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102

 
 
Document Number:
FFBF25-102
Revision #:
v1.0
Date Published:
1/1/2025
 

 

2025 Blue Cross and Blue Shield Service Benefit Plan - FEP Blue Focus
Section 5(g). Dental Benefits
Page 102

 

Benefits Description

Inpatient and Outpatient Facility Care

We cover inpatient and outpatient hospital care, as well as anesthesia administered at the facility,

 
  • To treat children up to age 22 with severe dental caries, or
     
  • When a non-dental physical impairment exists that makes hospitalization necessary to safeguard the health of the patient (even if the dental procedure itself is not covered).


You Pay
See Section 5(c) for inpatient and outpatient hospital benefits.  

 

Benefits Description
Not covered: Routine dental care

You Pay
All charges

 

Go to page 101. Go to page 103. 
 

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

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