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This brochure version is for internal use only.

2023 Blue Cross and Blue Shield Service Benefit Plan - FEP Blue Focus
Table of Contents
Page 1

Table of Contents

Introduction - 4
Plain Language - 4
Stop Healthcare Fraud! - 4
Discrimination is Against the Law - 5
Preventing Medical Mistakes - 6
FEHB Facts - 9

Coverage information - 9

• No pre-existing condition limitation - 9
• Minimum essential coverage (MEC) - 9
• Minimum value standard - 9
• Where you can get information about enrolling in the FEHB Program - 9
• Types of coverage available for you and your family - 9
• Family member coverage - 10
• Children’s Equity Act - 10
• When benefits and premiums start - 11
• When you retire - 11

When you lose benefits - 11

• When FEHB coverage ends - 11
• Upon divorce - 12
• Temporary Continuation of Coverage (TCC) - 12
• Finding replacement coverage - 12
• Health Insurance Marketplace - 12

Section 1. How This Plan Works - 13

General features of FEP Blue Focus - 13
We have a Preferred Provider Organization (PPO) - 13
How we pay professional and facility providers - 13
Your rights and responsibilities - 14
Your medical and claims records are confidential - 14

Section 2. Changes for 2023 - 15
Section 3. How You Get Care - 16

Identification cards - 16
Where you get covered care - 16
Balance Billing Protection - 16

• Covered professional providers - 16
• Covered facility providers - 17

What you must do to get covered care - 18

• Transitional care - 18
• If you are hospitalized when your enrollment begins - 18

You need prior Plan approval for certain services - 19

• Inpatient hospital admission, inpatient residential treatment center admission - 19
• Other services - 19
• Special prior authorization situations related to coordination of benefits (COB) - 23
• Prior notification – Maternity care - 24

How to request precertification for an admission or get prior approval for Other services - 24

• Non-urgent care claims - 25
• Urgent care claims - 25
• Concurrent care claims - 26
• Emergency inpatient admission - 26

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