limitations
FBF24.05f.21 MPDP Important contact information
FBF24.05f.22 MPDP Prior Approval
FBF24.05f.23 MPDP Catastrophic Maximums
FBF24.05f.24 MPDP Medical Foods
FBF24.05f.25 MPDP Here is how to obtain your prescription drugs and supplies
FBF24.05f.26 MPDP Covered Drugs and Supplies
FBF24.05f.27 Over-the-counter (OTC) contraceptive drugs and devices
FBF24.05f.28 Immunizations when provided by a Preferred retail pharmacy that participates in our vaccine network
FBF24.05f.29 Diabetic Meter Program
FBF24.05f.30 Medications to promote better health as recommended under the ACA
FBF24.05f.31 Generic medications to reduce breast cancer risk for women
FBF24.05f.32 Bowel preparation medications and antiretroviral therapy medications for HIV
FBF24.05f.33 Opioid Reversal Agents: Tier 1 medications limited to Narcan nasal spray and naloxone
FBF24.05f.34 Smoking and Tobacco Cessation Medications
FBF24.05f.35 Not Covered
FBF24.05f.36 Drugs From Other Sources
FBF24.05g.0 Section 5(g). Overview
FBF24.05g.1 Accidental Injury Benefit
FBF24.05g.2 Inpatient and Outpatient Facility Care
FBF24.05h.01 Health Tools
FBF24.05h.02 Services for the Deaf and Hearing Impaired
FBF24.05h.03 Web Accessibility for the Visually Impaired
FBF24.05h.04 Travel Benefit/Services Overseas
FBF24.05h.05 Healthy Families
FBF24.05h.06 Blue Health Assessment
FBF24.05h.07 Hypertension Management Program
FBF24.05h.08 MyBlue Customer eService
FBF24.05h.09 National Doctor & Hospital Finder
FBF24.05h.10 Care Management Programs
FBF24.05h.11 Flexible Benefits Option
FBF24.05h.12 Telehealth Services
FBF24.05h.13 Routine Annual Physical Incentive Program
FBF24.05h.14 The fepblue Mobile Application
FBF24.05i.0 Section 5(i). Services, Drugs, and Supplies Provided Overseas
FBF24.05N.0 Non-FEHB Benefits Available to Plan Members
FBF24.06 Section 6. General Exclusions - Services, Drugs, and Supplies We Do Not Cover
FBF24.07 Section 7. Filing a Claim for Covered Services
FBF24.08 Section 8. The Disputed Claims Process
FBF24.09.1.0 When you have other health coverage
FBF24.09.1.1 TRICARE and CHAMPVA
FBF24.09.1.2 Workers' Compensation
FBF24.09.1.3 Medicaid
FBF24.09.2 When other Government agencies are responsible for your care
FBF24.09.3 When others are responsible for injuries
FBF24.09.4 When you have Federal Employees Dental and Vision Insurance Plan (FEDVIP)
FBF24.09.5 Clinical trials
FBF24.09.6.1 When you have Medicare
FBF24.09.6.2 The Original Medicare Plan (Part A or Part B)
FBF24.09.6.3 Tell us about your Medicare coverage
FBF24.09.6.4 Private contract with your physician
FBF24.09.6.5 Medicare Advantage (Part C)
FBF24.09.6.6 Medicare prescription drug coverage (Part D)
FBF24.09.6.7 Medicare prescription drug coverage (Part B)
FBF24.09.6.8 Primary payor chart
FBF24.09.7 When you are age 65 or over and do not have Medicare
FBF24.09.8 Physicians Who Opt-Out of Medicare
FBF24.09.9 When you have the Original Medicare Plan (Part A, Part B, or both)
FBF24.09.95 Cost-share when Medicare is your primary payor
FBF24.10 Section 10. Definitions of Terms We Use in This Brochure
FBF24.11 Index
FBF24.12 Summary of Benefits for the Blue Cross and Blue Shield Service Benefit Plan FEP Blue Focus - 2024
FBF24.13 2024 Rate Information for the Blue Cross and Blue Shield Service Benefit Plan
FBF24-000-1 Cover page
FBF24-000-2 Inside cover
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