2025 Blue Cross and Blue Shield Service Benefit Plan - FEP Blue Focus
Index
Index
Index
Do not rely only on this page; it is for your convenience and may not show all pages where the terms appear. This Index is not an official statement of benefits.
Abortion - 43-44, 67-69, 111-112
Accidental injury - 77-80, 101, 129
Acupuncture - 43-44, 53, 64, 69-72
Affordable Care Act (ACA) - 12-13, 96-99, 140
Allergy care - 46-47
Allogeneic transplants - 61-63
Alternative treatments - 53
Ambulance - 76
Ambulatory surgical center - 69-72
Anesthesia - 64
Angiographies - 38, 69-72
Appeals - 27
Applied behavior analysis (ABA) - 47-48, 53-54, 111-112
Assistant surgeon - 19, 56-57
Autism spectrum disorder - 47-48, 69-72
Autologous transplants - 60-62
Biopsies - 39-41, 56-57, 69-72
Birthing centers - 17-19
Blood and blood plasma - 52, 69-72
Blood or marrow stem cell - 20-23, 60-62
Blue Distinction CentersBlue Distinction Specialty Care - 17-19
Blue Health Assessment - 39-41, 103, 132
Bone density tests - 38, 69-72
Brand-name drugs - 89-90, 94-95
Breast pump and supplies - 43-44
Breast reconstruction - 57-58Breastfeeding support and supplies - 43-44, 67-69
Cancer tests - 39-41
Cardiac rehabilitation - 20-23, 47-48, 69-72
Cardiovascular monitoring - 38, 69-72
Care Management Programs - 104-105
Case management - 104-105
Casts - 66-67, 69-72
Catastrophic protection - 16, 31, 142
Cervical cancer screening - 39-43
CHAMPVA - 119-120
Changes for 2025 - 16
Chemotherapy - 47-48, 69-72
Children’s Equity Act - 10-11
Chiropractic manipulative treatment - 53
Cholesterol tests - 38-41
Circumcision - 43-44, 56-57
Claims and claims filingClinic visits - 37-38, 69-72, 81-82
Clinical trials - 61-62, 122, 130
Cognitive rehabilitation - 48, 69-73
Coinsurance - 29, 31, 107
Colonoscopy - 39-41, 56-57, 69-72
Colorectal cancer testsConfidentiality - 14-15
Congenital anomalies - 56-57, 130
Consultations - 37-38, 81-82
Contact lenses - 49-50
Contraceptives - 45, 69-72, 89-90, 94-95
Coordination of benefits - 23-25
Copayments - 29, 31
CORE benefits - 130
Cosmetic surgery - 56-58, 130
Cost-share/cost-sharing - 29
Costs for covered services - 29-32
Coverage information - 9
Covered facility providers - 17-19
Covered professional providers - 17
CT scans - 38, 69-72
Custodial or long-term care - 111-112, 130
Daily Habits - 103
Deductible - 29, 31
Definitions - 129-137
Dental care - 101-102, 141
Diabetic education - 53-54, 69-72
Diabetic supplies
Diagnostic tests - 38, 81-82
Dialysis - 47-48, 51-52, 69-72
Disease Management - 104-105
Disputed claims - 116-118
Divorce - 9-10, 12
DNA analysis of stool samples - 39-41
Donor expenses - 63
Drugs (see: Prescription drugs)
Durable medical equipment - 51-52, 69-75, 113, 130-131Educational classes and programs - 53-54
EEGs - 38, 69-72
EKGs - 38, 69-72
Emergency - 26, 76-80, 140-142
Enrollment - 9-10, 90-91
Exception situations - 19
Exclusions - 111-112
Experimental or investigational - 111-112, 131
Extended care benefits - 73
Eyeglasses - 49-50
Facility providers - 17-19
Family planning - 45
Fecal occult blood test - 39-41
FEDVIP - 101, 121
fepblue mobile application - 106
fepblue-org - 4
Flexible benefits option - 105
Foot care - 50
Formulary/Preferred drug list - 85-87, 91-94
Fraud - 4-5
Gender affirming care - 57-58
Generic drugs - 87, 89-90, 94-95
Generic equivalents - 87
Genetic screening/testing - 38, 69-72
Health Insurance Marketplace - 12-13
Health tools - 103
Healthy Families - 103
Hearing aids and hearing services - 48-51, 110
Home health services - 52-53
Home nursing care (maternity) - 25, 43-44
Hospice care - 73-75
HospitalHuman papillomavirus (HPV) tests - 39-43
Hypertension Management Program - 103-104
Identification cards - 17
Immunizations - 39-43, 96-99
Inpatient hospital benefits - 66-67
Inpatient professional services - 37-38, 81-82
Insulin - 89-90, 94-95
Insulin pumps - 51-52
Laboratory and pathology services - 38, 66-72, 78-80
Low-dose CT screening - 135
Mammograms - 39-41
Manipulative treatment - 53
Maternity care - 27, 43-44
Maxillofacial surgery - 59
Medicaid - 120
Medical emergency - 77, 79-80, 141
Medical foods - 52, 88-89, 91-94, 132
Medical supplies - 52
Medically necessary - 17, 20, 23, 111-112, 132-133
Medicare - 1, 23-25, 59-60, 119-128
Medications and supplies - 89-90, 94-99
Medications to promote better health - 96-99
Member facilities - 39-41, 65-76, 78-79, 81-84
Mental health/substance use disorder - 17-19, 72-73, 81-84, 105
MRIs - 38, 69-72
Multiple procedures - 56-57
MyBlue Customer eService - 104
National Doctor & Hospital Finder - 104
Neurological testing - 38, 69-72
Never Events - 6-8, 133
Newborn care - 27, 43-44, 67-69
No Surprises Act (NSA) - 30-31
NON-CORE benefits - 133
Non-member facilities - 65-76, 81-84
Non-participating providers - 30, 133-134
Non-preferred providers - 14-15, 17, 30
Nurse - 52-53, 73-75, 103
Nutritional counseling - 17, 37-41, 105, 136
Observation care - 133
Obstetrical care - 43-44, 67-69
Occupational therapy - 48, 65-76
Office visits - 37-38, 81-82
Oral surgery - 59
Organ/tissue transplants - 55-64
Orthopedic devices - 50-51, 69-72
Osteoporosis screening - 39-41, 135
Ostomy and catheter supplies - 52
Out-of-pocket expenses - 31, 134
Outpatient facility services - 69-72, 102
Outpatient professional services - 37-38, 81-82
Overpayments - 32
Overseas Assistance Center - 107
Overseas services, drugs, supplies and claims - 31, 107-109
Oxygen - 50-51, 65-76
Pap tests - 39-43
Participating providers - 30-31, 133-134
Patient Safety and Quality Monitoring (PSQM) program - 88
Personal Health Record - 103
PET scans - 38, 69-72
Pharmacotherapy - 37-38, 47-48
Physical examinations - 106
Physical therapy - 48, 65-76
Physician - 14-15, 37-38, 126-127
Plan allowance - 30, 133-134
PPO - 14-15, 17-19, 135
Pre-admission testing - 66-67
Precertification - 20, 25, 135
Preferred providers - 14-15, 17, 19, 30
Pregnancy (see: Maternity care)
Prescription drugs
Prior approval - 20-23, 88, 91-94, 135
Professional providers - 17
Prostate cancer - 39-41
Prosthetic devices - 50-51, 56-57, 66-67, 69-72
Psychotherapy - 81-84
Pulmonary rehabilitation - 47-48, 69-72
Radiation therapy - 47-48, 69-72
Reconsiderations - 27, 116-118
Replacement coverage - 12-13
Reproductive servicesResidential treatment center (RTC) - 17-20, 72-73, 83, 130
Rights and responsibilities - 14-15
Room and board - 66-69, 72-73, 83
Routine Annual Physical Incentive Program - 106
Screening services - 39-41, 135
Second surgical opinion - 37-38
Self-injectable drugs - 85, 87-88
Skilled nursing facility (SNF) care - 73, 130
Smoking cessation - 53-54, 96-99
Social worker - 104-105
Specialty Drug Pharmacy Program - 85-86, 89-90, 108-109, 114
Specialty drugs - 85-86, 89-90, 94-95, 114, 136
Speech therapy - 48, 69-73
Speech-generating devices - 51-52
Stem cell transplants - 60-62
Sterilization procedures - 45, 56-57
Subrogation - 120-121, 136
Substance use disorder - 17, 72-73, 81-84
Surgery
Telehealth
Tobacco cessation - 53-54, 96-99
Transplants - 59-62
Travel benefit - 63, 103
Treatment therapies - 47-48
TRICARE - 119-120
Ultrasounds - 38, 69-72
Urgent care center - 77-80, 141
Urgent care claims - 26, 136
VA facility - 127
Vaccines - 39-43, 96-99
Verbal statements - 4, 27
Vision services - 49-50, 121
Waivers - 30
Weight control - 103, 110-112
Wheelchairs - 51-52
Wigs - 50-51
WRAP benefits - 137
X-rays - 38, 69-72
Abortion - 43-44, 67-69, 111-112
Accidental injury - 77-80, 101, 129
Acupuncture - 43-44, 53, 64, 69-72
Affordable Care Act (ACA) - 12-13, 96-99, 140
Allergy care - 46-47
Allogeneic transplants - 61-63
Alternative treatments - 53
Ambulance - 76
Ambulatory surgical center - 69-72
Anesthesia - 64
Angiographies - 38, 69-72
Appeals - 27
Applied behavior analysis (ABA) - 47-48, 53-54, 111-112
Assistant surgeon - 19, 56-57
Autism spectrum disorder - 47-48, 69-72
Autologous transplants - 60-62
Biopsies - 39-41, 56-57, 69-72
Birthing centers - 17-19
Blood and blood plasma - 52, 69-72
Blood or marrow stem cell - 20-23, 60-62
Blue Distinction CentersBlue Distinction Specialty Care - 17-19
Blue Health Assessment - 39-41, 103, 132
Bone density tests - 38, 69-72
Brand-name drugs - 89-90, 94-95
Breast pump and supplies - 43-44
Breast reconstruction - 57-58Breastfeeding support and supplies - 43-44, 67-69
Cancer tests - 39-41
Cardiac rehabilitation - 20-23, 47-48, 69-72
Cardiovascular monitoring - 38, 69-72
Care Management Programs - 104-105
Case management - 104-105
Casts - 66-67, 69-72
Catastrophic protection - 16, 31, 142
Cervical cancer screening - 39-43
CHAMPVA - 119-120
Changes for 2025 - 16
Chemotherapy - 47-48, 69-72
Children’s Equity Act - 10-11
Chiropractic manipulative treatment - 53
Cholesterol tests - 38-41
Circumcision - 43-44, 56-57
Claims and claims filingClinic visits - 37-38, 69-72, 81-82
Clinical trials - 61-62, 122, 130
Cognitive rehabilitation - 48, 69-73
Coinsurance - 29, 31, 107
Colonoscopy - 39-41, 56-57, 69-72
Colorectal cancer testsConfidentiality - 14-15
Congenital anomalies - 56-57, 130
Consultations - 37-38, 81-82
Contact lenses - 49-50
Contraceptives - 45, 69-72, 89-90, 94-95
Coordination of benefits - 23-25
Copayments - 29, 31
CORE benefits - 130
Cosmetic surgery - 56-58, 130
Cost-share/cost-sharing - 29
Costs for covered services - 29-32
Coverage information - 9
Covered facility providers - 17-19
Covered professional providers - 17
CT scans - 38, 69-72
Custodial or long-term care - 111-112, 130
Daily Habits - 103
Deductible - 29, 31
Definitions - 129-137
Dental care - 101-102, 141
Diabetic education - 53-54, 69-72
Diabetic supplies
Diabetic Meter Program - 96-99
Insulin pumps - 51-52
Insulin, test strips, and lancets - 89-90, 94-95
Needles and disposable syringes - 89-90, 94-95
Diagnostic and treatment services - 37-38Insulin pumps - 51-52
Insulin, test strips, and lancets - 89-90, 94-95
Needles and disposable syringes - 89-90, 94-95
Diagnostic tests - 38, 81-82
Dialysis - 47-48, 51-52, 69-72
Disease Management - 104-105
Disputed claims - 116-118
Divorce - 9-10, 12
DNA analysis of stool samples - 39-41
Donor expenses - 63
Drugs (see: Prescription drugs)
Durable medical equipment - 51-52, 69-75, 113, 130-131Educational classes and programs - 53-54
EEGs - 38, 69-72
EKGs - 38, 69-72
Emergency - 26, 76-80, 140-142
Enrollment - 9-10, 90-91
Exception situations - 19
Exclusions - 111-112
Experimental or investigational - 111-112, 131
Extended care benefits - 73
Eyeglasses - 49-50
Facility providers - 17-19
Family planning - 45
Fecal occult blood test - 39-41
FEDVIP - 101, 121
fepblue mobile application - 106
fepblue-org - 4
Flexible benefits option - 105
Foot care - 50
Formulary/Preferred drug list - 85-87, 91-94
Fraud - 4-5
Gender affirming care - 57-58
Generic drugs - 87, 89-90, 94-95
Generic equivalents - 87
Genetic screening/testing - 38, 69-72
Health Insurance Marketplace - 12-13
Health tools - 103
Healthy Families - 103
Hearing aids and hearing services - 48-51, 110
Home health services - 52-53
Home nursing care (maternity) - 25, 43-44
Hospice care - 73-75
HospitalHuman papillomavirus (HPV) tests - 39-43
Hypertension Management Program - 103-104
Identification cards - 17
Immunizations - 39-43, 96-99
Inpatient hospital benefits - 66-67
Inpatient professional services - 37-38, 81-82
Insulin - 89-90, 94-95
Insulin pumps - 51-52
Laboratory and pathology services - 38, 66-72, 78-80
Low-dose CT screening - 135
Mammograms - 39-41
Manipulative treatment - 53
Maternity care - 27, 43-44
Maxillofacial surgery - 59
Medicaid - 120
Medical emergency - 77, 79-80, 141
Medical foods - 52, 88-89, 91-94, 132
Medical supplies - 52
Medically necessary - 17, 20, 23, 111-112, 132-133
Medicare - 1, 23-25, 59-60, 119-128
Medications and supplies - 89-90, 94-99
Medications to promote better health - 96-99
Member facilities - 39-41, 65-76, 78-79, 81-84
Mental health/substance use disorder - 17-19, 72-73, 81-84, 105
MRIs - 38, 69-72
Multiple procedures - 56-57
MyBlue Customer eService - 104
National Doctor & Hospital Finder - 104
Neurological testing - 38, 69-72
Never Events - 6-8, 133
Newborn care - 27, 43-44, 67-69
No Surprises Act (NSA) - 30-31
NON-CORE benefits - 133
Non-member facilities - 65-76, 81-84
Non-participating providers - 30, 133-134
Non-preferred providers - 14-15, 17, 30
Nurse - 52-53, 73-75, 103
Nutritional counseling - 17, 37-41, 105, 136
Observation care - 133
Obstetrical care - 43-44, 67-69
Occupational therapy - 48, 65-76
Office visits - 37-38, 81-82
Oral surgery - 59
Organ/tissue transplants - 55-64
Orthopedic devices - 50-51, 69-72
Osteoporosis screening - 39-41, 135
Ostomy and catheter supplies - 52
Out-of-pocket expenses - 31, 134
Outpatient facility services - 69-72, 102
Outpatient professional services - 37-38, 81-82
Overpayments - 32
Overseas Assistance Center - 107
Overseas services, drugs, supplies and claims - 31, 107-109
Oxygen - 50-51, 65-76
Pap tests - 39-43
Participating providers - 30-31, 133-134
Patient Safety and Quality Monitoring (PSQM) program - 88
Personal Health Record - 103
PET scans - 38, 69-72
Pharmacotherapy - 37-38, 47-48
Physical examinations - 106
Physical therapy - 48, 65-76
Physician - 14-15, 37-38, 126-127
Plan allowance - 30, 133-134
PPO - 14-15, 17-19, 135
Pre-admission testing - 66-67
Precertification - 20, 25, 135
Preferred providers - 14-15, 17, 19, 30
Pregnancy (see: Maternity care)
Prescription drugs
Brand-name drugs - 89-90, 94-95
Drugs from other sources - 99-100
Generic drugs - 89-90, 94-95
Preferred retail pharmacies - 85-86, 89-90, 114
Retail Pharmacy Program - 85-86, 96-99, 141
Self-injectable drugs - 85, 87-88
Specialty Drug Pharmacy Program - 85-86, 89-90, 114, 141
Specialty drugs - 85-86, 89-90, 94-95, 114, 136
Preventive carePrimary care provider (PCP) - 36-54Drugs from other sources - 99-100
Generic drugs - 89-90, 94-95
Preferred retail pharmacies - 85-86, 89-90, 114
Retail Pharmacy Program - 85-86, 96-99, 141
Self-injectable drugs - 85, 87-88
Specialty Drug Pharmacy Program - 85-86, 89-90, 114, 141
Specialty drugs - 85-86, 89-90, 94-95, 114, 136
Prior approval - 20-23, 88, 91-94, 135
Professional providers - 17
Prostate cancer - 39-41
Prosthetic devices - 50-51, 56-57, 66-67, 69-72
Psychotherapy - 81-84
Pulmonary rehabilitation - 47-48, 69-72
Radiation therapy - 47-48, 69-72
Reconsiderations - 27, 116-118
Replacement coverage - 12-13
Reproductive servicesResidential treatment center (RTC) - 17-20, 72-73, 83, 130
Rights and responsibilities - 14-15
Room and board - 66-69, 72-73, 83
Routine Annual Physical Incentive Program - 106
Screening services - 39-41, 135
Second surgical opinion - 37-38
Self-injectable drugs - 85, 87-88
Skilled nursing facility (SNF) care - 73, 130
Smoking cessation - 53-54, 96-99
Social worker - 104-105
Specialty Drug Pharmacy Program - 85-86, 89-90, 108-109, 114
Specialty drugs - 85-86, 89-90, 94-95, 114, 136
Speech therapy - 48, 69-73
Speech-generating devices - 51-52
Stem cell transplants - 60-62
Sterilization procedures - 45, 56-57
Subrogation - 120-121, 136
Substance use disorder - 17, 72-73, 81-84
Surgery
Assistant surgeon - 19, 56-59, 62-64
Eye: cataract, amblyopia, strabismus - 49-50, 56-57
Gender affirming - 17, 57-58
Multiple procedures - 55-57
Oral and maxillofacial - 59
Outpatient - 17-19, 69-72
Reconstructive - 57-58
Sterilization, reversal of voluntary - 45, 56-57
Surgical implants - 50-51, 69-72
Surgical treatment of severe obesity - 20-23
Transplants - 59-64
Syringes - 89-90, 94-95Eye: cataract, amblyopia, strabismus - 49-50, 56-57
Gender affirming - 17, 57-58
Multiple procedures - 55-57
Oral and maxillofacial - 59
Outpatient - 17-19, 69-72
Reconstructive - 57-58
Sterilization, reversal of voluntary - 45, 56-57
Surgical implants - 50-51, 69-72
Surgical treatment of severe obesity - 20-23
Transplants - 59-64
Telehealth
Dermatology - 17, 37-38, 136
Mental health/substance use disorder - 105
Minor acute conditions - 17, 37-38, 133
Nutritional counseling - 17, 39-41, 105, 136
Temporary Continuation of Coverage (TCC) - 12Mental health/substance use disorder - 105
Minor acute conditions - 17, 37-38, 133
Nutritional counseling - 17, 39-41, 105, 136
Tobacco cessation - 53-54, 96-99
Transplants - 59-62
Travel benefit - 63, 103
Treatment therapies - 47-48
TRICARE - 119-120
Ultrasounds - 38, 69-72
Urgent care center - 77-80, 141
Urgent care claims - 26, 136
VA facility - 127
Vaccines - 39-43, 96-99
Verbal statements - 4, 27
Vision services - 49-50, 121
Waivers - 30
Weight control - 103, 110-112
Wheelchairs - 51-52
Wigs - 50-51
WRAP benefits - 137
X-rays - 38, 69-72