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This brochure version is for internal use only.
 
 
2023 Blue Cross and Blue Shield Service Benefit Plan - FEP Blue Focus
Index

Page 137
 
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 - 45-4771-73111-112     
Accidental injury - 80-83101  
Acupuncture - 5573-76  
Affordable Care Act (ACA) - 912  
Allergy care - 48 
Allogeneic transplants - 63-68  
Alternative treatments - 55 
Ambulance - 19-2280  
Ambulatory surgical center - 73-76100  
Anesthesia - 45-4770-76102  
Angiographies - 40-4173-76  
Appeals - 27115-118  
Applied behavior analysis (ABA) - 19-224973-76111-112 
Assistant surgeon - 18 
Autism spectrum disorder - 4973-76111-112  
Autologous transplants - 61-68 
Biopsies - 41-4457-5973-76   
Birthing centers - 17-182445-4770-73    
Blood and blood plasma - 5473-76  
Blood or marrow stem cell - 19-224961-68  
Blue Distinction Centers - 17-18 
for Transplants - 19-2266-68  
Blue Distinction Specialty Care - 17-22 
Blue Health Assessment - 41-44103130  
Bone density tests - 40-4173-76  
Brand-name drugs - 93 -100 
BRCA - 19-2240-44  
Breast pump and supplies - 45-47 
Breast reconstruction - 59-61 
Breast prostheses and surgical bras - 52 
Breastfeeding support and supplies - 45-47, 71-73  
Cancer tests - 41-44 
Cardiac rehabilitation - 19-224973-76  
Cardiovascular monitoring - 40-4173-76  
Care Management Programs - 104 
Case management - 104 
Casts - 57-5970-7173-76  
Catastrophic protection - 30126-127141  
Cervical cancer screening - 41-45 
CHAMPVA - 119-120 
Changes for 2022 - 15 
Chemotherapy - 4966-6873-76  
Children’s Equity Act - 10-11 
Chiropractic manipulative treatment - 4955  
Cholesterol tests - 40-44 
Circumcision - 45-4757-5971-73  
Claims and claims filing
Overseas - 30108-109 
Post-service - 26113-114116133    
Pre-service - 1926-27134  
Clinic visits - 39-4073-7685-86  
Clinical trials - 19-2263-65121-122128    
Cognitive rehabilitation - 5073-77113  
Coinsurance - 28107128  
Colonoscopy - 41-4457-5973-76  
Colorectal cancer tests
Colonoscopy - 41-4457-5973-76  
Fecal occult blood test - 41-44 
Sigmoidoscopy - 41-44 
Confidentiality - 13-14 
Congenital anomalies - 19-2257-59129  
Consultations - 39-4085-86  
Contact lenses - 51-52110  
Contraceptives - 4773-7693-100 
Coordination of benefits - 119-127  
Copayments - 28 
CORE benefits - 34-37   
Cosmetic surgery - 57-61129  
Cost-share/cost-sharing - 28 
Costs for covered services - 28-31 
Coverage information - 9 
Covered facility providers - 17-18 
Covered professional providers - 16 
CT scans - 40-4173-76128
Custodial or long term care - 129 
Deductible - 28 
Definitions - 128-136 
Dental care - 101-102110121   
Diabetic education - 5573-76  
Diabetic supplies
Diabetic Meter Program - 93-100 
Insulin pumps - 53-54  
Insulin, test strips, and lancets - 93-100 
Needles and disposable syringes - 93-100
Diagnostic and treatment services - 39-40 
Diagnostic tests - 40-4185-88  
Dialysis - 4953-5473-76  
Disease Management - 104
Disputed claims - 27116-118  
Divorce - 12 
DNA analysis of stool samples - 41-44 
Donor expenses - 66-68 
Drugs (see: Prescription drugs)
Durable medical equipment - 53-5473-76129  
Prosthetic devices - 19-2270-7173-76    
Educational classes and programs - 55 
EEGs - 40-4173-76
EKGs - 40-4173-76
Emergency - 182680-84101107    
Enrollment - 9-101618-19 
Exception situations - 18 
Exclusions - 111-112
Experimental or investigational - 61-63111-112130  
Extended care benefits - 77 
Eyeglasses - 51-52 
Facility providers - 17-18 
Family planning - 47 
Fecal occult blood test - 41-44 
FEDVIP - 27101121  
fepblue mobile application - 106 
fepblue.org - 4  
Flexible benefits option - 105 
Foot care - 52 
Formulary/Preferred drug list - 91 
Fraud - 4-5 
Gender affirming care - 19-225256-5969   
Generic drugs - 93-100 
Generic equivalents - 89-90 
Genetic screening/testing - 19-2240-4173-76  
Health Insurance Marketplace - 12 
Health tools - 103 
Healthy Families - 103 
Hearing aids and hearing services - 50-51 
Home health services - 54-55 
Home nursing care (maternity) - 45-4754-55 
Hospice care - 77-79 
Hospital - 17-18  
inpatient - 70-7187102125  
outpatient - 73-7688102    
Human papillomavirus (HPV) tests - 41-45 
Hypertension Management Program - 103-104 
Identification cards - 16 
Immunizations - 41-4593-100  
Inpatient hospital benefits - 70-71 
Inpatient professional services - 39-4085-86  
Insulin - 93-100 
Insulin pumps - 53-54 
Intensity-modulated radiation therapy (IMRT) - 19-2249  
Laboratory and pathology services - 18 
Low-dose CT screening - 134 
Mammograms - 41-44 
Manipulative treatment - 55 
Maternity care - 242645-47  
Maxillofacial surgery - 61 
Medicaid - 120 
Medical emergency - 8183-84  
Medical foods - 5493-100131  
Medical supplies - 5470-7993-100   
Medically necessary - 192326111-112131    
Medicare - 123-24119-127  
Medications and supplies - 93-100 
 
Services provided by a hospital:
 
  • Inpatient (pages 69-70)
You pay:

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

Non-preferred (Member/Non-member): You pay all charges
 
  • Outpatient (pages 72-75)
You pay:

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

Non-preferred (Member/Non-member): You pay all charges
 
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