2025 Blue Cross and Blue Shield Service Benefit Plan - Standard and Basic Option
Index
Page 168
Index
Page 168
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
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
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
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 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