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33

 
 
Document Number:
FFBF25-033
Revision #:
v1.0
Date Published:
1/1/2025
 

 

2025 Blue Cross and Blue Shield Service Benefit Plan - FEP Blue Focus
Section 5. FEP Blue Focus Benefits
Page 33

 

Section 5. FEP Blue Focus Benefits

 

See Section 2 for how our benefits changed this year. Near the end of the brochure is a summary of benefits for this plan and Section 5 provides an overview of FEP Blue Focus.

 

Section 5. FEP Blue Focus Overview - 35 
Section 5(a). Medical Services and Supplies Provided by Physicians and Other Healthcare Professionals - 36 
Diagnostic and Treatment Services - 37 
Lab, X-ray and Other Diagnostic Tests - 38 
Preventive Care, Adult - 39 
Preventive Care, Child - 41 
Maternity Care - 43 
Family Planning - 45 
Reproductive Services - 46 
Allergy Care - 46 
Treatment Therapies - 47 
Physical Therapy, Occupational Therapy, Speech Therapy, and Cognitive Rehabilitation Therapy - 48 
Hearing Services - 48 
Vision Services (Testing, Treatment, and Supplies) - 49 
Foot Care - 50 
Orthopedic and Prosthetic Devices - 50 
Durable Medical Equipment (DME) - 51 
Medical Supplies - 52 
Home Health Services - 52 
Alternative/Manipulative Treatment - 53 
Educational Classes and Programs - 53 
Section 5(b). Surgical and Anesthesia Services Provided by Physicians and Other Healthcare Professionals - 55 
Surgical Procedures - 56 
Reconstructive Surgery - 57 
Oral and Maxillofacial Surgery - 59 
Organ/Tissue Transplants - 63 
Anesthesia - 64 
Section 5(c). Services Provided by a Hospital or Other Facility, and Ambulance Services - 65 
Inpatient Hospital - 66 
Maternity – Facility - 67 
Outpatient Hospital or Ambulatory Surgical Center - 69 
Residential Treatment Center - 72 
Extended Care Benefits/Skilled Nursing Care Facility Benefits - 73 
Hospice Care - 73 
Ambulance - 76 
Section 5(d). Emergency Services/Accidents - 77 
Accidental Injury - 78 
Medical Emergency - 79 
Ambulance - 80 
Section 5(e). Mental Health and Substance Use Disorder Benefits - 81 
Professional Services - 81 
Inpatient Hospital or Other Covered Facility - 83 
Residential Treatment Center - 83 
Outpatient Hospital or Other Covered Facility - 83 
Section 5(f). Prescription Drug Benefits - 85 

 

Go to page 32. Go to page 34.
 

Blue Cross Blue Shield Federal Employee Program
Confidential - Internal Plan use only

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