2025 Blue Cross and Blue Shield Service Benefit Plan - Standard and Basic Option
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 - 47-48, 136-137
Accidental injury - 19-20, 90-93, 123-124, 157
Acupuncture - 60-61, 73-74
Affordable Care Act (ACA) - 116-121
Allergy care - 51-52
Allogeneic transplants - 69-71
Alternative treatments - 60-61
Ambulance - 88-89
Ambulatory surgical center - 78-82
Anesthesia - 73-74
Angiographies - 40-41, 78-82
Appeals - 27, 142-144
Applied behavior analysis (ABA) - 52-53, 78-82
Assistant surgeon - 19-20, 62-64
Autism spectrum disorder - 52-53, 78-82
Autologous transplants - 69-71
Average wholesale price (AWP) - 104-108, 161-163
Biopsies - 63-64, 78-82
Birthing centers - 17-19
Blood and blood plasma - 58-59, 78-82
Blood or marrow stem cell transplants - 68-73
Blue Distinction Centers - 17-19, 72-73, 82-83 Blue Health Assessment - 127-128,159
Bone density tests - 40-41, 78-82
Brand-name drugs - 100-101, 104-108, 110-111
Breast pump and supplies - 47-48
Breast reconstruction - 64-66Breastfeeding support and supplies - 47-48
Cancer Tests - 42-44
Cardiac rehabilitation - 52-53, 78-82
Cardiovascular monitoring - 40-41, 78-82
Care Management Programs - 129-130
Case management - 85-87, 129-131
Casts - 76-82
Catastrophic protection - 33-34, 112-113, 170, 172
Cervical cancer screening - 42-46
CHAMPVA - 146-147
Changes for 2025 - 16
Chemotherapy - 52-53, 78-82
Children’s Equity Act - 11
Chiropractic manipulative treatment - 60
Cholesterol tests - 42-44
Circumcision - 47-48, 63-64
Claims and claims filing - 138-141
Clinic visits - 39-40, 95-96
Clinical trials - 71, 148-149
Cognitive rehabilitation - 53-54, 78-82
Coinsurance - 29-32
Colorectal cancer tests - 42-44Confidentiality - 14-15
Congenital anomalies - 63-64, 158
Consultations - 39-40, 95-96
Contact lenses - 54-55
Contraceptive devices and drugs - 49-50, 104-108, 113-121
Coordination of benefits - 146-156
Copayments - 28
Cosmetic surgery - 63-66, 158
Cost-sharing - 28
Costs for covered services - 28-34
Coverage information - 9
Covered facility providers - 17-19
Covered professional providers - 17
CT scans - 40-41, 78-82
Custodial care - 76-78, 83-85, 96-98, 158
Daily Habits - 127
Deductible - 28
Definitions - 157-166
Dental care - 123-126
Diabetes Management Program - 127
Diabetic education - 61, 78-82
Diabetic supplies - 57-59, 116-121
Diagnostic tests - 40-41, 94-98
Dialysis - 52-53, 57-58, 78-82
Disease Management - 129-130
Disputed claims process - 142-144
Divorce - 12
DNA analysis of stool samples - 42-44
Donor expenses (transplants) - 71-72
Drugs (see: Prescription drugs)
Durable medical equipment (DME) - 57-58 Educational Classes and Programs - 61
EEGs - 40-41, 78-82
EKGs - 40-41, 78-82
Emergency - 88-93
Enrollment - 9-10
Exception situations - 19-21
Exclusions - 136-137
Experimental or investigational - 136-137, 159
Extended care benefits - 84-85
Eyeglasses - 54-55
Facility Providers - 17-19
Family planning - 49-50
Fecal occult blood test - 42-44
FEDVIP - 123, 148
fepblue mobile application - 131
fepblue.org - 4
Flexible benefits option - 130-131
Foot care - 56
Formulary/Preferred drug list - 100-101, 110-111
Foundation for the Accreditation of Cellular Therapy (FACT) accredited facility - 17-19, 68
Fraud - 4-5
Freestanding ambulatory facilities - 17-19
Gender Affirming Care - 64-66
Generic drugs - 100-101, 110-111
Generic Incentive Program - 102-104
Genetic screening/testing - 40-41, 78-82
Health Insurance Marketplace - 13
Health Tools - 127
Healthy Families - 127
Hearing aids and hearing services - 54, 56-57, 135
Home health services - 59 -60
Home nursing care (maternity) - 47-48, 59-60
Hospice care - 85-87
HospitalHuman papillomavirus (HPV) tests - 42-46
Hypertension Management Program - 128
Immunizations - 42-46, 116-121
Inpatient hospital benefits - 76-78
Inpatient professional services - 39-40, 95-96
Insulin - 104-108, 113-116
Insulin pumps - 57-58
Laboratory and Pathology Services - 19-20
Low-dose CT screening - 164
Mail Service Prescription Drug Program - 99-101, 104-108, 113-116, 133-134, 139-140
Mammograms - 42-44
Manipulative treatment - 60, 78-82
Maternity care - 26, 47-48
Maxillofacial surgery - 67
Medicaid - 147
Medical emergency -76-78, 90, 92-93
Medical foods - 58-59, 102-108, 112-116, 160
Medical supplies - 58-59, 76-82, 85-87
Medically necessary - 5-6
Member facilities - 161-163
Mental health/substance use disorder - 94-98
MRIs - 40-41, 78-82
Multiple procedures - 63-64
MyBlue Customer eService - 129
National Doctor & Hospital Finder - 129
Neurological testing - 40-41, 78-82
Never Events - 6-8, 161
Newborn care - 26, 47-48
No Surprises Act (NSA) - 32
Non-member facilities - 161-163
Non-participating providers - 14-15, 24, 161-163
Non-preferred providers - 29-32
Non-PSHB benefits - 135
Nurse - 59-60, 85-87, 127
Nutritional counseling - 17, 39-40, 42-46
Observation Care - 161
Obstetrical care - 47-48
Occupational therapy - 53-54, 85-87
Office visits - 39-40, 95-96
Oral surgery - 67
Organ/tissue transplants - 68, 71-73
Orthopedic devices - 56-57, 78-82
Osteopathic manipulative treatment - 60
Osteoporosis screening - 164
Ostomy and catheter supplies - 58-59
Out-of-pocket expenses - 33-34, 37, 161-163
Outpatient facility services - 47-48, 82-83
Outpatient professional services - 39-40
Overpayments - 34
Overseas Assistance Center - 132
Overseas services, drugs, supplies and claims - 132-134
Oxygen - 57-59, 85-87
Pap Tests - 42-46
Participating providers - 14-15
Patient Safety and Quality Monitoring (PSQM) Program - 101-102
Personal Health Record - 127
PET scans - 40-41, 78-82
Pharmacotherapy - 39-40, 52-53
Physical examination - 42-46, 136-137
Physical therapy - 53-54, 85-87
Physician - 14-15, 17, 19-20
Plan allowance - 161-163
PPO - 14-15, 164
Pre-admission testing - 76-78
Precertification - 21, 164
Preferred providers - 14-15, 17, 29-32
Pregnancy (see: Maternity care)
Pregnancy Care Incentive Program -128-129
Prescription drugs - 99-122
Prior approval - 21-25, 102-104, 112-113
Professional providers - 17
Prostate cancer tests - 42-44
Prosthetic devices - 56-57, 76-82
Psychotherapy - 95-97
Pulmonary rehabilitation - 52-53, 78-82
Radiation Therapy - 52-53, 78-82
Reconsiderations - 26-27, 142-144
Renal dialysis - 52-53, 78-82
Replacement coverage - 13
Reproductive services - 50-51, 157 Residential Treatment Center (RTC) - 17-19, 21, 83-84, 96-97
Retail Pharmacy Program - 99-100, 133-134, 139-140
Rights and responsibilities - 14-15
Room and board - 76-78, 83-84, 96-97
Screening Services - 164
Second surgical opinion - 39-40
Self-injectable drugs - 99-100
Skilled nursing facility (SNF) care - 17-19, 21, 84-85
Smoking cessation - 61, 116-121, 127
Social worker - 129-130
Specialty Drug Pharmacy Program - 99-101, 104-108, 133-134, 139-140
Specialty drugs - 100-101, 104-108, 110-111, 165
Speech therapy - 53-54, 78-82, 85-87
Speech-Generating Devices - 57-58
Stem Cell Transplants - 68-71
Sterilization procedures - 49-50, 63-64
Subrogation - 147-148, 165
Substance use disorder - 17-19, 83-84, 94-98, 131
Surgery - 17-19, 21, 24, 54-55, 62-74, 82-83, 158
Telehealth - 17, 39-40, 95-96, 131, 165
Tobacco cessation - 61, 116 -121, 127
Transplants - 21-24, 62-74
Travel benefit - 72-73, 127
Treatment therapies - 52-53
TRICARE - 146-147
Ultrasounds - 40-41, 78-82
Urgent care center - 90-93
Urgent care claims - 25, 165-166
VA Facilities - 34, 155
Vision services - 54-55, 148
Waivers - 29
Weight control - 127-128, 135
Wheelchairs - 57-58
Wigs - 56-57
X-rays - 19-20, 40-41, 78-82
Accidental injury - 19-20, 90-93, 123-124, 157
Acupuncture - 60-61, 73-74
Affordable Care Act (ACA) - 116-121
Allergy care - 51-52
Allogeneic transplants - 69-71
Alternative treatments - 60-61
Ambulance - 88-89
Ambulatory surgical center - 78-82
Anesthesia - 73-74
Angiographies - 40-41, 78-82
Appeals - 27, 142-144
Applied behavior analysis (ABA) - 52-53, 78-82
Assistant surgeon - 19-20, 62-64
Autism spectrum disorder - 52-53, 78-82
Autologous transplants - 69-71
Average wholesale price (AWP) - 104-108, 161-163
Biopsies - 63-64, 78-82
Birthing centers - 17-19
Blood and blood plasma - 58-59, 78-82
Blood or marrow stem cell transplants - 68-73
Blue Distinction Centers - 17-19, 72-73, 82-83 Blue Health Assessment - 127-128,159
Bone density tests - 40-41, 78-82
Brand-name drugs - 100-101, 104-108, 110-111
Breast pump and supplies - 47-48
Breast reconstruction - 64-66Breastfeeding support and supplies - 47-48
Cancer Tests - 42-44
Cardiac rehabilitation - 52-53, 78-82
Cardiovascular monitoring - 40-41, 78-82
Care Management Programs - 129-130
Case management - 85-87, 129-131
Casts - 76-82
Catastrophic protection - 33-34, 112-113, 170, 172
Cervical cancer screening - 42-46
CHAMPVA - 146-147
Changes for 2025 - 16
Chemotherapy - 52-53, 78-82
Children’s Equity Act - 11
Chiropractic manipulative treatment - 60
Cholesterol tests - 42-44
Circumcision - 47-48, 63-64
Claims and claims filing - 138-141
Clinic visits - 39-40, 95-96
Clinical trials - 71, 148-149
Cognitive rehabilitation - 53-54, 78-82
Coinsurance - 29-32
Colorectal cancer tests - 42-44Confidentiality - 14-15
Congenital anomalies - 63-64, 158
Consultations - 39-40, 95-96
Contact lenses - 54-55
Contraceptive devices and drugs - 49-50, 104-108, 113-121
Coordination of benefits - 146-156
Copayments - 28
Cosmetic surgery - 63-66, 158
Cost-sharing - 28
Costs for covered services - 28-34
Coverage information - 9
Covered facility providers - 17-19
Covered professional providers - 17
CT scans - 40-41, 78-82
Custodial care - 76-78, 83-85, 96-98, 158
Daily Habits - 127
Deductible - 28
Definitions - 157-166
Dental care - 123-126
Diabetes Management Program - 127
Diabetic education - 61, 78-82
Diabetic supplies - 57-59, 116-121
Diabetic Meter Program - 104-108
Insulin pumps - 57-58
Insulin, test strips, and lancets - 104-108, 113-116
Needles and disposable syringes - 104-108, 113-116
Diagnostic and treatment services - 39-40, 78-82 Insulin pumps - 57-58
Insulin, test strips, and lancets - 104-108, 113-116
Needles and disposable syringes - 104-108, 113-116
Diagnostic tests - 40-41, 94-98
Dialysis - 52-53, 57-58, 78-82
Disease Management - 129-130
Disputed claims process - 142-144
Divorce - 12
DNA analysis of stool samples - 42-44
Donor expenses (transplants) - 71-72
Drugs (see: Prescription drugs)
Durable medical equipment (DME) - 57-58 Educational Classes and Programs - 61
EEGs - 40-41, 78-82
EKGs - 40-41, 78-82
Emergency - 88-93
Enrollment - 9-10
Exception situations - 19-21
Exclusions - 136-137
Experimental or investigational - 136-137, 159
Extended care benefits - 84-85
Eyeglasses - 54-55
Facility Providers - 17-19
Family planning - 49-50
Fecal occult blood test - 42-44
FEDVIP - 123, 148
fepblue mobile application - 131
fepblue.org - 4
Flexible benefits option - 130-131
Foot care - 56
Formulary/Preferred drug list - 100-101, 110-111
Foundation for the Accreditation of Cellular Therapy (FACT) accredited facility - 17-19, 68
Fraud - 4-5
Freestanding ambulatory facilities - 17-19
Gender Affirming Care - 64-66
Generic drugs - 100-101, 110-111
Generic Incentive Program - 102-104
Genetic screening/testing - 40-41, 78-82
Health Insurance Marketplace - 13
Health Tools - 127
Healthy Families - 127
Hearing aids and hearing services - 54, 56-57, 135
Home health services - 59 -60
Home nursing care (maternity) - 47-48, 59-60
Hospice care - 85-87
HospitalHuman papillomavirus (HPV) tests - 42-46
Hypertension Management Program - 128
Immunizations - 42-46, 116-121
Inpatient hospital benefits - 76-78
Inpatient professional services - 39-40, 95-96
Insulin - 104-108, 113-116
Insulin pumps - 57-58
Laboratory and Pathology Services - 19-20
Low-dose CT screening - 164
Mail Service Prescription Drug Program - 99-101, 104-108, 113-116, 133-134, 139-140
Mammograms - 42-44
Manipulative treatment - 60, 78-82
Maternity care - 26, 47-48
Maxillofacial surgery - 67
Medicaid - 147
Medical emergency -76-78, 90, 92-93
Medical foods - 58-59, 102-108, 112-116, 160
Medical supplies - 58-59, 76-82, 85-87
Medically necessary - 5-6
Reimbursement account - 129
Medications and supplies - 104-108, 113-121 Member facilities - 161-163
Mental health/substance use disorder - 94-98
MRIs - 40-41, 78-82
Multiple procedures - 63-64
MyBlue Customer eService - 129
National Doctor & Hospital Finder - 129
Neurological testing - 40-41, 78-82
Never Events - 6-8, 161
Newborn care - 26, 47-48
No Surprises Act (NSA) - 32
Non-member facilities - 161-163
Non-participating providers - 14-15, 24, 161-163
Non-preferred providers - 29-32
Non-PSHB benefits - 135
Nurse - 59-60, 85-87, 127
Nutritional counseling - 17, 39-40, 42-46
Observation Care - 161
Obstetrical care - 47-48
Occupational therapy - 53-54, 85-87
Office visits - 39-40, 95-96
Oral surgery - 67
Organ/tissue transplants - 68, 71-73
Orthopedic devices - 56-57, 78-82
Osteopathic manipulative treatment - 60
Osteoporosis screening - 164
Ostomy and catheter supplies - 58-59
Out-of-pocket expenses - 33-34, 37, 161-163
Outpatient facility services - 47-48, 82-83
Outpatient professional services - 39-40
Overpayments - 34
Overseas Assistance Center - 132
Overseas services, drugs, supplies and claims - 132-134
Oxygen - 57-59, 85-87
Pap Tests - 42-46
Participating providers - 14-15
Patient Safety and Quality Monitoring (PSQM) Program - 101-102
Personal Health Record - 127
PET scans - 40-41, 78-82
Pharmacotherapy - 39-40, 52-53
Physical examination - 42-46, 136-137
Physical therapy - 53-54, 85-87
Physician - 14-15, 17, 19-20
Plan allowance - 161-163
PPO - 14-15, 164
Pre-admission testing - 76-78
Precertification - 21, 164
Preferred providers - 14-15, 17, 29-32
Pregnancy (see: Maternity care)
Pregnancy Care Incentive Program -128-129
Prescription drugs - 99-122
Brand-name drugs - 100-101, 110-111
Drugs from other sources - 121-122
Generic drugs - 100-101, 110-111
Mail Service Prescription Drug Program - 99-101, 104-108, 113-116
Preferred retail pharmacies - 99-100, 102-108, 116-121, 139-140
Retail Pharmacy Program - 99-100, 133-134
Self-injectable drugs - 99-100
Specialty Drug Pharmacy Program - 99-100, 104-108, 133-134, 139-140
Specialty drugs - 100-101, 104-108, 165
Preventive carePrimary care provider - 17, 37 Drugs from other sources - 121-122
Generic drugs - 100-101, 110-111
Mail Service Prescription Drug Program - 99-101, 104-108, 113-116
Preferred retail pharmacies - 99-100, 102-108, 116-121, 139-140
Retail Pharmacy Program - 99-100, 133-134
Self-injectable drugs - 99-100
Specialty Drug Pharmacy Program - 99-100, 104-108, 133-134, 139-140
Specialty drugs - 100-101, 104-108, 165
Prior approval - 21-25, 102-104, 112-113
Professional providers - 17
Prostate cancer tests - 42-44
Prosthetic devices - 56-57, 76-82
Psychotherapy - 95-97
Pulmonary rehabilitation - 52-53, 78-82
Radiation Therapy - 52-53, 78-82
Reconsiderations - 26-27, 142-144
Renal dialysis - 52-53, 78-82
Replacement coverage - 13
Reproductive services - 50-51, 157 Residential Treatment Center (RTC) - 17-19, 21, 83-84, 96-97
Retail Pharmacy Program - 99-100, 133-134, 139-140
Rights and responsibilities - 14-15
Room and board - 76-78, 83-84, 96-97
Screening Services - 164
Second surgical opinion - 39-40
Self-injectable drugs - 99-100
Skilled nursing facility (SNF) care - 17-19, 21, 84-85
Smoking cessation - 61, 116-121, 127
Social worker - 129-130
Specialty Drug Pharmacy Program - 99-101, 104-108, 133-134, 139-140
Specialty drugs - 100-101, 104-108, 110-111, 165
Speech therapy - 53-54, 78-82, 85-87
Speech-Generating Devices - 57-58
Stem Cell Transplants - 68-71
Sterilization procedures - 49-50, 63-64
Subrogation - 147-148, 165
Substance use disorder - 17-19, 83-84, 94-98, 131
Surgery - 17-19, 21, 24, 54-55, 62-74, 82-83, 158
Assistant surgeon - 19-20
Eye: cataract, amblyopia, strabismus - 54-55, 63-64
Gender affirming - 64-66
Multiple procedures - 63-64
Oral and maxillofacial - 67
Outpatient - 75-89
Reconstructive -64-66
Sterilization, reversal of voluntary - 49-50, 63-64
Surgical implants - 56-57, 78-82
Surgical treatment of severe obesity - 21-24
Transplants - 21-24, 68-73
Syringes - 104-108, 113-116 Eye: cataract, amblyopia, strabismus - 54-55, 63-64
Gender affirming - 64-66
Multiple procedures - 63-64
Oral and maxillofacial - 67
Outpatient - 75-89
Reconstructive -64-66
Sterilization, reversal of voluntary - 49-50, 63-64
Surgical implants - 56-57, 78-82
Surgical treatment of severe obesity - 21-24
Transplants - 21-24, 68-73
Telehealth - 17, 39-40, 95-96, 131, 165
Dermatology - 39-40, 131, 165
Mental health/substance use disorder - 95-96
Minor acute conditions -39-40, 131, 161
Nutritional counseling - 17, 42-46, 131
Temporary Continuation of Coverage (TCC) - 13 Mental health/substance use disorder - 95-96
Minor acute conditions -39-40, 131, 161
Nutritional counseling - 17, 42-46, 131
Tobacco cessation - 61, 116 -121, 127
Transplants - 21-24, 62-74
Travel benefit - 72-73, 127
Treatment therapies - 52-53
TRICARE - 146-147
Ultrasounds - 40-41, 78-82
Urgent care center - 90-93
Urgent care claims - 25, 165-166
VA Facilities - 34, 155
Vision services - 54-55, 148
Waivers - 29
Weight control - 127-128, 135
Wheelchairs - 57-58
Wigs - 56-57
X-rays - 19-20, 40-41, 78-82