PSHB FEP Blue Standard and FEP Blue Basic Options
2027 Blue Cross and Blue Shield Service Benefit Plan
FEP Blue Standard and FEP Blue Basic
FEP Blue Standard and FEP Blue Basic
Index
Do not rely only on this page; it is for your convenience and may not show all pages where the terms appear. This Index is not an official statement of benefits.
Abortion - 50-52, 147-148
Accidental injury - 93-96, 134-135, 168
Acupuncture - 65, 77-78, 82-86
Affordable Care Act (ACA) - 126-131
Allergy care - 55-56
Allogeneic transplants - 73-76
Alternative treatments - 65
Ambulance - 91-92
Ambulatory surgical center - 20-22, 82-86
Anesthesia - 77-78
Angiographies - 43-44, 82-86
Appeals - 30, 122-123
Applied behavior analysis (ABA) - 56-57, 82-86
Assistant surgeon - 22-23, 50-52, 68-69
Autism spectrum disorder - 56-57, 82-86
Autologous transplants - 72-76
Average wholesale price (AWP) - 173-174
Biopsies - 45-48, 68-69, 82-86
Birthing centers - 20-22
Blood and blood plasma - 63, 82-86
Blood or marrow stem cell transplants - 72-77
Blue Distinction Centers - 20-22, 76-77
Blue Health Assessment - 138-139, 171
Bone density tests - 43-44, 82-86
Brand-name drugs - 103-105, 107-117, 120-121
Breast pump and supplies - 50-52, 62-63
Breast reconstruction - 69-70
Cancer tests - 45-48
Cardiac rehabilitation - 56-57, 82-86
Cardiovascular monitoring - 43-44, 82-86
Care Management Programs - 141
Case management - 141
Casts - 68-69, 80-86
Catastrophic protection - 36-37, 122-123
Cervical cancer screening - 45-50
CHAMPVA - 157-158
Changes for 2027 - 16-19
Chemotherapy - 56-57, 82-86
Children’s Equity Act - 11
Chiropractic manipulative treatment - 64
Cholesterol tests - 45-48
Circumcision - 50-52, 68-69
Claims and claims filing - 149
Clinic visits - 42-43, 98-99
Clinical trials - 75, 159-160, 169
Cognitive rehabilitation - 58, 82-86
Coinsurance - 32-35
Colorectal cancer tests
Congenital anomalies - 68-69, 169
Consultations - 42-43, 98-99
Contact lenses - 59-60
Contraceptive devices and drugs - 53-54, 107-117, 123-131
Coordination of benefits - 157-167
Copayments - 31
Cosmetic surgery - 68-69, 169
Cost-sharing - 31
Costs for covered services - 31-37
Coverage information - 9
Covered facility providers - 20-22
Covered professional providers - 20
Cryopreservation - 54-55
CT scans - 43-44, 82-86
Custodial care - 80-82, 147-148, 169
Daily Habits - 138
Deductible - 31
Definitions - 168-177
Dental care - 71, 134-137
Diabetes Management Program - 138
Diabetic education - 65-66, 82-86
Diabetic supplies
Diagnostic tests - 43-44, 50-52, 97-101
Dialysis - 20-22, 56-57, 62-63, 82-86
Disease Management - 141
Disputed claims process - 153-156
Divorce - 12
DNA analysis of stool samples - 45-48
Donor expenses (transplants) - 54-55, 75-77
Drugs (see: Prescription drugs)
Durable medical equipment (DME) - 62-63
EEGs - 43-44, 82-86
EKGs - 43-44, 82-86
Emergency - 22-23, 29, 93-96
Enrollment - 9-10
Exception situations - 22-24
Exclusions - 147-148
Experimental or investigational - 170
Extended care benefits - 88-89
Eyeglasses - 59-60
Facility providers - 14-15, 20-22
Family planning - 53-54
Fecal occult blood test - 45-48
FEDVIP - 134, 159
fepblue mobile application - 142
fepblue.org - 4
Flexible benefits option - 141-142
Foot care - 60
Formulary/Preferred drug list - 103-105, 120-121
Foundation for the Accreditation of Cellular Therapy (FACT) accredited facility - 20-22, 72
Fraud - 4
Freestanding ambulatory facilities - 20-22
Generic drugs - 103-105, 120-122
Generic Incentive Program - 106-107
Genetic screening/testing - 24-27, 43-44, 82-86
Health Insurance Marketplace - 13
Health tools - 138
Healthy Families - 138
Hearing aids and hearing services - 24-27, 58-59, 61-62
Home health services - 63-64
Home nursing care (maternity) - 63-64
Hospice care - 89-91
Hospital
Hypertension Management Program - 139
Iatrogenic infertility - 54-55
Immunizations - 45-50, 107-117, 126-131
Inpatient hospital benefits - 80-82
Inpatient professional services - 42-43, 98-99
Insulin - 107-117, 123-126
Insulin pumps - 62-63
Laboratory and pathology services - 43-44, 80-86, 93-96
Low-dose CT screening - 175
Mail Service Prescription Drug Program - 102-105, 107-117, 123-126, 144-145, 150-151
Mammograms - 45-48
Manipulative treatment - 64, 82-86
Maternity care - 50-52
Maxillofacial surgery - 71, 135
Medicaid - 158
Medical emergency - 22-23, 93-96
Medical foods - 63, 106-117, 122-126, 171
Medical supplies - 63
Medically necessary - 172
Medicare - 1, 157-167
Member facilities - 14-15, 173-174
Mental health/substance use disorder - 20, 87-88, 97-101, 142
MRIs - 43-44, 82-86
Multiple procedures - 68-69
MyBlue Customer eService - 140
National Doctor & Hospital Finder - 140
Neurological testing - 43-44, 82-86
Never Events - 6-8, 172
Newborn care - 29, 42-43, 50-52
No Surprises Act (NSA) - 35
Non-member facilities - 14-15, 173-174
Non-participating providers - 14-15, 27, 173-175
Non-preferred providers - 32-35, 40
Non-PSHB benefits - 146
Nurse - 63-64, 89-91, 138
Nutritional counseling - 20, 42-43, 45-50, 80-82, 142
Observation care - 173
Obstetrical care - 50-52
Occupational therapy - 58, 89-91
Office visits - 42-43, 98-99
Oral surgery - 71
Organ/tissue transplants - 72, 75-77
Orthopedic devices - 61-62, 82-86
Osteopathic manipulative treatment - 64
Osteoporosis screening - 175
Ostomy and catheter supplies - 63
Out-of-pocket expenses - 32-37
Outpatient facility services - 86-87
Outpatient professional services - 42-43
Overpayments - 37
Overseas Assistance Center - 143
Overseas services, drugs, supplies and claims - 143-145
Oxygen - 63, 80-86
Pap tests - 45-50
Participating providers - 14-15
Patient Safety and Quality Monitoring (PSQM) Program - 105-106
Personal Health Record - 138
PET scans - 43-44, 82-86
Pharmacotherapy - 42-43, 56-57
Physical examination - 45-50, 82-86, 147-148
Physical therapy - 58, 89-91
Physician - 14-15, 20
Plan allowance - 32-35, 173-174
PPO - 14-15, 175
Pre-admission testing - 80-82
Precertification - 24, 27-28, 175
Preferred providers - 14-15, 20, 22-23
Pregnancy (see: Maternity care)
Pregnancy Care Incentive Program - 140
Prescription drugs
Prior approval - 24-28, 175-176
Professional providers - 20
Prostate cancer tests - 45-48
Prosthetic devices - 61-62, 80-86
Psychotherapy - 98-100
Pulmonary rehabilitation - 56-57, 82-86
Radiation therapy - 24-27, 56-57, 82-86
Reconsiderations - 29-30, 153-155
Renal dialysis - 56-57, 82-86
Replacement coverage - 13
Reproductive services - 24-27, 54-55
Retail Pharmacy Program - 102-103, 106-117, 144-145, 150-151
Rights and responsibilities - 14-15
Room and board - 80-82, 87-89, 99-100
Screening services - 175
Second surgical opinion - 42-43
Self-injectable drugs - 41, 67, 79, 82-86
Skilled nursing facility (SNF) care - 20-22, 88-89
Smoking cessation - 65-66, 107-117, 126-131, 138
Social worker - 141
Specialty Drug Pharmacy Program - 102-117, 144-145, 150-151
Specialty drugs - 103-105, 107-117, 120-121, 150-151, 176
Speech therapy - 58, 82-86, 89-91
Speech-Generating Devices - 62-63
Stem Cell Transplants - 72-77
Sterilization procedures - 53-54, 68-69
Subrogation - 158-159, 176
Substance use disorder - 20, 87-88, 97-101, 142
Surgery
Telehealth
Tobacco cessation - 65-66, 107-117, 126-131, 138
Transplants - 24-27, 68-69, 72-77
Travel benefit - 76-77, 138
Treatment therapies - 56-57
TRICARE - 157-158
Ultrasounds - 43-44, 82-86
Urgent care center - 93-96
Urgent care claims - 28, 177
VA facilities - 37
Vision services - 59-60, 159
Waivers - 32
Weight control - 45-50
Wheelchairs - 62-63
Wigs - 61-62
X-rays - 43-44, 82-86
Accidental injury - 93-96, 134-135, 168
Acupuncture - 65, 77-78, 82-86
Affordable Care Act (ACA) - 126-131
Allergy care - 55-56
Allogeneic transplants - 73-76
Alternative treatments - 65
Ambulance - 91-92
Ambulatory surgical center - 20-22, 82-86
Anesthesia - 77-78
Angiographies - 43-44, 82-86
Appeals - 30, 122-123
Applied behavior analysis (ABA) - 56-57, 82-86
Assistant surgeon - 22-23, 50-52, 68-69
Autism spectrum disorder - 56-57, 82-86
Autologous transplants - 72-76
Average wholesale price (AWP) - 173-174
Biopsies - 45-48, 68-69, 82-86
Birthing centers - 20-22
Blood and blood plasma - 63, 82-86
Blood or marrow stem cell transplants - 72-77
Blue Distinction Centers - 20-22, 76-77
for Transplants - 24, 72, 75-77
Blue Distinction Specialty Care - 20-22Blue Health Assessment - 138-139, 171
Bone density tests - 43-44, 82-86
Brand-name drugs - 103-105, 107-117, 120-121
Breast pump and supplies - 50-52, 62-63
Breast reconstruction - 69-70
Breast prostheses and surgical bras - 61--62
Breastfeeding support and supplies - 50-52Cancer tests - 45-48
Cardiac rehabilitation - 56-57, 82-86
Cardiovascular monitoring - 43-44, 82-86
Care Management Programs - 141
Case management - 141
Casts - 68-69, 80-86
Catastrophic protection - 36-37, 122-123
Cervical cancer screening - 45-50
CHAMPVA - 157-158
Changes for 2027 - 16-19
Chemotherapy - 56-57, 82-86
Children’s Equity Act - 11
Chiropractic manipulative treatment - 64
Cholesterol tests - 45-48
Circumcision - 50-52, 68-69
Claims and claims filing - 149
Clinic visits - 42-43, 98-99
Clinical trials - 75, 159-160, 169
Cognitive rehabilitation - 58, 82-86
Coinsurance - 32-35
Colorectal cancer tests
Colonoscopy - 45-48, 68-69, 82-86
Fecal occult blood test - 45-48
Sigmoidoscopy - 45-48
Confidentiality - 14-15Fecal occult blood test - 45-48
Sigmoidoscopy - 45-48
Congenital anomalies - 68-69, 169
Consultations - 42-43, 98-99
Contact lenses - 59-60
Contraceptive devices and drugs - 53-54, 107-117, 123-131
Coordination of benefits - 157-167
Copayments - 31
Cosmetic surgery - 68-69, 169
Cost-sharing - 31
Costs for covered services - 31-37
Coverage information - 9
Covered facility providers - 20-22
Covered professional providers - 20
Cryopreservation - 54-55
CT scans - 43-44, 82-86
Custodial care - 80-82, 147-148, 169
Daily Habits - 138
Deductible - 31
Definitions - 168-177
Dental care - 71, 134-137
Diabetes Management Program - 138
Diabetic education - 65-66, 82-86
Diabetic supplies
Diabetic Meter Program - 107-117
Insulin pumps - 62-63
Insulin, test strips, and lancets - 107-117, 123-126
Needles and disposable syringes - 107-1-17, 123-126
Diagnostic and treatment services - 42-43, 82-86Insulin pumps - 62-63
Insulin, test strips, and lancets - 107-117, 123-126
Needles and disposable syringes - 107-1-17, 123-126
Diagnostic tests - 43-44, 50-52, 97-101
Dialysis - 20-22, 56-57, 62-63, 82-86
Disease Management - 141
Disputed claims process - 153-156
Divorce - 12
DNA analysis of stool samples - 45-48
Donor expenses (transplants) - 54-55, 75-77
Drugs (see: Prescription drugs)
Durable medical equipment (DME) - 62-63
Prosthetic devices - 61-62, 80-86
Educational classes and programs - 65-66EEGs - 43-44, 82-86
EKGs - 43-44, 82-86
Emergency - 22-23, 29, 93-96
Enrollment - 9-10
Exception situations - 22-24
Exclusions - 147-148
Experimental or investigational - 170
Extended care benefits - 88-89
Eyeglasses - 59-60
Facility providers - 14-15, 20-22
Family planning - 53-54
Fecal occult blood test - 45-48
FEDVIP - 134, 159
fepblue mobile application - 142
fepblue.org - 4
Flexible benefits option - 141-142
Foot care - 60
Formulary/Preferred drug list - 103-105, 120-121
Foundation for the Accreditation of Cellular Therapy (FACT) accredited facility - 20-22, 72
Fraud - 4
Freestanding ambulatory facilities - 20-22
Generic drugs - 103-105, 120-122
Generic Incentive Program - 106-107
Genetic screening/testing - 24-27, 43-44, 82-86
Health Insurance Marketplace - 13
Health tools - 138
Healthy Families - 138
Hearing aids and hearing services - 24-27, 58-59, 61-62
Home health services - 63-64
Home nursing care (maternity) - 63-64
Hospice care - 89-91
Hospital
Inpatient - 24, 80-82, 99
Outpatient - 82-86, 100
Human papillomavirus (HPV) tests - 45-50Outpatient - 82-86, 100
Hypertension Management Program - 139
Iatrogenic infertility - 54-55
Immunizations - 45-50, 107-117, 126-131
Inpatient hospital benefits - 80-82
Inpatient professional services - 42-43, 98-99
Insulin - 107-117, 123-126
Insulin pumps - 62-63
Laboratory and pathology services - 43-44, 80-86, 93-96
Low-dose CT screening - 175
Mail Service Prescription Drug Program - 102-105, 107-117, 123-126, 144-145, 150-151
Mammograms - 45-48
Manipulative treatment - 64, 82-86
Maternity care - 50-52
Maxillofacial surgery - 71, 135
Medicaid - 158
Medical emergency - 22-23, 93-96
Medical foods - 63, 106-117, 122-126, 171
Medical supplies - 63
Medically necessary - 172
Medicare - 1, 157-167
Reimbursement account
Medications and supplies - 107-117, 123-131Member facilities - 14-15, 173-174
Mental health/substance use disorder - 20, 87-88, 97-101, 142
MRIs - 43-44, 82-86
Multiple procedures - 68-69
MyBlue Customer eService - 140
National Doctor & Hospital Finder - 140
Neurological testing - 43-44, 82-86
Never Events - 6-8, 172
Newborn care - 29, 42-43, 50-52
No Surprises Act (NSA) - 35
Non-member facilities - 14-15, 173-174
Non-participating providers - 14-15, 27, 173-175
Non-preferred providers - 32-35, 40
Non-PSHB benefits - 146
Nurse - 63-64, 89-91, 138
Nutritional counseling - 20, 42-43, 45-50, 80-82, 142
Observation care - 173
Obstetrical care - 50-52
Occupational therapy - 58, 89-91
Office visits - 42-43, 98-99
Oral surgery - 71
Organ/tissue transplants - 72, 75-77
Orthopedic devices - 61-62, 82-86
Osteopathic manipulative treatment - 64
Osteoporosis screening - 175
Ostomy and catheter supplies - 63
Out-of-pocket expenses - 32-37
Outpatient facility services - 86-87
Outpatient professional services - 42-43
Overpayments - 37
Overseas Assistance Center - 143
Overseas services, drugs, supplies and claims - 143-145
Oxygen - 63, 80-86
Pap tests - 45-50
Participating providers - 14-15
Patient Safety and Quality Monitoring (PSQM) Program - 105-106
Personal Health Record - 138
PET scans - 43-44, 82-86
Pharmacotherapy - 42-43, 56-57
Physical examination - 45-50, 82-86, 147-148
Physical therapy - 58, 89-91
Physician - 14-15, 20
Plan allowance - 32-35, 173-174
PPO - 14-15, 175
Pre-admission testing - 80-82
Precertification - 24, 27-28, 175
Preferred providers - 14-15, 20, 22-23
Pregnancy (see: Maternity care)
Pregnancy Care Incentive Program - 140
Prescription drugs
Brand-name drugs - 103-105, 107-117, 120-121
Drugs from other sources - 117-118, 132-133
Generic drugs - 103-105, 120-122
Mail Service Prescription Drug Program - 102-105, 107-117, 123-126, 144-145, 150-151
Preferred retail pharmacies - 106-117, 126-131, 150-151
Retail Pharmacy Program - 102-103, 106-117, 144-145, 150-151
Self-injectable drugs - 41, 67, 79, 82-86
Specialty Drug Pharmacy Program - 10-2-103, 107-117, 144-145, 150-151
Specialty drugs - 103-117, 120-121, 150-151, 176
Preventive careDrugs from other sources - 117-118, 132-133
Generic drugs - 103-105, 120-122
Mail Service Prescription Drug Program - 102-105, 107-117, 123-126, 144-145, 150-151
Preferred retail pharmacies - 106-117, 126-131, 150-151
Retail Pharmacy Program - 102-103, 106-117, 144-145, 150-151
Self-injectable drugs - 41, 67, 79, 82-86
Specialty Drug Pharmacy Program - 10-2-103, 107-117, 144-145, 150-151
Specialty drugs - 103-117, 120-121, 150-151, 176
Adult - 45-48, 175
Child - 48-50
Primary care provider - 20Child - 48-50
Prior approval - 24-28, 175-176
Professional providers - 20
Prostate cancer tests - 45-48
Prosthetic devices - 61-62, 80-86
Psychotherapy - 98-100
Pulmonary rehabilitation - 56-57, 82-86
Radiation therapy - 24-27, 56-57, 82-86
Reconsiderations - 29-30, 153-155
Renal dialysis - 56-57, 82-86
Replacement coverage - 13
Reproductive services - 24-27, 54-55
Assisted reproductive technology (ART) - 168
Residential Treatment Center (RTC) - 20-22, 87-88, 99-100Retail Pharmacy Program - 102-103, 106-117, 144-145, 150-151
Rights and responsibilities - 14-15
Room and board - 80-82, 87-89, 99-100
Screening services - 175
Second surgical opinion - 42-43
Self-injectable drugs - 41, 67, 79, 82-86
Skilled nursing facility (SNF) care - 20-22, 88-89
Smoking cessation - 65-66, 107-117, 126-131, 138
Social worker - 141
Specialty Drug Pharmacy Program - 102-117, 144-145, 150-151
Specialty drugs - 103-105, 107-117, 120-121, 150-151, 176
Speech therapy - 58, 82-86, 89-91
Speech-Generating Devices - 62-63
Stem Cell Transplants - 72-77
Sterilization procedures - 53-54, 68-69
Subrogation - 158-159, 176
Substance use disorder - 20, 87-88, 97-101, 142
Surgery
Assistant surgeon - 22-23, 41, 67-69
Eye: cataract, amblyopia, strabismus - 59-60, 68-69
Multiple procedures - 68-69
Oral and maxillofacial - 71
Outpatient - 79, 173
Reconstructive - 69-70
Sterilization, reversal of voluntary - 53--54, 68-69
Surgical implants - 61-62, 82-86
Surgical treatment of severe obesity - 24--27, 68-69
Transplants - 24-27, 72-77
Syringes - 107-117, 123-126Eye: cataract, amblyopia, strabismus - 59-60, 68-69
Multiple procedures - 68-69
Oral and maxillofacial - 71
Outpatient - 79, 173
Reconstructive - 69-70
Sterilization, reversal of voluntary - 53--54, 68-69
Surgical implants - 61-62, 82-86
Surgical treatment of severe obesity - 24--27, 68-69
Transplants - 24-27, 72-77
Telehealth
Dermatology - 20, 42-43, 142, 176
Mental health/substance use disorder - 20, 142
Minor acute conditions - 20, 42-43, 142, 172
Nutritional counseling - 20, 45-50, 142
Temporary Continuation of Coverage (TCC) - 13Mental health/substance use disorder - 20, 142
Minor acute conditions - 20, 42-43, 142, 172
Nutritional counseling - 20, 45-50, 142
Tobacco cessation - 65-66, 107-117, 126-131, 138
Transplants - 24-27, 68-69, 72-77
Travel benefit - 76-77, 138
Treatment therapies - 56-57
TRICARE - 157-158
Ultrasounds - 43-44, 82-86
Urgent care center - 93-96
Urgent care claims - 28, 177
VA facilities - 37
Vision services - 59-60, 159
Waivers - 32
Weight control - 45-50
Wheelchairs - 62-63
Wigs - 61-62
X-rays - 43-44, 82-86