2025 Blue Cross and Blue Shield Service Benefit Plan - FEP Blue Focus
Section 5(a). Medical Services and Supplies Provided by Physicians and Other Healthcare Professionals
Page 53

 

Benefit Description

Home Health Services (cont.)

Not covered:
 
  • Nursing care requested by, or for the convenience of, the patient or the patient’s family
     
  • Services primarily for bathing, feeding, exercising, moving the patient, homemaking, giving medication, or acting as a companion or sitter
     
  • Services provided by a nurse, nursing assistant, health aide, or other similarly licensed or unlicensed person that are billed by a skilled nursing facility, extended care facility, or nursing home
     
  • Private duty nursing


You Pay
All charges

 

Benefit Description

Alternative/Manipulative Treatment
Benefits for manipulative treatment and acupuncture are subject to a combined limit of 10 visits per person per calendar year
 
  • Acupuncture is covered when performed and billed by a healthcare provider who is licensed or certified to perform acupuncture by the state where the services are provided, and who is acting within the scope of that license or certification. See Section 3 for more information.
     
    Note: See Section 5(b) for our coverage of acupuncture when provided as anesthesia for covered surgery.
     
    Note: See earlier in this section for our coverage of acupuncture when provided as anesthesia for covered maternity care.
  • Manipulative treatment limited to:
     
    • Osteopathic manipulative treatment to any body region
       
    • Chiropractic spinal and/or extraspinal manipulative treatment

See Section 5(c) for facility benefits.


You Pay
Preferred: $25 copayment per visit (no deductible)

Non-preferred (Participating/Non-participating): You pay all charges

Note: You pay 30% of the Plan allowance (deductible applies) for agents, drugs, and/or supplies administered or obtained in connection with your care. 

 

Benefit Description

Not covered:
 
  • Biofeedback
     
  • Self-care or self-help training


You Pay
All charges

 

Benefit Description

Educational Classes and Programs
  • Smoking and tobacco cessation treatment including:
     
    • Counseling for smoking and tobacco use cessation
       
    • Smoking and tobacco cessation classes
      Note: See Section 5(f) for our coverage of smoking and tobacco cessation drugs.


You Pay
Preferred: Nothing (no deductible)

Non-preferred (Participating/Non-participating): You pay all charges

 

Benefit Description
 
  • Diabetic education

    Note: See previous information in this section for our coverage of nutritional counseling services that are not part of a diabetic education program.

You Pay
Preferred: 30% of the Plan allowance (deductible applies)

Non-preferred (Participating/Non-participating): You pay all charges

 

Benefit Description

Not covered:
 
  • Educational or other counseling or training services, or applied behavior analysis (ABA), when performed as part of an educational class or program
     
  • Premenstrual syndrome (PMS), lactation, headache, eating disorder, and other educational clinics unless described earlier in this section as being covered 
     
  • Recreational or educational therapy, and any related diagnostic testing except as provided by a hospital as part of a covered inpatient stay
     
  • Services performed or billed by a school or halfway house or a member of its staff


You Pay
All charges

 

Educational Classes and Programs - continued on next page

 

Go to page 52. Go to page 54.