2025 Blue Cross and Blue Shield Service Benefit Plan - Standard and Basic Option
Section 5. Benefits
Page 36
Section 5. Benefits
Page 36
Not Covered (Inpatient or Outpatient) - 97
Section 5(f). Prescription Drug Benefits - 99 Covered Medications and Supplies - 104
Section 5(f)(a). FEP Medicare Prescription Drug Plan - 109 Covered Medications and Supplies - 113
Section 5(g). Dental Benefits - 123 Section 5(h). Wellness and Other Special Features - 127 Health Tools - 127
Services for the Deaf and Hearing Impaired - 127
Web Accessibility for the Visually Impaired - 127
Travel Benefit/Services Overseas - 127
Healthy Families - 127
Diabetes Management Program - 127
Blue Health Assessment - 127
Hypertension Management Program - 128
Pregnancy Care Incentive Program - 128
Annual Incentive Limitation - 129
Reimbursement Account for Basic Option Members Enrolled in Medicare Part A and Part B - 129
MyBlue® Customer eService - 129
National Doctor & Hospital Finder - 129
Care Management Programs - 129
Flexible Benefits Option - 130
Telehealth Services - 131
The fepblue Mobile Application - 131
Section 5(i). Services, Drugs, and Supplies Provided Overseas - 132 Services for the Deaf and Hearing Impaired - 127
Web Accessibility for the Visually Impaired - 127
Travel Benefit/Services Overseas - 127
Healthy Families - 127
Diabetes Management Program - 127
Blue Health Assessment - 127
Hypertension Management Program - 128
Pregnancy Care Incentive Program - 128
Annual Incentive Limitation - 129
Reimbursement Account for Basic Option Members Enrolled in Medicare Part A and Part B - 129
MyBlue® Customer eService - 129
National Doctor & Hospital Finder - 129
Care Management Programs - 129
Flexible Benefits Option - 130
Telehealth Services - 131
The fepblue Mobile Application - 131
Non-PSHB Benefits Available to Plan Members - 135