2023 Blue Cross and Blue Shield Service Benefit Plan - FEP Blue Focus
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 - 45-47, 71-73, 111-112     
Accidental injury - 80-83, 101  
Acupuncture - 55, 73-76  
Affordable Care Act (ACA) - 9, 12  
Allergy care - 48 
Allogeneic transplants - 63-68  
Alternative treatments - 55 
Ambulance - 19-22, 80  
Ambulatory surgical center - 73-76, 100  
Anesthesia - 45-47, 70-76, 102  
Angiographies - 40-41, 73-76  
Appeals - 27, 115-118  
Applied behavior analysis (ABA) - 19-22, 49, 73-76, 111-112 
Assistant surgeon - 18 
Autism spectrum disorder - 49, 73-76, 111-112  
Autologous transplants - 61-68 
Biopsies - 41-44, 57-59, 73-76   
Birthing centers - 17-18, 24, 45-47, 70-73    
Blood and blood plasma - 54, 73-76  
Blood or marrow stem cell - 19-22, 49, 61-68  
Blue Distinction Centers - 17-18 
for Transplants - 19-22, 66-68  
Blue Distinction Specialty Care - 17-22 
Blue Health Assessment - 41-44, 103, 130  
Bone density tests - 40-41, 73-76  
Brand-name drugs - 93 -100 
BRCA - 19-22, 40-44  
Breast pump and supplies - 45-47 
Breast reconstruction - 59-61 Breastfeeding support and supplies - 45-47, 71-73  
Cancer tests - 41-44 
Cardiac rehabilitation - 19-22, 49, 73-76  
Cardiovascular monitoring - 40-41, 73-76  
Care Management Programs - 104 
Case management - 104 
Casts - 57-59, 70-71, 73-76  
Catastrophic protection - 30, 126-127, 141  
Cervical cancer screening - 41-45 
CHAMPVA - 119-120 
Changes for 2022 - 15 
Chemotherapy - 49, 66-68, 73-76  
Children’s Equity Act - 10-11 
Chiropractic manipulative treatment - 49, 55  
Cholesterol tests - 40-44 
Circumcision - 45-47, 57-59, 71-73  
Claims and claims filingClinic visits - 39-40, 73-76, 85-86  
Clinical trials - 19-22, 63-65, 121-122, 128    
Cognitive rehabilitation - 50, 73-77, 113  
Coinsurance - 28, 107, 128  
Colonoscopy - 41-44, 57-59, 73-76  
Colorectal cancer testsConfidentiality - 13-14 
Congenital anomalies - 19-22, 57-59, 129  
Consultations - 39-40, 85-86  
Contact lenses - 51-52, 110  
Contraceptives - 47, 73-76, 93-100 
Coordination of benefits - 119-127  
Copayments - 28 
CORE benefits - 34-37   
Cosmetic surgery - 57-61, 129  
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 - 40-41, 73-76, 128
Custodial or long term care - 129 
Deductible - 28 
Definitions - 128-136 
Dental care - 101-102, 110, 121   
Diabetic education - 55, 73-76  
Diabetic suppliesDiagnostic and treatment services - 39-40 
Diagnostic tests - 40-41, 85-88  
Dialysis - 49, 53-54, 73-76  
Disease Management - 104
Disputed claims - 27, 116-118  
Divorce - 12 
DNA analysis of stool samples - 41-44 
Donor expenses - 66-68 
Drugs (see: Prescription drugs)
Durable medical equipment - 53-54, 73-76, 129  Educational classes and programs - 55 
EEGs - 40-41, 73-76
EKGs - 40-41, 73-76
Emergency - 18, 26, 80-84, 101, 107    
Enrollment - 9-10, 16, 18-19 
Exception situations - 18 
Exclusions - 111-112
Experimental or investigational - 61-63, 111-112, 130  
Extended care benefits - 77 
Eyeglasses - 51-52 
Facility providers - 17-18 
Family planning - 47 
Fecal occult blood test - 41-44 
FEDVIP - 27, 101, 121  
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 - 19-22, 52, 56-59, 69   
Generic drugs - 93-100 
Generic equivalents - 89-90 
Genetic screening/testing - 19-22, 40-41, 73-76  
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) - 45-47, 54-55 
Hospice care - 77-79 
Hospital - 17-18  Human papillomavirus (HPV) tests - 41-45 
Hypertension Management Program - 103-104 
Identification cards - 16 
Immunizations - 41-45, 93-100  
Inpatient hospital benefits - 70-71 
Inpatient professional services - 39-40, 85-86  
Insulin - 93-100 
Insulin pumps - 53-54 
Intensity-modulated radiation therapy (IMRT) - 19-22, 49  
Laboratory and pathology services - 18 
Low-dose CT screening - 134 
Mammograms - 41-44 
Manipulative treatment - 55 
Maternity care - 24, 26, 45-47  
Maxillofacial surgery - 61 
Medicaid - 120 
Medical emergency - 81, 83-84  
Medical foods - 54, 93-100, 131  
Medical supplies - 54, 70-79, 93-100   
Medically necessary - 19, 23, 26, 111-112, 131    
Medicare - 1, 23-24, 119-127  
Medications and supplies - 93-100 
Medications to promote better health - 44-45, 93-100 
Member facilities - 17-18
Mental health/substance use disorder - 85-88
MRIs - 40-41, 73-76, 128
Multiple procedures - 57-59  
MyBlue Customer eService - 104
National Doctor & Hospital Finder - 104
Neurological testing - 40-41, 73-76
Never Events - 6-8, 131
Newborn care - 26, 39-40, 44-47, 71-73
No Surprises Act (NSA) - 29-30
NON-CORE benefits - 34-37
Non-member facilities - 17-18
Non-participating providers - 29-30, 133
Non-preferred providers - 16, 29-30
Nurse - 54-55, 77-79
Nutritional counseling - 39-45, 57-59, 70-73
Observation care - 132
Obstetrical care - 45-47, 71-73
Occupational therapy - 50, 73-79
Office visits - 39-40, 85-86
Online Health Coach (OHC) - 103
Oral surgery - 61
Organ/tissue transplants - 19-22, 61-63, 65-68
Orthopedic devices - 52, 59-61, 73-76
Osteoporosis screening - 134 
Ostomy and catheter supplies - 54
Out-of-pocket expenses - 30, 133
Outpatient facility services - 73-76, 102
Outpatient professional services - 39-40, 85-86
Overpayments - 31
Overseas Assistance Center - 107 
Overseas services, drugs, supplies and claims - 30, 107-109 
Oxygen - 53-54, 70-79
Pap tests - 41-45
Participating providers - 29-30
Patient Safety and Quality Monitoring (PSQM) program - 89-90 
Personal Health Record - 103
PET scans - 40-41, 73-76, 128
Pharmacotherapy - 39-40, 49 
Physical examinations - 73-76, 111-112  
Physical therapy - 50, 73-79
Physician - 16, 123, 126, 130, 133
Plan allowance - 29, 132-133
PPO - 13-14, 17-18, 133
Pre-admission testing - 70-71
Precertification - 19-22, 24-26, 56-57, 69, 76-77, 85, 87,133-134
Preferred providers - 13-14, 16, 104
Pregnancy (see: Maternity care)
Prescription drugsPreventive carePrimary care provider (PCP) - 34 
Prior approval - 19-25, 40-44, 49, 53-54, 56-59, 61-63, 66-69, 73-80, 85-86, 89-90, 134 
Professional providers - 16
Prostate cancer - 41-44
Prosthetic devices - 52, 57-59, 70-71, 73-76
Psychotherapy - 85-88 
Pulmonary rehabilitation - 49, 73-76
Radiation therapy - 49, 73-76
Reconsiderations - 27, 116-118
Replacement coverage - 11-12
Reproductive services - 47-48, 128Residential treatment center (RTC) - 17-19, 24-26, 76-77, 87 
Rights and responsibilities - 13-14
Room and board - 70-71, 76-77, 87
Routine Annual Physical Incentive Program - 106
Screening services - 134
Second surgical opinion - 39, 40
Self-injectable drugs - 89-100
Skilled nursing facility (SNF) care - 77, 129
Smoking cessation - 55, 93-100
Social worker - 104
Specialty Drug Pharmacy Program - 93-100, 108-109, 114
Specialty drugs - 89-100, 134
Speech therapy - 50, 73-79
Speech-generating devices - 53-54
Stem cell transplants - 19-22, 61-63
Sterilization procedures - 47, 57-59
Subrogation - 120-121, 135 
Substance use disorder - 85-88
Surgery - 17-22, 51-52, 56-69, 129Syringes - 93-100
TelehealthTemporary Continuation of Coverage (TCC) - 11-12
Tobacco cessation - 55, 93-100
Transplants - 17-22, 49, 61-68
Travel benefit - 66-68,103 
Treatment therapies - 49-50
TRICARE - 119-122 -
Ultrasounds - 40-41, 73-76
Urgent care center - 82-84
Urgent care claims - 25, 135
VA facility - 126 
Vaccines - 41-45, 93-100
Verbal statements - 4, 27, 104
Vision services - 51-52
Waivers - 29
Weight control - 19-22, 57-59
Wheelchairs - 53-54
Wigs - 37, 52 
WRAP benefits - 34-37
X-rays - 40-41, 73-76