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
Preventive Care, Child

 

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

Benefit Description

Preventive Care, Child
Benefits are provided for preventive care services for children up to age 22. This includes:
 
  • Well-child visits, examinations, and other preventive services as described in the Bright Future Guidelines as provided by the American Academy of Pediatrics. For a complete list of the American Academy of Pediatrics Bright Future Guidelines, go to https://brightfutures.aap.org
     
  • Children's immunizations endorsed by the Centers for Disease Control (CDC) including DTaP/Tdap, Polio, Measles, Mumps, and Rubella (MMR), and Varicella. For a complete list of immunizations, go to the website at https://www.cdc.gov/vaccines/imz-schedules/index.html
    Note: U.S. FDA licensure may restrict the use of certain vaccines to specific age ranges, frequencies, and/or other patient-specific indications, including gender.
     
  • You may also find a complete list of preventive care services recommended under the U.S. Preventive Services Task Force (USPSTF) A and B recommendations online at https://www.uspreventiveservicestaskforce.org/uspstf/recommendation-topics/uspstf-a-and-b-recommendations.
     
  • To build your personalized list of preventive services, go to https://health.gov/myhealthfinder
     
  • Nutritional counseling
     
Note: Preventive care benefits for each of the services listed below are limited to one per calendar year:
 
  • Screening for hepatitis B for children age 13 and over
     
  • Screening for chlamydial infection
     
  • Screening for gonorrhea infection
     
  • Cervical cancer screening tests
     
    • Human papillomavirus (HPV) tests of the cervix
       
    • Pap tests of the cervix
       
  • Screening for human immunodeficiency virus (HIV) infection
     
  • Screening for syphilis infection
     
  • Screening for latent tuberculosis infection for children ages 18 through 21

Note: If your child receives both preventive and diagnostic services from a Preferred provider on the same day, you are responsible for paying the cost-share for the diagnostic services.

Note: When nutritional counseling is via the contracted telehealth provider network, we provide benefits as shown here for Preferred providers. Refer to Section 5(h), Wellness and Other Special Features, for information on how to access a telehealth provider.

Any procedure, injection, diagnostic service, laboratory, or X-ray service done in conjunction with a routine examination and not included in the preventive listing of services will be subject to the applicable member copayments, coinsurance, and deductible.


You Pay
Preferred: Nothing (no deductible)

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

Note: When care is provided by a Non-preferred laboratory and/or radiologist, as stated in Section 3 for an exception, you pay:
 
  • Participating laboratories or radiologists: Nothing (no deductible)
     
  • Non-participating laboratories or radiologists: The difference between our allowance and the billed amount (no deductible)

Notes:
 
  • For services billed by Non-preferred providers (Participating/Non-participating) related to influenza (flu) vaccines, we pay the Plan allowance. If you receive the influenza (flu) vaccine from a Non-participating provider, you pay any difference between our allowance and the billed amount (no deductible).
     
  • When billed by a facility, such as the outpatient department of a hospital, we provide benefits as shown here, according to the contracting status of the facility.

 

Benefit Description

Obesity counseling, screening and referral to intensive nutrition and behavioral weight-loss therapy, or counseling under the USPSTF A and B recommendations are covered as part of prevention and treatment of obesity as follows:
 
  • Unlimited nutritional counseling including nutritional counseling via the contracted telehealth provider network
     
  • Unlimited visits for counseling on prevention and reducing health risks
     
  • Unlimited visits for individual and group behavioral counseling for obesity
     
  • And, for those children or adolescents with a body mass index (BMI) at or above the 85th percentile, unlimited family-centered programs when medically identified to support obesity prevention and management by an in-network provider.

Notes:
 
  • Benefits are available for anti-obesity medications. See Section 5(f).
     
  • See Section 5(b) for information related to benefits for the surgical treatment of severe obesity.


You Pay
Preferred: Nothing (no deductible)

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

 

Benefit Description

Not covered:
  • Self-administered health risk assessments (other than the Blue Health Assessment)
     
  • Screening services requested solely by the member, such as commercially advertised heart scans, body scans, and tests performed in mobile traveling vans
     
  • Physical exams required for obtaining or continuing employment or insurance, attending schools or camp, athletic exams, or travel
     
  • Immunizations, boosters, and medications for travel or work-related exposure. Medical benefits may be available for these services.
  • Phone consultations and online medical evaluation and management services (telemedicine) for preventive services, except as noted above for nutritional counseling.

You Pay
All charges