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
Section 5. Benefits
FEP Blue Standard and FEP Blue Basic
Section 5. Benefits
Section 5. Benefits
See Section 2 for how our benefits changed this year. The Summary of Benefits is the benefits summary of each option. Make sure that you review the benefits that are available under the option in which you are enrolled.
Section 5. Standard and Basic Option Overview - 40
Section 5(a). Medical Services and Supplies Provided by Physicians and Other Healthcare Professionals - 41
Non-PSHB Benefits Available to Plan Members - 146
Section 5. Standard and Basic Option Overview - 40
Section 5(a). Medical Services and Supplies Provided by Physicians and Other Healthcare Professionals - 41
Diagnostic and Treatment Services - 42
Lab, X-ray and Other Diagnostic Tests - 43
Preventive Care, Adult - 45
Preventive Care, Child - 48
Maternity Care - 50
Family Planning - 53
Reproductive Services - 54
Allergy Care - 55
Treatment Therapies - 56
Physical Therapy, Occupational Therapy, Speech Therapy, and Cognitive Rehabilitation Therapy - 58
Hearing Services - 58
Vision Services (Testing, Treatment, and Supplies) - 59
Foot Care - 60
Orthopedic and Prosthetic Devices - 61
Durable Medical Equipment (DME) - 62
Medical Supplies - 63
Home Health Services - 63
Manipulative Treatment - 64
Alternative Treatments - 65
Educational Classes and Programs - 65
Section 5(b). Surgical and Anesthesia Services Provided by Physicians and Other Healthcare Professionals - 67Lab, X-ray and Other Diagnostic Tests - 43
Preventive Care, Adult - 45
Preventive Care, Child - 48
Maternity Care - 50
Family Planning - 53
Reproductive Services - 54
Allergy Care - 55
Treatment Therapies - 56
Physical Therapy, Occupational Therapy, Speech Therapy, and Cognitive Rehabilitation Therapy - 58
Hearing Services - 58
Vision Services (Testing, Treatment, and Supplies) - 59
Foot Care - 60
Orthopedic and Prosthetic Devices - 61
Durable Medical Equipment (DME) - 62
Medical Supplies - 63
Home Health Services - 63
Manipulative Treatment - 64
Alternative Treatments - 65
Educational Classes and Programs - 65
Surgical Procedures - 68
Reconstructive Surgery - 69
Oral and Maxillofacial Surgery - 71
Organ/Tissue Transplants - 72
Anesthesia - 77
Section 5(c). Services Provided by a Hospital or Other Facility, and Ambulance Services - 79Reconstructive Surgery - 69
Oral and Maxillofacial Surgery - 71
Organ/Tissue Transplants - 72
Anesthesia - 77
Inpatient Hospital - 80
Outpatient Hospital or Ambulatory Surgical Center - 82
Blue Distinction® Specialty Care - 86
Residential Treatment Center - 87
Extended Care Benefits/Skilled Nursing Care Facility Benefits - 88
Hospice Care - 89
Ambulance - 91
Section 5(d). Emergency Services/Accidents - 93Outpatient Hospital or Ambulatory Surgical Center - 82
Blue Distinction® Specialty Care - 86
Residential Treatment Center - 87
Extended Care Benefits/Skilled Nursing Care Facility Benefits - 88
Hospice Care - 89
Ambulance - 91
Accidental Injury - 94
Medical Emergency - 95
Ambulance - 96
Section 5(e). Mental Health and Substance Use Disorder Benefits - 97Medical Emergency - 95
Ambulance - 96
Professional Services - 98
Inpatient Hospital or Other Covered Facility - 99
Residential Treatment Center - 99
Outpatient Hospital or Other Covered Facility - 100
Not Covered (Inpatient or Outpatient) - 100
Section 5(f). Prescription Drug Benefits - 102Inpatient Hospital or Other Covered Facility - 99
Residential Treatment Center - 99
Outpatient Hospital or Other Covered Facility - 100
Not Covered (Inpatient or Outpatient) - 100
Covered Medications and Supplies - 107
Section 5(f)(a). FEP Medicare Prescription Drug Program - 119Covered Medications and Supplies - 123
Section 5(g). Dental Benefits - 134Accidental Injury Benefit - 134
Dental Benefits - 135
Section 5(h). Wellness and Other Special Features - 138Dental Benefits - 135
Health Tools - 138
Services for the Deaf and Hearing Impaired - 138
Web Accessibility for the Visually Impaired - 138
Travel Benefit/Services Overseas - 138
Healthy Families - 138
Diabetes Management Program - 138
Blue Health Assessment - 139
Hypertension Management Program - 139
Pregnancy Care Incentive Program - 140
Annual Incentive Limitation - 140
Reimbursement Account for Basic Option Members Enrolled in Medicare Part A and Part B - 140
MyBlue® Customer eService - 140
National Doctor & Hospital Finder - 140
Care Management Programs - 141
Flexible Benefits Option - 141
Telehealth Services - 142
The fepblue Mobile Application - 142
Weight Loss Management Program - 142
Section 5(i). Services, Drugs, and Supplies Provided Overseas - 143Services for the Deaf and Hearing Impaired - 138
Web Accessibility for the Visually Impaired - 138
Travel Benefit/Services Overseas - 138
Healthy Families - 138
Diabetes Management Program - 138
Blue Health Assessment - 139
Hypertension Management Program - 139
Pregnancy Care Incentive Program - 140
Annual Incentive Limitation - 140
Reimbursement Account for Basic Option Members Enrolled in Medicare Part A and Part B - 140
MyBlue® Customer eService - 140
National Doctor & Hospital Finder - 140
Care Management Programs - 141
Flexible Benefits Option - 141
Telehealth Services - 142
The fepblue Mobile Application - 142
Weight Loss Management Program - 142
Non-PSHB Benefits Available to Plan Members - 146