2025 Blue Cross and Blue Shield Service Benefit Plan - Standard and Basic Option
Section 5. Benefits
Page 35
Section 5. Benefits
Page 35
Section 5. Benefits
See towards the end of the brochure for a benefits summary of each option. Make sure that you review the benefits that are available under the option in which you are enrolled.
Section 5. Standard and Basic Option Overview - 37
Section 5(a). Medical Services and Supplies Provided by Physicians and Other Healthcare Professionals - 38
Section 5. Standard and Basic Option Overview - 37
Section 5(a). Medical Services and Supplies Provided by Physicians and Other Healthcare Professionals - 38
Diagnostic and Treatment Services - 39
Lab, X-ray and Other Diagnostic Tests - 40
Preventive Care, Adult - 42
Preventive Care, Child - 45
Maternity Care - 47
Family Planning - 49
Reproductive Services - 50
Allergy Care - 51
Treatment Therapies - 52
Physical Therapy, Occupational Therapy, Speech Therapy, and Cognitive Rehabilitation Therapy - 53
Hearing Services (Testing, Treatment, and Supplies) - 54
Vision Services (Testing, Treatment, and Supplies) - 54
Foot Care - 56
Orthopedic and Prosthetic Devices - 56
Durable Medical Equipment (DME) - 57
Medical Supplies - 58
Home Health Services - 59
Manipulative Treatment - 60
Alternative Treatments - 60
Educational Classes and Programs - 61
Lab, X-ray and Other Diagnostic Tests - 40
Preventive Care, Adult - 42
Preventive Care, Child - 45
Maternity Care - 47
Family Planning - 49
Reproductive Services - 50
Allergy Care - 51
Treatment Therapies - 52
Physical Therapy, Occupational Therapy, Speech Therapy, and Cognitive Rehabilitation Therapy - 53
Hearing Services (Testing, Treatment, and Supplies) - 54
Vision Services (Testing, Treatment, and Supplies) - 54
Foot Care - 56
Orthopedic and Prosthetic Devices - 56
Durable Medical Equipment (DME) - 57
Medical Supplies - 58
Home Health Services - 59
Manipulative Treatment - 60
Alternative Treatments - 60
Educational Classes and Programs - 61
Section 5(b). Surgical and Anesthesia Services Provided by Physicians and Other Healthcare Professionals - 62
Surgical Procedures - 63
Reconstructive Surgery - 64
Oral and Maxillofacial Surgery - 67
Organ/Tissue Transplants - 68
Anesthesia - 73
Section 5(c). Services Provided by a Hospital or Other Facility, and Ambulance Services - 75 Oral and Maxillofacial Surgery - 67
Organ/Tissue Transplants - 68
Anesthesia - 73
Inpatient Hospital - 76
Outpatient Hospital or Ambulatory Surgical Center - 78
Blue Distinction® Specialty Care - 82
Residential Treatment Center - 83
Extended Care Benefits/Skilled Nursing Care Facility Benefits - 84
Hospice Care - 85
Ambulance - 88
Section 5(d). Emergency Services/Accidents - 90 Section 5(e). Mental Health and Substance Use Disorder Benefits - 94
Outpatient Hospital or Ambulatory Surgical Center - 78
Blue Distinction® Specialty Care - 82
Residential Treatment Center - 83
Extended Care Benefits/Skilled Nursing Care Facility Benefits - 84
Hospice Care - 85
Ambulance - 88