|
FBF24.00.1.1
|
Cover Page
|
v1.0
|
01/01/2024 |
|
FBF24.00.1.2
|
Inside cover
|
v1.0
|
01/01/2024 |
|
FBF24.00.1.3
|
Table of Contents
|
v1.1
|
03/19/2024 |
|
FBF24.00.2.1
|
Introduction
|
v1.0
|
01/01/2024 |
|
FBF24.00.2.2
|
Plain Language
|
v1.0
|
01/01/2024 |
|
FBF24.00.2.3
|
Stop Healthcare Fraud
|
v1.0
|
01/01/2024 |
|
FBF24.00.2.4
|
Discrimination is Against the Law
|
v1.0
|
01/01/2024 |
|
FBF24.00.2.5
|
Preventing Medical Mistakes
|
v1.0
|
01/01/2024 |
|
FBF24.00.3.1.1
|
No pre-existing condition limitation
|
v1.0
|
01/01/2024 |
|
FBF24.00.3.1.2
|
Minimum essential coverage (MEC)
|
v1.0
|
01/01/2024 |
|
FBF24.00.3.1.3
|
Minimum value standard
|
v1.0
|
01/01/2024 |
|
FBF24.00.3.1.4
|
Where you can get information about enrolling in the FEHB Program
|
v1.0
|
01/01/2024 |
|
FBF24.00.3.1.5
|
Enrollment types available for you and your family
|
v1.0
|
01/01/2024 |
|
FBF24.00.3.1.6
|
Family member coverage
|
v1.0
|
01/01/2024 |
|
FBF24.00.3.1.7
|
Children's Equity Act
|
v1.0
|
01/01/2024 |
|
FBF24.00.3.1.8
|
When benefits and premiums start
|
v1.0
|
01/01/2024 |
|
FBF24.00.3.1.9
|
When you retire
|
v1.0
|
01/01/2024 |
|
FBF24.00.3.2.1
|
When FEHB coverage ends
|
v1.0
|
01/01/2024 |
|
FBF24.00.3.2.2
|
Upon divorce
|
v1.0
|
01/01/2024 |
|
FBF24.00.3.2.3
|
Temporary Continuation of Coverage (TCC)
|
v1.0
|
01/01/2024 |
|
FBF24.00.3.2.4
|
Finding replacement coverage
|
v1.0
|
01/01/2024 |
|
FBF24.00.3.2.5
|
Health Insurance Marketplace
|
v1.0
|
01/01/2024 |
|
FBF24.01.0
|
Section 1. How This Plan Works
|
v1.0
|
01/01/2024 |
|
FBF24.01.1
|
General features of FEP Blue Focus/We have a Preferred Provider Organization (PPO)
|
v1.0
|
01/01/2024 |
|
FBF24.01.2
|
How we pay professional and facility providers
|
v1.0
|
01/01/2024 |
|
FBF24.01.3
|
Your rights and responsibilities
|
v1.0
|
01/01/2024 |
|
FBF24.01.4
|
Your medical and claims records are confidential
|
v1.0
|
01/01/2024 |
|
FBF24.02
|
Section 2. Changes for 2024
|
v1.0
|
01/01/2024 |
|
FBF24.03.1
|
Identification cards
|
v1.0
|
01/01/2024 |
|
FBF24.03.2.0
|
Where you get covered care
|
v1.0
|
01/01/2024 |
|
FBF24.03.2.01
|
Balance Billing Protection
|
v1.0
|
01/01/2024 |
|
FBF24.03.2.1
|
Covered professional providers
|
v1.0
|
01/01/2024 |
|
FBF24.03.2.2
|
Covered facility providers
|
v1.0
|
01/01/2024 |
|
FBF24.03.3.0
|
What you must do to get covered care
|
v1.0
|
01/01/2024 |
|
FBF24.03.3.1
|
Transitional care
|
v1.0
|
01/01/2024 |
|
FBF24.03.3.2
|
If you are hospitalized when your enrollment begins
|
v1.0
|
01/01/2024 |
|
FBF24.03.4.00
|
You need prior Plan approval for certain services
|
v1.0
|
01/01/2024 |
|
FBF24.03.4.01
|
Inpatient hospital admission, inpatient residential treatment center admission
|
v1.0
|
01/01/2024 |
|
FBF24.03.4.02
|
Other services
|
v1.0
|
01/01/2024 |
|
FBF24.03.4.03
|
Special prior authorization situations related to coordination of benefits (COB)
|
v1.0
|
01/01/2024 |
|
FBF24.03.4.04
|
Prior notification - Maternity care
|
v1.0
|
01/01/2024 |
|
FBF24.03.4.05
|
How to request precertification for an admission or get approval for Other services
|
v1.0
|
01/01/2024 |
|
FBF24.03.4.06
|
Non-urgent care claims
|
v1.0
|
01/01/2024 |
|
FBF24.03.4.07
|
Urgent care claims
|
v1.0
|
01/01/2024 |
|
FBF24.03.4.08
|
Concurrent care claims
|
v1.0
|
01/01/2024 |
|
FBF24.03.4.09
|
Emergency inpatient admission
|
v1.0
|
01/01/2024 |
|
FBF24.03.4.10
|
Maternity care
|
v1.0
|
01/01/2024 |
|
FBF24.03.4.11
|
If your facility stay needs to be extended
|
v1.0
|
01/01/2024 |
|
FBF24.03.4.12
|
If your treatment needs to be extended
|
v1.0
|
01/01/2024 |
|
FBF24.03.5.0
|
If you disagree with our pre-service claim decision
|
v1.0
|
01/01/2024 |
|
FBF24.03.5.1
|
To reconsider a non-urgent care claim
|
v1.0
|
01/01/2024 |
|
FBF24.03.5.2
|
To reconsider an urgent care claim
|
v1.0
|
01/01/2024 |
|
FBF24.03.5.3
|
To file an appeal with OPM
|
v1.0
|
01/01/2024 |
|
FBF24.04.01
|
Cost-share/Cost-sharing
|
v1.0
|
01/01/2024 |
|
FBF24.04.02
|
Copayment
|
v1.0
|
01/01/2024 |
|
FBF24.04.03
|
Deductible
|
v1.0
|
01/01/2024 |
|
FBF24.04.04
|
Coinsurance
|
v1.0
|
01/01/2024 |
|
FBF24.04.05
|
If your provider routinely waives your cost
|
v1.0
|
01/01/2024 |
|
FBF24.04.06
|
Waivers
|
v1.0
|
01/01/2024 |
|
FBF24.04.07
|
Differences between our allowance and the bill
|
v1.0
|
01/01/2024 |
|
FBF24.04.08
|
Important Notice About Surprise Billing – Know Your Rights
|
v1.0
|
01/01/2024 |
|
FBF24.04.09
|
Your costs for other care
|
v1.0
|
01/01/2024 |
|
FBF24.04.10
|
Your catastrophic protection out-of-pocket maximum for deductibles, coinsurance, and copayments
|
v1.0
|
01/01/2024 |
|
FBF24.04.11
|
Carryover
|
v1.0
|
01/01/2024 |
|
FBF24.04.12
|
If we overpay you
|
v1.0
|
01/01/2024 |
|
FBF24.04.13
|
When Government facilities bill us
|
v1.0
|
01/01/2024 |
|
FBF24.04.14
|
The Federal Flexible Spending Account Program – FSAFEDS
|
v1.0
|
01/01/2024 |
|
FBF24.05.01
|
Section 5. Benefits - Table of Contents
|
v1.1
|
03/19/2024 |
|
FBF24.05.02
|
Section 5. FEP Blue Focus Overview
|
v1.0
|
01/01/2024 |
|
FBF24.05a.0
|
Section 5(a). Overview
|
v1.0
|
01/01/2024 |
|
FBF24.05a.01
|
Diagnostic and Treatment Services
|
v1.0
|
01/01/2024 |
|
FBF24.05a.02
|
Lab, X-ray and Other Diagnostic Tests
|
v1.0
|
01/01/2024 |
|
FBF24.05a.03
|
Preventive Care, Adult
|
v1.0
|
01/01/2024 |
|
FBF24.05a.04
|
Preventive Care, Child
|
v1.0
|
01/01/2024 |
|
FBF24.05a.05
|
Maternity Care
|
v1.0
|
01/01/2024 |
|
FBF24.05a.06
|
Family Planning
|
v1.0
|
01/01/2024 |
|
FBF24.05a.07
|
Reproductive Services
|
v1.0
|
01/01/2024 |
|
FBF24.05a.08
|
Allergy Care
|
v1.0
|
01/01/2024 |
|
FBF24.05a.09
|
Treatment Therapies
|
v1.0
|
01/01/2024 |
|
FBF24.05a.10
|
Physical Therapy, Occupational Therapy, Speech Therapy, and Cognitive Rehabilitation Therapy
|
v1.0
|
01/01/2024 |
|
FBF24.05a.11
|
Hearing Services
|
v1.0
|
01/01/2024 |
|
FBF24.05a.12
|
Vision Services (Testing, Treatment, and Supplies)
|
v1.0
|
01/01/2024 |
|
FBF24.05a.13
|
Foot Care
|
v1.0
|
01/01/2024 |
|
FBF24.05a.14
|
Orthopedic and Prosthetic Devices
|
v1.0
|
01/01/2024 |
|
FBF24.05a.15
|
Durable Medical Equipment (DME)
|
v1.0
|
01/01/2024 |
|
FBF24.05a.16
|
Medical Supplies
|
v1.0
|
01/01/2024 |
|
FBF24.05a.17
|
Home Health Services
|
v1.0
|
01/01/2024 |
|
FBF24.05a.18
|
Alternative/Manipulative Treatment
|
v1.0
|
01/01/2024 |
|
FBF24.05a.19
|
Educational Classes and Programs
|
v1.0
|
01/01/2024 |
|
FBF24.05b.0
|
Section 5(b). Overview
|
v1.1
|
01/01/2024 |
|
FBF24.05b.1
|
Surgical Procedures
|
v1.0
|
01/01/2024 |
|
FBF24.05b.2
|
Reconstructive Surgery
|
v1.0
|
01/01/2024 |
|
FBF24.05b.3
|
Oral and Maxillofacial Surgery
|
v1.0
|
01/01/2024 |
|
FBF24.05b.4
|
Organ/Tissue Transplants
|
v1.0
|
01/01/2024 |
|
FBF24.05b.5
|
Anesthesia
|
v1.0
|
01/01/2024 |
|
FBF24.05c.0
|
Section 5(c). Overview
|
v1.0
|
01/01/2024 |
|
FBF24.05c.1
|
Inpatient Hospital
|
v1.0
|
01/01/2024 |
|
FBF24.05c.2
|
Maternity - Facility
|
v1.0
|
01/01/2024 |
|
FBF24.05c.3
|
Outpatient Hospital or Ambulatory Surgical Center
|
v1.0
|
01/01/2024 |
|
FBF24.05c.4
|
Residential Treatment Center
|
v1.0
|
01/01/2024 |
|
FBF24.05c.5
|
Extended Care Benefits/Skilled Nursing Care Facility Benefits
|
v1.0
|
01/01/2024 |
|
FBF24.05c.6
|
Hospice Care
|
v1.0
|
01/01/2024 |
|
FBF24.05c.7
|
Ambulance
|
v1.0
|
01/01/2024 |
|
FBF24.05d.0
|
Section 5(d). Overview
|
v1.1
|
01/01/2024 |
|
FBF24.05d.1
|
Accidental Injury
|
v1.1
|
01/01/2024 |
|
FBF24.05d.2
|
Medical Emergency
|
v1.1
|
01/01/2024 |
|
FBF24.05d.3
|
Ambulance
|
v1.0
|
01/01/2024 |
|
FBF24.05e.0
|
Section 5(e). Overview
|
v1.0
|
01/01/2024 |
|
FBF24.05e.1
|
Professional Services
|
v1.0
|
01/01/2024 |
|
FBF24.05e.2
|
Inpatient Hospital or Other Covered Facility
|
v1.0
|
01/01/2024 |
|
FBF24.05e.3
|
Residential Treatment Center
|
v1.0
|
01/01/2024 |
|
FBF24.05e.4
|
Outpatient Hospital or Other Covered Facility
|
v1.0
|
01/01/2024 |
|
FBF24.05f.0
|
Section 5(f). Overview
|
v1.0
|
01/01/2024 |
|
FBF24.05f.01
|
There are important features you should be aware of
|
v1.0
|
01/01/2024 |
|
FBF24.05f.02
|
Who can write your prescriptions
|
v1.0
|
01/01/2024 |
|
FBF24.05f.03
|
Where you can obtain them
|
v1.0
|
01/01/2024 |
|
FBF24.05f.04
|
What is covered
|
v1.0
|
01/01/2024 |
|
FBF24.05f.05
|
Generic equivalents
|
v1.0
|
01/01/2024 |
|
FBF24.05f.06
|
Disclosure of information
|
v1.0
|
01/01/2024 |
|
FBF24.05f.07
|
These are the dispensing limitations
|
v1.0
|
01/01/2024 |
|
FBF24.05f.08
|
Patient Safety and Quality Monitoring (PSQM)
|
v1.0
|
01/01/2024 |
|
FBF24.05f.09
|
Prior Approval
|
v1.0
|
01/01/2024 |
|
FBF24.05f.10
|
Medical Foods
|
v1.0
|
01/01/2024 |
|
FBF24.05f.11
|
Here is how to obtain your prescription drugs and supplies
|
v1.0
|
01/01/2024 |
|
FBF24.05f.12
|
Preferred retail pharmacies
|
v1.0
|
01/01/2024 |
|
FBF24.05f.13
|
Section 5(f). MPDP Overview
|
v1.0
|
01/01/2024 |
|
FBF24.05f.14
|
MPDP There are important features you should be aware of
|
v1.0
|
01/01/2024 |
|
FBF24.05f.15
|
MPDP Who can write your prescriptions
|
v1.0
|
01/01/2024 |
|
FBF24.05f.16
|
MPDP Where you can obtain them
|
v1.0
|
01/01/2024 |
|
FBF24.05f.17
|
MPDP What is covered
|
v1.0
|
01/01/2024 |
|
FBF24.05f.18
|
MPDP Generic equivalents
|
v1.0
|
01/01/2024 |
|
FBF24.05f.19
|
MPDP Disclosure of information
|
v1.0
|
01/01/2024 |
|
FBF24.05f.20
|
MPDP These are the dispensing limitations
|
v1.0
|
01/01/2024 |
|
FBF24.05f.21
|
MPDP Important contact information
|
v1.0
|
01/01/2024 |
|
FBF24.05f.22
|
MPDP Prior Approval
|
v1.0
|
01/01/2024 |
|
FBF24.05f.23
|
MPDP Catastrophic Maximums
|
v1.0
|
01/01/2024 |
|
FBF24.05f.24
|
MPDP Medical Foods
|
v1.0
|
01/01/2024 |
|
FBF24.05f.25
|
MPDP Here is how to obtain your prescription drugs and supplies
|
v1.0
|
01/01/2024 |
|
FBF24.05f.26
|
MPDP Covered Drugs and Supplies
|
v1.0
|
01/01/2024 |
|
FBF24.05f.27
|
Over-the-counter (OTC) contraceptive drugs and devices
|
v1.0
|
01/01/2024 |
|
FBF24.05f.28
|
Immunizations when provided by a Preferred retail pharmacy that participates in our vaccine network
|
v1.0
|
01/01/2024 |
|
FBF24.05f.29
|
Diabetic Meter Program
|
v1.0
|
01/01/2024 |
|
FBF24.05f.30
|
Medications to promote better health as recommended under the ACA
|
v1.0
|
01/01/2024 |
|
FBF24.05f.31
|
Generic medications to reduce breast cancer risk for women
|
v1.0
|
01/01/2024 |
|
FBF24.05f.32
|
Bowel preparation medications and antiretroviral therapy medications for HIV
|
v1.0
|
01/01/2024 |
|
FBF24.05f.33
|
Opioid Reversal Agents: Tier 1 medications limited to Narcan nasal spray and naloxone
|
v1.0
|
01/01/2024 |
|
FBF24.05f.34
|
Smoking and Tobacco Cessation Medications
|
v1.0
|
01/01/2024 |
|
FBF24.05f.35
|
Not Covered
|
v1.0
|
01/01/2024 |
|
FBF24.05f.36
|
Drugs From Other Sources
|
v1.0
|
01/01/2024 |
|
FBF24.05g.0
|
Section 5(g). Overview
|
v1.0
|
01/01/2024 |
|
FBF24.05g.1
|
Accidental Injury Benefit
|
v1.0
|
01/01/2024 |
|
FBF24.05g.2
|
Inpatient and Outpatient Facility Care
|
v1.0
|
01/01/2024 |
|
FBF24.05h.01
|
Health Tools
|
v1.0
|
01/01/2024 |
|
FBF24.05h.02
|
Services for the Deaf and Hearing Impaired
|
v1.0
|
01/01/2024 |
|
FBF24.05h.03
|
Web Accessibility for the Visually Impaired
|
v1.0
|
01/01/2024 |
|
FBF24.05h.04
|
Travel Benefit/Services Overseas
|
v1.0
|
01/01/2024 |
|
FBF24.05h.05
|
Healthy Families
|
v1.0
|
01/01/2024 |
|
FBF24.05h.06
|
Blue Health Assessment
|
v1.0
|
01/01/2024 |
|
FBF24.05h.07
|
Hypertension Management Program
|
v1.0
|
01/01/2024 |
|
FBF24.05h.08
|
MyBlue Customer eService
|
v1.0
|
01/01/2024 |
|
FBF24.05h.09
|
National Doctor & Hospital Finder
|
v1.0
|
01/01/2024 |
|
FBF24.05h.10
|
Care Management Programs
|
v1.0
|
01/01/2024 |
|
FBF24.05h.11
|
Flexible Benefits Option
|
v1.0
|
01/01/2024 |
|
FBF24.05h.12
|
Telehealth Services
|
v1.0
|
01/01/2024 |
|
FBF24.05h.13
|
Routine Annual Physical Incentive Program
|
v1.0
|
01/01/2024 |
|
FBF24.05h.14
|
The fepblue Mobile Application
|
v1.0
|
01/01/2024 |
|
FBF24.05i.0
|
Section 5(i). Services, Drugs, and Supplies Provided Overseas
|
v1.1
|
01/01/2024 |
|
FBF24.05N.0
|
Non-FEHB Benefits Available to Plan Members
|
v1.0
|
01/01/2024 |
|
FBF24.06
|
Section 6. General Exclusions - Services, Drugs, and Supplies We Do Not Cover
|
v1.0
|
01/01/2024 |
|
FBF24.07
|
Section 7. Filing a Claim for Covered Services
|
v1.0
|
01/01/2024 |
|
FBF24.08
|
Section 8. The Disputed Claims Process
|
v1.0
|
01/01/2024 |
|
FBF24.09.1.0
|
When you have other health coverage
|
v1.0
|
01/01/2024 |
|
FBF24.09.1.1
|
TRICARE and CHAMPVA
|
v1.0
|
01/01/2024 |
|
FBF24.09.1.2
|
Workers' Compensation
|
v1.0
|
01/01/2024 |
|
FBF24.09.1.3
|
Medicaid
|
v1.0
|
01/01/2024 |
|
FBF24.09.2
|
When other Government agencies are responsible for your care
|
v1.0
|
01/01/2024 |
|
FBF24.09.3
|
When others are responsible for injuries
|
v1.0
|
01/01/2024 |
|
FBF24.09.4
|
When you have Federal Employees Dental and Vision Insurance Plan (FEDVIP)
|
v1.0
|
01/01/2024 |
|
FBF24.09.5
|
Clinical trials
|
v1.0
|
01/01/2024 |
|
FBF24.09.6.1
|
When you have Medicare
|
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01/01/2024 |
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FBF24.09.6.2
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The Original Medicare Plan (Part A or Part B)
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v1.0
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01/01/2024 |
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FBF24.09.6.3
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Tell us about your Medicare coverage
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v1.0
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01/01/2024 |
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FBF24.09.6.4
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Private contract with your physician
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v1.0
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01/01/2024 |
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FBF24.09.6.5
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Medicare Advantage (Part C)
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v1.0
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01/01/2024 |
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FBF24.09.6.6
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Medicare prescription drug coverage (Part D)
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v1.0
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01/01/2024 |
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FBF24.09.6.7
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Medicare prescription drug coverage (Part B)
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v1.0
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01/01/2024 |
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FBF24.09.6.8
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Primary payor chart
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01/01/2024 |
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FBF24.09.7
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When you are age 65 or over and do not have Medicare
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v1.0
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01/01/2024 |
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FBF24.09.8
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Physicians Who Opt-Out of Medicare
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v1.0
|
01/01/2024 |
|
FBF24.09.9
|
When you have the Original Medicare Plan (Part A, Part B, or both)
|
v1.0
|
01/01/2024 |
|
FBF24.09.95
|
Cost-share when Medicare is your primary payor
|
v1.0
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01/01/2024 |
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FBF24.10
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Section 10. Definitions of Terms We Use in This Brochure
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v1.1
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01/01/2024 |
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FBF24.11
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Index
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v1.1
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03/19/2024 |
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FBF24.12
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Summary of Benefits for the Blue Cross and Blue Shield Service Benefit Plan FEP Blue Focus - 2024
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v1.0
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01/01/2024 |
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FBF24.13
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2024 Rate Information for the Blue Cross and Blue Shield Service Benefit Plan
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01/01/2024 |
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FBF24-000-1
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Cover page
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Inside cover
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