2025 Blue Cross and Blue Shield Service Benefit Plan - Standard and Basic Option
Table of Contents
Page 1
Table of Contents
Page 1
Table of Contents
Introduction - 4
Plain Language - 4
Stop Health Care Fraud! - 4
Discrimination is Against the Law - 5
Preventing Medical Mistakes - 6
PSHB Facts - 9
Plain Language - 4
Stop Health Care Fraud! - 4
Discrimination is Against the Law - 5
Preventing Medical Mistakes - 6
PSHB Facts - 9
Coverage information - 9
• No pre-existing condition limitation - 9
• Minimum essential coverage (MEC) - 9
• Minimum value standard - 9
• Where you can get information about enrolling in the PSHB Program - 9
• Enrollment types available for you and your family - 9
• Family Member Coverage - 10
• Children’s Equity Act - 11
• Medicare Prescription Drug Plan (PDP) Employer Group Waiver Plan (EGWP) - 11
• When benefits and premiums start - 11
• When you retire - 12
When you lose benefits - 12
• When PSHB coverage ends - 12
• Upon divorce - 12
• Medicare PDP EGWP - 12
• Temporary Continuation of Coverage (TCC) - 13
• Finding replacement coverage - 13
• Health Insurance Marketplace - 13
• No pre-existing condition limitation - 9
• Minimum essential coverage (MEC) - 9
• Minimum value standard - 9
• Where you can get information about enrolling in the PSHB Program - 9
• Enrollment types available for you and your family - 9
• Family Member Coverage - 10
• Children’s Equity Act - 11
• Medicare Prescription Drug Plan (PDP) Employer Group Waiver Plan (EGWP) - 11
• When benefits and premiums start - 11
• When you retire - 12
When you lose benefits - 12
• When PSHB coverage ends - 12
• Upon divorce - 12
• Medicare PDP EGWP - 12
• Temporary Continuation of Coverage (TCC) - 13
• Finding replacement coverage - 13
• Health Insurance Marketplace - 13
Section 1. How This Plan Works - 14
General features of our Standard and Basic Options - 14
We have a Preferred Provider Organization (PPO) - 14
How we pay professional and facility providers - 14
Your rights and responsibilities - 15
Your medical and claims records are confidential - 15
We have a Preferred Provider Organization (PPO) - 14
How we pay professional and facility providers - 14
Your rights and responsibilities - 15
Your medical and claims records are confidential - 15
Identification cards - 17
Where you get covered care - 17
Balance Billing Protection - 17
• Covered professional providers - 17
• Covered facility providers - 17
What you must do to get covered care - 19
• Transitional care - 20
• If you are hospitalized when your enrollment begins - 20
You need prior Plan approval for certain services - 21
• Inpatient hospital admission, inpatient residential treatment center admission, or skilled nursing facility admission - 21
• Other services - 21
• Surgery by Non-participating providers under Standard Option - 24
How to request precertification for an admission or get prior authorization for Other services - 24
• Non-urgent care claims - 25
• Urgent care claims - 25
• Concurrent care claims - 25
Where you get covered care - 17
Balance Billing Protection - 17
• Covered professional providers - 17
• Covered facility providers - 17
What you must do to get covered care - 19
• Transitional care - 20
• If you are hospitalized when your enrollment begins - 20
You need prior Plan approval for certain services - 21
• Inpatient hospital admission, inpatient residential treatment center admission, or skilled nursing facility admission - 21
• Other services - 21
• Surgery by Non-participating providers under Standard Option - 24
How to request precertification for an admission or get prior authorization for Other services - 24
• Non-urgent care claims - 25
• Urgent care claims - 25
• Concurrent care claims - 25
Go to Inside cover. Go to page 2.