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
Treatment Therapies

 

Note: We state whether or not the calendar year deductible applies for each benefit listed in this section.

Benefit Description

Treatment Therapies
Outpatient treatment therapies:
 
  • Chemotherapy and radiation therapy
    Note: We cover high-dose chemotherapy and/or radiation therapy in connection with bone marrow transplants, and drugs or medications to stimulate or mobilize stem cells for transplant procedures, only for those conditions listed as covered under Organ/Tissue Transplants in Section 5(b). See also, Other services under You need prior Plan approval for certain services in Section 3.
     
  • Proton beam therapy*, stereotactic radiosurgery* and stereotactic body radiation therapy
     
  • Renal dialysis – Hemodialysis and peritoneal dialysis
     
  • Intravenous (IV)/infusion therapy – Home IV or infusion therapy
    Note: Home nursing visits (skilled) associated with Home IV/infusion therapy are covered as shown under Home Health Services later in this section.
     
  • Outpatient cardiac rehabilitation
     
  • Pulmonary rehabilitation therapy
     
  • Applied behavior analysis (ABA)* for the treatment of an autism spectrum disorder limited to 200 hours per person, per calendar year (see prior approval requirements in Section 3)
     
  • Auto-immune infusion medications: Remicade, Renflexis or Inflectra
     
  • Agents, drugs, and/or supplies administered or obtained in connection with your care

Notes:
 
  • See Section 5(c) for our payment levels for treatment therapies billed for by the outpatient department of a hospital.

*Prior approval required


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

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

 

Benefit Description

Inpatient treatment therapies:
 
  • Chemotherapy and radiation therapy
    Note: We cover high-dose chemotherapy and/or radiation therapy in connection with bone marrow transplants, and drugs or medications to stimulate or mobilize stem cells for transplant procedures, only for those conditions listed as covered under Organ/Tissue Transplants in Section 5(b). See also, Other services under You need prior Plan approval for certain services in Section 3.
     
  • Renal dialysis – Hemodialysis and peritoneal dialysis
     
  • Pharmacotherapy (medication management) (See Section 5(c) for our coverage of drugs administered in connection with these treatment therapies.)
     
  • Applied behavior analysis (ABA)* for the treatment of an autism spectrum disorder

*Prior approval required


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

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