2025 Blue Cross and Blue Shield Service Benefit Plan - FEP Blue Focus
Table of Contents
Page 2
Table of Contents
Page 2
• Maternity care - 27
• If your facility stay needs to be extended - 27
• If your treatment needs to be extended - 27
• If your facility stay needs to be extended - 27
• If your treatment needs to be extended - 27
If you disagree with our pre-service claim decision - 27
• To reconsider a non-urgent care claim - 27
• To reconsider an urgent care claim - 27
• To file an appeal with OPM - 28
• To reconsider an urgent care claim - 27
• To file an appeal with OPM - 28
Section 4. Your Costs for Covered Services - 29
Cost-share/Cost-sharing - 29
Copayment - 29
Deductible - 29
Coinsurance - 29
If your provider routinely waives your cost - 29
Waivers - 30
Differences between our allowance and the bill - 30
Important Notice About Surprise Billing – Know Your Rights - 30
Your costs for other care - 31
Your catastrophic protection out-of-pocket maximum for deductibles, coinsurance, and copayments - 31
Carryover - 32
If we overpay you - 32
When Government facilities bill us - 32
The Federal Flexible Spending Account Program - FSAFEDS - 32
Copayment - 29
Deductible - 29
Coinsurance - 29
If your provider routinely waives your cost - 29
Waivers - 30
Differences between our allowance and the bill - 30
Important Notice About Surprise Billing – Know Your Rights - 30
Your costs for other care - 31
Your catastrophic protection out-of-pocket maximum for deductibles, coinsurance, and copayments - 31
Carryover - 32
If we overpay you - 32
When Government facilities bill us - 32
The Federal Flexible Spending Account Program - FSAFEDS - 32
Section 5. FEP Blue Focus Benefits - 33
Section 6. General Exclusions – Services, Drugs, and Supplies We Do Not Cover - 111
Section 7. Filing a Claim for Covered Services - 113
Section 8. The Disputed Claims Process - 116
Section 9. Coordinating Benefits With Medicare and Other Coverage - 119
Section 7. Filing a Claim for Covered Services - 113
Section 8. The Disputed Claims Process - 116
Section 9. Coordinating Benefits With Medicare and Other Coverage - 119
When you have other health coverage - 119
When other Government agencies are responsible for your care - 120
When others are responsible for injuries - 120
When you have Federal Employees Dental and Vision Insurance Plan (FEDVIP) - 121
Clinical trials - 122
When you have Medicare - 122
When others are responsible for injuries - 120
When you have Federal Employees Dental and Vision Insurance Plan (FEDVIP) - 121
Clinical trials - 122
When you have Medicare - 122
• The Original Medicare Plan (Part A or Part B) - 122
• Tell us about your Medicare coverage - 123
• Private contract with your physician - 123
• Medicare Advantage (Part C) - 123
• Medicare prescription drug coverage (Part D) - 124
• Medicare prescription drug coverage (Part B) - 124
• Tell us about your Medicare coverage - 123
• Private contract with your physician - 123
• Medicare Advantage (Part C) - 123
• Medicare prescription drug coverage (Part D) - 124
• Medicare prescription drug coverage (Part B) - 124