2027 Blue Cross and Blue Shield Service Benefit Plan
FEP Blue Standard and FEP Blue Basic
Section 2. Changes for 2027
Section 2. Changes for 2027
 
 
Do not rely only on these change descriptions; this Section is not an official statement of benefits. For that, go to Section 5. Benefits. Also, we edited and clarified language throughout the brochure; any language change not shown here is a clarification that does not change benefits.
Medical - Professional
Changes Standard Option only
  • We now offer a doula benefit up to $1,000 per pregnancy (see page 52).

Basic Option only
  • For members up to age 18, the copayment per visit for preferred primary care providers is $20.

Medical - Inpatient
Changes Standard Option only
  • The per admission copay to a preferred inpatient facility is $600 (see page 80).
     
  • The copay for Blue Distinction Specialty Care related to inpatient knee, hip, spine and bariatric surgeries is $350 per admission (no deductible) (see pages 86-87).

Basic Option only
  • The copayment for inpatient admission is now a $500 per day copayment (see page 80).
     
  • The copayment for Blue Distinction Center inpatient admission related to knee, hip, spine and bariatric surgeries is now a $200 per day (see pages 86-87).

Medical - Outpatient Facility
Changes Standard Option only
  • The copayment for Blue Distinction Specialty Care related to outpatient knee, hip, spine and bariatric surgeries is $200 per day per facility (no deductible) (see page 87).

Basic Option only
  • The copayment for outpatient observation services performed and billed by a hospital or freestanding ambulatory facility is now $500 per day (see page 83).
     
  • The cost-share for outpatient hospital emergency room services and supplies, including professional provider services, diagnostic studies, radiology services, laboratory tests, and pathology services, when billed by the hospital is now a $500 per day per facility copayment (see page 95).
     
  • The copayment for Blue Distinction Specialty Care related to outpatient knee, hip, spine and bariatric surgeries is $100 per day per facility (no deductible) (see page 87).

Pharmacy Changes
Standard Option only
  • For members enrolled in our regular pharmacy program, your Tier 4 (preferred specialty drug) cost-share will now be $175 for each purchase of up to a 30-day supply; $525 for 31-90-day supply, no deductible, when purchased from the Specialty Drug Program (see page 110).
     
  • For members enrolled in our Medicare Prescription Drug Program (MPDP), your Tier 4 (preferred specialty drug) cost-share is $60 for up to a 30-day supply, with a maximum of $180 for a 31 to 90-day supply, when purchased from a preferred retail pharmacy (see page 123).
     
  • For members enrolled in our regular pharmacy program, your Tier 2 (preferred brand-name drug) cost-share is now 30% of the Plan allowance ($150 maximum) for up to 30-day supply, ($300 maximum for a 31 to 90-day supply) when purchased at a preferred retail pharmacy (no deductible) (see page 107).
     
  • For members enrolled in our regular pharmacy drug program, your cost-share for Tier 2 diabetic medication purchased through a preferred retail pharmacy is now $35 for each purchase of up to a 30-day supply and $70 for a 31 to 90-day supply (no deductible) (see page 111).
     
  • For members enrolled in our regular pharmacy drug program, your cost-share for Tier 2 insulin purchased through a preferred retail pharmacy is now $35 for each purchase of up to a 30-day supply ($70 for a 31 to 90-day supply) (no deductible) (see page 111).
     
  • For members enrolled in our regular pharmacy program, your cost-share for Tier 3 (non-preferred brand name drug) is 50% ($450 for up to a 30-day supply), with a maximum of $1,350 for a 31 to 90-day supply, when purchased from a preferred retail pharmacy (no deductible) (see page 107).
     
  • For members enrolled in our regular pharmacy program, your cost-share for Tier 4 (preferred specialty drug) is 30% of the Plan allowance limited to one purchase of up to a 30-day supply (up to a maximum of $250) when purchased from a preferred retail pharmacy (no deductible) (see page 107).
     
  • For members enrolled in our regular pharmacy drug program, your Tier 5 (non-preferred specialty drug) cost-share will be 35% of Plan allowance for each purchase up to a 30-day supply ($450 maximum) when purchased from a preferred retail pharmacy (see page 108).
     
  • For members enrolled in our regular pharmacy drug program, your Tier 5 (non-preferred specialty drug) cost-share will be $300 for each purchase up to a 30-day supply ($900 for 31 to 90-day supply), when purchased through the Specialty Drug Pharmacy Program (see page 110).
     
  • For members enrolled in our Medicare Prescription Drug Program (MPDP), your cost-share for Tier 2 asthma medications is now $50 (no deductible) when ordered through our Mail Service Pharmacy Program (see page 125).
     
  • For members enrolled in our Medicare Prescription Drug Program, your cost-share for Tier 2 insulins purchased through a preferred Mail Service pharmacy is now $20 for each purchase of up to a 30-day supply ($50 for a 31 to 90-day supply) (no deductible) (see page 125).
     
  • For members enrolled in our Medicare Prescription Drug Program (MPDP), your cost-share for Tier 3 (non-preferred brand-name drug) is now 50% of the Plan allowance with a $50 maximum for each purchase of up to a 30-day supply ($150 maximum for a 90-day supply) (no deductible) when purchased from a preferred retail pharmacy (see page 123).

Basic Option only
  • For members enrolled in our regular pharmacy program, your cost-share for Tier 4 (preferred specialty drug) is 35% of the Plan allowance limited to one purchase of up to a 30-day supply (up to a maximum of $450) (see page 107).
     
  • For members enrolled in our regular pharmacy program, your cost-share for Tier 5 (non-preferred specialty drug) is 40% of the Plan allowance limited to one purchase (up to a maximum of $550) for a 30-day supply when purchased from a preferred retail pharmacy (see page 108).
     
  • For members enrolled in our regular pharmacy program, your cost-share for Tier 4 (preferred specialty drug) is 35% of the Plan allowance (up to a maximum of $450) for 30-day supply when ordered through the Specialty Pharmacy Program (see page 110).
     
  • For members enrolled in our Medicare Prescription Drug Program (MPDP), your cost-share for Tier 4 (preferred specialty drug) is now $75 for each purchase of up to a 30-day supply, and $225 for 31 to 90-day supply when purchased through a preferred retail pharmacy (see page 123).
     
  • For members enrolled in our Medicare Prescription Drug Program (MPDP), your cost-share for Tier 4 (preferred specialty drug) ordered through our Mail Service Prescription Drug Program is now $200 (see page 125).
     
  • For members enrolled in our regular pharmacy drug program, your cost-share for a Tier 2 (preferred brand-name drug) is now 35% of the Plan allowance up to a maximum of $250 for purchases up to a 30-day supply and $500 for purchases of up to 31-90 days (see page 107).
     
  • For members enrolled in our regular pharmacy drug program, your cost-share for Tier 2 diabetic medications, test strips, and supplies purchased through a preferred retail pharmacy is now $35 for each purchase of up to a 30-day supply ($105 for a 31 to 90-day supply) (see page 111).
     
  • For members enrolled in our regular pharmacy program, your cost-share for Tier 3 (non-preferred brand name drug) is 60% ($550 for up to a 30-day supply, with a maximum of $1,650 for up to a 31 to 90-day supply) when purchased from a preferred retail pharmacy (see page 107).
     
  • For members enrolled in our regular pharmacy program, your cost-share for Tier 5 (non-preferred specialty drug) is 40% of the Plan allowance for a 30-day supply (up to a maximum of $550) when purchased through the Specialty pharmacy (see page 107).
     
  • For members enrolled in our Medicare Prescription Drug Program (MPDP), your cost-share for Tier 3 (non-preferred brand-name drug) is 50% ($100 maximum for up to a 30-day supply, with a maximum of $300 for up to a 31 to 90-day supply) (see page 123).
     
  • For members enrolled in our Medicare Prescription Drug Program (MPDP), your cost-share for Tier 3 (non-preferred brand-name drug) ordered through our Mail Service Prescription Drug Program is now $175 (see page 125).

Both Standard Option and Basic Option
  • For members enrolled in our Medicare Prescription Drug Program, the prescription out-of-pocket catastrophic maximum is now $2,400 (see pages 36 and 123).

Other Changes
Standard Option only
  • The preferred catastrophic protection out-of-pocket maximum for Self Only enrollment will be $7,000. For Self Plus One or Self and Family enrollment, the out-of-pocket maximum will be $14,000.
     
  • The non-preferred catastrophic protection out-of-pocket maximum will be $9,000 for Self Only and $18,000 for Self Plus One or Self and Family.
     
  • The annual deductible is $500 per person ($1,000 maximum for Self Plus One or Self and Family enrollment).

Basic Option only
  • The preferred catastrophic protection out-of-pocket maximum for Self Only enrollment will be $8,500. For Self Plus One or Self and Family enrollment, the out-of-pocket maximum is $17,000.

Both Standard Option and Basic Option
  • We will no longer provide 8 over-the-counter (OTC) COVID-19 tests per member.
     
  • There is no longer an exception process for members in mid-treatment for diagnosed gender dysphoria.
     
  • Air ambulance transport that is not a medical emergency will not be covered without prior authorization (see pages 25, 89, 91, and 143).
     
  • Prior approval is required for MRI, PET and CT scans (see pages 44 and 84).
     
  • Members who elect to receive electronic explanations of benefits (EOBs) will receive a $10 credit to their health account (see page 138).