2023 Blue Cross and Blue Shield Service Benefit Plan - FEP Blue Focus
Index
Index
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
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 supplies
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 drugs
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, 129
Telehealth
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
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
Breast prostheses and surgical bras - 52
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 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 Insulin pumps - 53-54
Insulin, test strips, and lancets - 93-100
Needles and disposable syringes - 93-100
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 drugs
Brand-name drugs - 93-100
Drugs from other sources - 100
Generic drugs - 93-100
Preferred retail pharmacies - 93-100, 114
Retail Pharmacy Program - 89-90, 108-109
Self-injectable drugs - 93-100
Specialty Drug Pharmacy Program - 89-90, 93-100, 114
Specialty drugs - 93-100, 134
Preventive carePrimary care provider (PCP) - 34 Drugs from other sources - 100
Generic drugs - 93-100
Preferred retail pharmacies - 93-100, 114
Retail Pharmacy Program - 89-90, 108-109
Self-injectable drugs - 93-100
Specialty Drug Pharmacy Program - 89-90, 93-100, 114
Specialty drugs - 93-100, 134
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, 129
Assistant surgeon - 18
Eye: cataract, amblyopia, strabismus - 57-59
Gender affirming - 19-24, 57-59
Multiple procedures - 56-59
Oral and maxillofacial - 61
Outpatient - 57-59, 73-76
Reconstructive - 19-22, 59-61
Sterilization, reversal of voluntary - 47, 57-59
Surgical implants - 52, 73-76
Surgical treatment of morbid obesity - 19-22, 57-59
Transplants - 19-22, 61-68
Syringes - 93-100Eye: cataract, amblyopia, strabismus - 57-59
Gender affirming - 19-24, 57-59
Multiple procedures - 56-59
Oral and maxillofacial - 61
Outpatient - 57-59, 73-76
Reconstructive - 19-22, 59-61
Sterilization, reversal of voluntary - 47, 57-59
Surgical implants - 52, 73-76
Surgical treatment of morbid obesity - 19-22, 57-59
Transplants - 19-22, 61-68
Telehealth
Dermatology - 39-40, 135
Mental health/substance use disorder - 85-86, 135
Minor acute conditions - 39-40, 131
Nutritional counseling - 41-45, 105
Temporary Continuation of Coverage (TCC) - 11-12Mental health/substance use disorder - 85-86, 135
Minor acute conditions - 39-40, 131
Nutritional counseling - 41-45, 105
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