2024 Blue Cross and Blue Shield Service Benefit Plan - Standard and Basic Option
Section 1. How This Plan Works
General features of our Standard and Basic Options/We have a Preferred Provider Organization (PPO)
Section 1. How This Plan Works
General features of our Standard and Basic Options/We have a Preferred Provider Organization (PPO)
General features of our Standard and Basic Options
We have a Preferred Provider Organization (PPO)
Our fee-for-service Plan offers services through a PPO. This means that certain hospitals and other healthcare providers are “Preferred providers.” When you use our PPO (Preferred) providers, you will receive covered services at a reduced cost. Your Local Plan (or, for Preferred retail pharmacies, CVS Caremark) is solely responsible for the selection of PPO providers in your area. Contact your Local Plan for the names of PPO (Preferred) providers and to verify their continued participation. You can also visit www.fepblue.org/provider/ to use our National Doctor & Hospital Finder. You can reach our website through the PSHB website, www.opm.gov/healthcare-insurance.
Under Standard Option, PPO (Preferred) benefits apply only when you use a PPO (Preferred) provider. PPO networks may be more extensive in some areas than in others. We cannot guarantee the availability of every specialty in all areas. If no PPO (Preferred) provider is available, or you do not use a PPO (Preferred) provider, non-PPO (non-preferred) benefits apply.
Under Basic Option, you must use Preferred providers in order to receive benefits. See Section 3 for the exceptions to this requirement.
Note: Dentists and oral surgeons who are in our Preferred Dental Network for routine dental care are not necessarily Preferred providers for other services covered by this Plan under other benefit provisions (such as the surgical benefit for oral and maxillofacial surgery). Call us at the customer service phone number on the back of your ID card to verify that your provider is Preferred for the type of care (e.g., routine dental care or oral surgery) you are scheduled to receive.
We have a Preferred Provider Organization (PPO)
Our fee-for-service Plan offers services through a PPO. This means that certain hospitals and other healthcare providers are “Preferred providers.” When you use our PPO (Preferred) providers, you will receive covered services at a reduced cost. Your Local Plan (or, for Preferred retail pharmacies, CVS Caremark) is solely responsible for the selection of PPO providers in your area. Contact your Local Plan for the names of PPO (Preferred) providers and to verify their continued participation. You can also visit www.fepblue.org/provider/ to use our National Doctor & Hospital Finder. You can reach our website through the PSHB website, www.opm.gov/healthcare-insurance.
Under Standard Option, PPO (Preferred) benefits apply only when you use a PPO (Preferred) provider. PPO networks may be more extensive in some areas than in others. We cannot guarantee the availability of every specialty in all areas. If no PPO (Preferred) provider is available, or you do not use a PPO (Preferred) provider, non-PPO (non-preferred) benefits apply.
Under Basic Option, you must use Preferred providers in order to receive benefits. See Section 3 for the exceptions to this requirement.
Note: Dentists and oral surgeons who are in our Preferred Dental Network for routine dental care are not necessarily Preferred providers for other services covered by this Plan under other benefit provisions (such as the surgical benefit for oral and maxillofacial surgery). Call us at the customer service phone number on the back of your ID card to verify that your provider is Preferred for the type of care (e.g., routine dental care or oral surgery) you are scheduled to receive.