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This brochure version is for internal use only.

2023 Blue Cross and Blue Shield Service Benefit Plan - FEP Blue Focus
Section 5(a). Medical Services and Supplies Provided by Physicians and Other Healthcare Professionals
Page 55

Benefit Description

Home Health Services (cont.)

Services provided by a nurse, nursing assistant, health aide, or other similarly licensed or unlicensed person that are billed by a skilled nursing facility, extended care facility, or nursing home
Private duty nursing

You Pay
All charges

Benefit Description

Alternative/Manipulative Treatment
Benefits for manipulative treatment and acupuncture are subject to a combined limit of 10 visits per person per calendar year

Acupuncture is covered when performed and billed by a healthcare provider who is licensed or certified to perform acupuncture by the state where the services are provided, and who is acting within the scope of that license or certification. See page 16 for more information.

Note: See page 68 for our coverage of acupuncture when provided as anesthesia for covered surgery.

Note: See page 45 for our coverage of acupuncture when provided as anesthesia for covered maternity care.
Manipulative treatment limited to:
- Osteopathic manipulative treatment to any body region
- Chiropractic spinal and/or extraspinal manipulative treatment

See Section 5(c), page 75, for facility benefits.

You Pay
Preferred: $25 copayment per visit (no deductible)

Non-preferred (Participating/Non-participating): You pay all charges

Note: You pay 30% of the Plan allowance (deductible applies) for agents, drugs, and/or supplies administered or obtained in connection with your care. (See page 128 for more information about “agents.”)

Benefit Description
Not covered:

Biofeedback
Self-care or self-help training

You Pay
All charges

Benefit Description

Educational Classes and Programs

Smoking and tobacco cessation treatment including:
- Counseling for smoking and tobacco use cessation
- Smoking and tobacco cessation classes
  Note: See Section 5(f) for our coverage of smoking and tobacco cessation drugs.

You Pay
Preferred: Nothing (no deductible)

Non-preferred (Participating/Non-participating): You pay all charges

Benefit Description

Diabetic education

Note: See pages 39, 41 and 44 for our coverage of nutritional counseling services that are not part of a diabetic education program.

You Pay
Preferred: 30% of the Plan allowance (deductible applies)

Non-preferred (Participating/Non-participating): You pay all charges

Benefit Description
Not covered:

Marital, family, educational, or other counseling or training services, or applied behavior analysis (ABA), when performed as part of an educational class or program
Premenstrual syndrome (PMS), lactation (except as described on page 46), headache, eating disorder (except as described on page 39), and other educational clinics
Recreational or educational therapy, and any related diagnostic testing except as provided by a hospital as part of a covered inpatient stay
Services performed or billed by a school or halfway house or a member of its staff

You Pay
All charges

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