Enrollment

Most Frequently Asked Questions (FAQs)

Learn the answers to commonly asked questions about benefit options, enrolling, finding the right doctor, Medicare and other topics.

Customer Service FAQs

Can I continue coverage after my enrollment terminates?

Employees and/or their family members losing coverage may elect to continue coverage in a Federal Employee Health Benefit (FEHB) Plan or with the local Blue Cross Blue Shield Plan. Coverage ends for employees and eligible family members when the employee separates from Federal employment. Coverage can also end for eligible family members who no longer qualify as dependents. Coverage will be extended for 31 days at no cost after the enrollment terminates for any reason other than voluntary cancellation.

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Who do I call if I have a question about a claim payment?

If you have questions about a claim payment, please call the Blue Cross Blue Shield Plan listed on the Explanation of Benefits (EOB) that you received for your claim. If you do not have the EOB available, you may call the Customer Service phone number listed on the back of your identification card for further assistance. You can also find the contact information for your Local Plan in the Contact Us section of this Web site.

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Do I need a referral to see a specialist?

No, you do not need a referral to see a specialist.

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How can I request an additional or replacement identification card?

To request an additional or replacement ID card visit Customer eService or call your local Blue Cross Blue Shield Plan. To locate the contact information for your Local Plan, please visit the Contact Us section of this Web site.

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Enrollment & Benefits FAQs

How to continue coverage in an FEHB Plan?

Temporary Continuation of Coverage (TCC) allows former employees to continue their healthcare coverage for up to 18 months and eligible family members to continue their healthcare coverage for up to 36 months. Members enrolling in TCC are responsible for both the employee and employer share of the premium, plus an additional 2% administrative fee.

TCC is available to:

  1. Employees and/or their eligible family members when the employee separates from Federal service, except an involuntary separation due to gross misconduct
  2. Individuals who experience a change in circumstance that results in their being ineligible to be considered a dependent (e.g., divorce or annulment from employee, unmarried children who reach 26, or children under 22 who marry)

Spouse Equity allows certain former spouses of civil service employees, former employees and annuitants to continue coverage. Unlike TCC, there is no time limit on the length of enrollment. Coverage remains in effect as long as the former spouse is eligible. Former spouses are responsible for both the employee and employer share of the premium with no administrative fee.

Spouse Equity is available to:

  1. Former spouses who do not remarry before age 55
  2. Former spouses who were enrolled as a dependent any time during the 18 months preceding the divorce
  3. Former spouse who currently receives, or has future title to receive a portion of the annuity payable to the employee upon retirement

To verify eligibility and enroll, members electing TCC or Spouse Equity must contact their or the employee's employing agency (or OPM for annuitants).

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How to continue coverage with the local Blue Cross Blue Shield Plan?

Conversion coverage allows any employee, annuitant or family member to continue non-FEHB coverage with the local Blue Cross Blue Shield Plan. Unlike TCC or Spouse Equity, any member whose FEHB coverage has terminated for any reason is eligible. Coverage remains in effect as long as the policy is in force.

Members who do not qualify for or decide not to enroll in TCC or Spouse Equity are eligible for conversion. Members whose TCC or Spouse Equity coverage ends may also apply for conversion coverage offered by the terminated member's local Blue Cross Blue Shield Plan.

Benefits and rates for conversion coverage will differ from those under the FEHB Program. Benefits which may have been provided under the FEHB coverage are not guaranteed and do not in any way affect the benefits available to the member under conversion coverage. However, the local Blue Cross and Blue Shield Plan will not ask you questions about your health and will not impose a waiting period for pre-existing conditions.

For more information on conversion coverage offered by your local Blue Cross Blue Shield Plan, please contact the customer service number on the back of your Blue Cross Blue Shield Service Benefit Plan member ID card.

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What is the difference between Standard Option and Basic Option?

While both Options offer comprehensive benefits for you and your family, they are structured differently to complement different healthcare needs. Under Basic Option, you must use Preferred providers to provide all the medical care you and your family need. You pay a copayment for most services, and there is no deductible. Standard Option provides benefits regardless of whether you use a Preferred or Non-preferred provider; however, your out-of-pocket expenses will likely be lower if you choose a Preferred provider. For more information about the differences between the two Options, please visit the Compare Benefits section of this website or consult the Blue Cross and Blue Shield Service Benefit Plan brochure or use askblue.fepblue.org to learn more about the differences between Basic Option and Standard Option.

Whether you decide to enroll in Standard Option or Basic Option, please be sure to use the appropriate enrollment code:

 SelfSelf and Family
Standard Option104105
Basic Option111112

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Does the Service Benefit Plan offer dental benefits?

Yes. Both Standard Option and Basic Option offer some level of dental benefits. Basic Option provides coverage for preventive dental care services only while Standard Option provides coverage for preventive dental care and some other non-routine services. Additional information is available in the Basic Option Dental Benefits and Standard Option Dental Benefits sections of this website or consult the Blue Cross and Blue Shield Service Benefit Plan brochure for more details.

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What is Temporary Continuation of Coverage (TCC) and what are the requirements to enroll under the TCC provisions of the Federal Employees Health Benefits (FEHB) law?

Temporary Continuation of Coverage (TCC) is available to:

  1. Employees who lose their FEHBP coverage because they leave their federal jobs; except in involuntary separations due to misconducts
  2. Children who lose their FEHBP family member status because they become age 26 or marry
  3. Former spouses who lose their FEHBP family member status because of divorce or annulment

TCC allows former employees to continue their healthcare coverage for up to 18 months and former family members (children and former spouses) to continue healthcare coverage for up to 36 months. TCC enrollees must pay the full premium for the plan they select (that is, both the employee and Government shares of the premium) plus a 2 percent administrative charge. For more specific information about TCC, please contact your employing office's health benefits officer.

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When is Open Season?

The US Office of Personnel Management (OPM) holds Open Season each year from the Monday of the second full workweek in November through the Monday of the second full workweek in December. Your Open Season election generally will take effect the following January. Please contact your employing office's health benefits officer for additional information.

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Where can I call to get benefit information about the Service Benefit Plan?

During Open Season, you may call our Open Season Information Center at 1-800-411-BLUE. You may also contact your local Blue Cross Blue Shield Plan year-round for information about the Service Benefit Plan. To locate the contact information for your Local Plan, please visit the Contact Us section of this website. For current members, you can also find the phone number on the back of your identification card.

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Does Standard Option or Basic Option provide coverage if I am overseas?

Yes, the Service Benefit Plan provides overseas coverage for you and your covered family members. Physician care and care by other covered professional providers performed outside the U.S. are paid at the Preferred level using an Overseas Fee Schedule or a provider negotiated amount. Under both options, you pay the difference between our payment and the amount billed, in addition to any applicable coinsurance, copayment and/or deductible amounts. For more information, please visit the Overseas Benefits section of this website or consult the Blue Cross and Blue Shield Service Benefit Plan brochure.

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General Pharmacy FAQs

What is the formulary list?

The formulary list is a list of medicines that are considered the preferred treatment for a patient's condition and that can be used as a guide for a doctor when prescribing medicine. The formulary list was developed by an independent panel of doctors and pharmacists who worked with the Service Benefit Plan to ensure that the medicines listed were the most clinically appropriate and cost-effective medicines. While your prescription medicine program is not limited to the drugs on the formulary list, using formulary medicines may reduce your out-of-pocket expense. You can find a link to the formulary list here.

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What are the benefits of a formulary list?

The formulary list:

  • Promotes use of prescriptions that could improve patient care and contain costs
  • Empowers the member to be an educated healthcare consumer
  • May encourage members to discuss their prescription medicine treatment with their physicians
  • Aids the physician in making informed decisions based on appropriate clinical and prescribing guidelines

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What if I want to take a medicine that is not on the formulary list?

Medicines that are not listed on the formulary are considered Non-Preferred medicines. You may still receive benefits if you choose a Non-Preferred medicine; however, your out-of-pocket expenses will be greater.

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Where can I obtain a list of prescription drugs that require prior approval?

You can visit CVS Caremark’s website for a list of prescription drugs that require prior approval, along with an explanation of the prior approval criteria, forms, and rationale. Your physician can also provide you with more information concerning prior approvals.

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Are generic medications as safe and effective as brand-name medications?

There are some myths about generic medications. Some people believe that generic medications are not as safe as their brand-name counterparts. Others believe that they are more likely to cause side effects than brand-name medications. The fact is that the FDA mandates that all FDA-approved medications, brand name and generic, must be safe and effective. In order to get FDA approval, the generic medication must contain the same active ingredients as the brand-name product and must meet the same strict quality standards. The generic medication must also be the equivalent in strength and dosage to the original brand-name medication.

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Why are generic drugs less expensive than brand-name drugs?

It's expensive to create a new brand name drug and market it to the public. Generic drug manufacturers do not have those expenses, since they don't pay for the research that led to the discovery of the new drug. Therefore, the medications they produce can cost significantly less for the exact same ingredients, strengths and doses. Those savings are usually passed on to you through lower out-of-pocket costs when generics are selected. Generic medications could lower your out-of-pocket costs by up to 60 percent over the cost of a brand-name medication.

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How can I find out if there is a generic medication for the brand-name drug that I am taking?

There are two ways to find out if the brand-name drug you are taking is available in generic form. You can click on Pharmacy and then follow the prompts to the Standard Option mail or retail pharmacy, or Basic Option retail pharmacy and you will be taken to the CVS Caremark login page. If you do not have a login ID and password, follow the prompts to create one. Once you have logged in, follow the prompts to enter drug information. You can also contact the mail service and retail prescription programs at the following toll- free numbers and a customer service representative will assist you.

  • Retail 1-800-624-5060
  • Mail Service 1-800-262-7890
  • Specialty 1-888-346-3731

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How do I find a participating pharmacy?

You can visit our online pharmacy finder or contact the Retail Pharmacy Program 1-800-624-5060 for the most up-to-date listing in your area.

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I have Standard Option. Based on the benefits, is it more beneficial for me to go to my retail pharmacy or through the Mail Service Prescription Drug Program?

This is a decision that is entirely up to you. In order to make an informed decision, you will need to determine the Service Benefit Plan Preferred retail price and your contribution to the cost of the medication. You can then compare the retail coinsurance cost to the flat copayment of $80 for first 30 brand-name prescriptions filled (and/or refills ordered) per calendar year, $50 per brand-name prescription/refill thereafter, and $15.00 for generic medicines if you use the Mail Service Prescription program.

To make sure you are getting the best value check the cost of your prescription drugs on our retail pharmacy site , by using the "price quote" feature on the retail program website. If you do not have a login ID and password, follow the prompts to create one. Once you have logged in, click on 'Check Drug Cost' on the left hand side of the page. On the Check Drug Cost page, select the participant's name and enter the name of the drug. Click the 'Search' button. Select the appropriate strength and click 'Continue'. On the next page, enter the quantity your doctor has prescribed and select a retail pharmacy. Click 'Get Results'. The next page will provide estimated copayment amounts for the brand and generic forms of the drug, if available, for both retail and mail order.

You can also contact the CVS Caremark Customer Care Unit at the following toll- free numbers and ask a customer service representative to assist you.

  • Retail 1-800-624-5060
  • Mail Service 1-800-262-7890

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I have Standard Option. Can you transfer my prescription from the Mail Service Prescription Drug Program to my local pharmacy?

Yes. A valid prescription can be transferred from the Mail Service Prescription Drug Program to your participating retail pharmacy. However, once the prescription is transferred, a new prescription will be needed before the Mail Service Prescription Drug Program can dispense the medicine again.

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I have Basic Option. How do I know what copayment I'll pay for the drug I'm currently taking?

Under Basic Option, there are five copayment levels. The copayment levels are:

  • $10 copayment for generic drugs (30-day supply) 
  • $45 copayment for Preferred brand name drugs (30-day supply) 
  • 50% coinsurance for Non-Preferred brand name drugs, with a minimum $55 copayment
  • $60 copayment (30-day supply) for preferred specialty drugs from a Preferred Retail Pharmacy; or $50 copay copayment (30-day supply) or $140 copayment (90-day supply) for preferred specialty drugs from the Specialty Drug Pharmacy
  • $80 copayment (30-day supply) for non-preferred specialty drugs from a Preferred Retail Pharmacy; or $70 copay copayment (30-day supply) or $195 copayment (90-day supply) for non-preferred specialty drugs from the Specialty Drug Pharmacy

You can find information on which level your medicines are in and the associated cost by visiting the "price quote" feature on the Retail Program Web site where you will be directed to Caremark.com. If you do not have a login ID and password, follow the prompts to create one. Once you have logged in, click on 'Check Drug Cost' on the left hand side of the page. On the Check Drug Cost page, select the participant's name and enter the name of the drug. Click the 'Search' button. Select the appropriate strength and click 'Continue'. On the next page, enter the quantity your doctor has prescribed and select a retail pharmacy. Click 'Get Results'. The next page will provide estimated copayment amounts for the brand and generic forms of the drug, if available, for both retail and mail order.

You may also contact the Retail Prescription Program at 1-800-624-5060 and a customer service representative will assist you.

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I have Basic Option. Why are there different copayment levels for different drugs?

The cost of medicines varies greatly, even though there may be different medicines available to treat the same condition. Generic medicines typically offer the most savings and have the lowest copayment. Brand name medicines generally are more expensive and there can be many different brand name medicines at various cost levels available to treat the same condition.

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I have Basic Option. Can I get my medicine from an out-of-network pharmacy?

If you obtain your medicine from an out-of-network pharmacy, you will be responsible for 100 percent of the medicine's cost.

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Overseas FAQs

Am I covered overseas?

Yes, your Service Benefit Plan coverage protects you around the world. Benefits for covered services under both Standard and Basic Option are paid at the Preferred level. Physician care performed outside the U.S. is paid at the Preferred level using an Overseas Fee Schedule or a provider negotiated amount. You may be responsible for differences between our payment and the provider charge since overseas providers do not agree to accept our payment as payment in full in all cases. See Section 5(i) in the Service Benefit Plan brochure for more information about how benefits are paid for care performed overseas.

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How do I file a claim?

You can file your Overseas claims by completing your claim form online through your MyBlue account or by mailing or faxing your claim. You can also file your claim online using MyBlue on fepblue.org.

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How do I file a claim online?

Filing your Overseas Medical and Pharmacy claims online will provide faster processing and rapid claims payment. Submitting your Overseas Medical and Pharmacy claims online is easy. Just follow these simple steps to access MyBlue and set up or sign in with your username and password and you will be ready to get started.

  1. To register, go to MyBlue, www.fepblue.org/myblue, and click on the 'Sign Up' link.
  2. Follow instructions under Get Going with MyBlue member registration and click the orange submit link.
  3. You will then be taken back to MyBlue where you can log in using your new username and password. That’s it!

Once you have signed in or registered click on the “Submit an Overseas claim” link on MyBlue .

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How do I file a claim by mail or fax?

You can find our Overseas Medical Claim Form and the Retail Prescription Drug Overseas Claim Form on our website, www.fepblue.org in the forms library, or you can call 1-888-999-9862 to request that we send you some claim forms.

If you access a claim form on our web site, you can enter the information directly on the claim form; print a copy to send to us and save a copy for your records.

In most situations, you will need to pay the provider up front and submit a completed Overseas Claim Form and itemized bills to us at Federal Employee Program, Overseas Claims, P.O. Box 261570, Miami, FL 33126. You may also fax your claims to us at 001- 410-781-7637 (or 1-888-650-6525 toll-free). Payment for covered services will be sent to you. If the provider does not require payment at the time the care is performed, you may request we pay the provider directly by filling out 6B of the claim form and leaving 6 and 6A blank. Send the claim form along with the itemized bills from the provider to the address or fax number listed above and on the back of the claim form. Box 4 must include the diagnosis or reason for the services in order to process your claim.

To file a claim for covered drugs and supplies you purchase from pharmacies outside of the United States, Puerto Rico, and the U.S. Virgin Islands, send a completed FEP® Retail Prescription Drug Overseas Claim Form, along with itemized pharmacy receipts or bills to Blue Cross and Blue Shield Service Benefit Plan Retail Pharmacy Program P.O. Box 52057, Phoenix, AZ 85072-2057, or fax your claim to 001-480-614-7674.

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How do I fax overseas claims to a toll free number?

There is a two step process for faxing claims to our toll free number in the United States from most overseas locations.

  1. The international caller first dials the AT&T Direct Access Code for the country from which they are faxing.
  2. The caller will hear a recording asking them to enter the U.S. toll free number they want to fax. A "1" is not required before the toll free number.

AT&T has a dialing guide and a list of access codes available at
http://www.business.att.com/bt/dial_guide.jsp

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What is an itemized bill?

An itemized bill must be on the provider’s letterhead or the equivalent and must include:

  1. Name of the patient
  2. Name and address of person or firm providing the service or supply
  3. Date for each service or supply
  4. Type or description for each service or supply
  5. The diagnosis for each service or supply
  6. The charge for each service or supply

Please note, we cannot accept a statement of account or a payment reminder as an itemized bill. To be considered valid and itemized, the bill must include the information listed above.

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Why was my claim returned to me?

We need certain information in order to determine benefits and therefore, properly process your claim under the Service Benefit Plan. When we do not have the necessary information, it will delay the processing of your claim while we try to obtain it from you. Listed below are some commonly omitted items which cause claim delays. We hope that providing this information to you will enable us to serve you better by reducing delays.

Commonly MISSING items on the Overseas Medical Claim Form and/or the provider’s bill include:

  1. Diagnosis or reason for treatment
  2. Accident date or date of onset of injury
  3. Patient’s complete name on both bill and claim form
  4. U.S. brand name (or generic equivalent) for drugs purchased - if you do not have this information, please provide the insert that comes with the drug (usually a white sheet of paper which describes the drug )
  5. Description of medical or dental services performed
  6. Description of surgical procedure performed
  7. Length of time patient was anesthetized
  8. Signature of the patient or subscriber
  9. Dates of service - a range of dates, such as indicating “10 visits between January and March”, is not sufficient. We must have each individual date that medical service was provided. We also need to have inpatient dates of service when you are hospitalized.

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How do I receive reimbursement?

If you would like a wire transfer or payment in a foreign currency for your medical claims, be sure to follow the directions, and fill out boxes 6 and 6A on the Overseas Medical Claim Form. Please note the wire transfer or a check in the local currency may take longer to process than a paper check in U.S. dollars. If you do not request these options, payment will be made by check in U.S. dollars.

Payments for covered drugs and supplies you purchase from pharmacies outside of the United States and Puerto Rico will only be made by check in U.S. dollars.

Note concerning the Authorization For Assignment of Benefits section on the claim form - Please remember that if you would like to have our payment assigned (made payable to the provider of service), item 6B, which is the Authorization for Assignment of Benefits section on the Overseas Medical Claim Form, must be completed in its entirety.

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What if my claims are in a different language and currency?

That is not a problem. When your claim is received, we will do the translation and currency conversion. The currency conversion is based on the date of service or the date you paid the bill, if you provide that information. For the most accurate currency conversion, please provide us a receipt with the date the bill was paid, the amount you paid and the exchange rate used, if available.

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What if I have Medicare or supplemental travel insurance?

Medicare does not provide benefits for care performed outside the U.S. Therefore, if you have Medicare as your primary insurer and services were rendered outside the United States and U.S. Territories, there is no need to send your claim first to Medicare. Please send the completed claim form and itemized bills to us. We will consider benefits at 100% of our plan allowance.

If you choose a supplemental insurance plan to cover you while overseas, we will remain the primary insurance. This means that you will submit any claims for medical care to us first.

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Do I have benefits for evacuation?

Our Worldwide Assistance Center offers emergency evacuation services only to the nearest facility that is adequately equipped to treat your condition. Benefits are not available to transport you to a facility in the United States unless it is the closest facility that can provide adequate treatment. Benefits are not available for evacuation in the event of a natural disaster.

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Does Caremark send medication overseas?

If you have Standard Option, your coverage includes our Mail Service Pharmacy benefit. You can order prescription drugs through the Mail Service Pharmacy if your address has a U.S. zip code, and the prescribing physician is licensed in the U.S. We suggest you contact Caremark directly to ensure your specific medication can be mailed overseas. You may contact them by calling (800)-262-7890 or by writing to them at Caremark, P.O. Box 52057, Phoenix, AZ 85072-2080. You may be eligible for an extended filling of the prescription from Caremark while overseas or before going overseas, so you may also want to discuss this with Caremark. Please note this will require a prescription from your doctor for 12 months and is not applicable for controlled substances.

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What if I need to find a provider?

The Worldwide Assistance Center can help you locate a hospital or physician in our network closest to your area. You may also view a list of our network providers on our website, www.fepblue.org.

If you are overseas and need assistance locating providers (whether in our out of network), contact the Worldwide Assistance Center, by calling the center collect at 1- 804-673-1678 or email the Worldwide Assistance Center at fepoverseas@axa-assistance.us. Members in the United States, Puerto Rico, or the U.S. Virgin Islands should call 1-800-699-4337 or email the Worldwide Assistance Center at fepoverseas@axa-assistance.us.

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What types of providers are in your international provider network?

We have a network of participating hospitals overseas, as well as a network of professional providers who have agreed to accept a negotiated amount as payment in full for their services. The Worldwide Assistance Center can help you locate a hospital or physician in our network closest to your area. If you are overseas and need assistance locating providers (whether in our out of network), contact the Worldwide Assistance Center, by calling the center collect at 1-804-673-1678 or email the Worldwide Assistance Center at fepoverseas@axa-assistance.us. Members in the United States, Puerto Rico, or the U.S. Virgin Islands should call 1-800-699-4337 or email the Worldwide Assistance Center at fepoverseas@axa-assistance.us.

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Can I get a printed copy of the Overseas Provider directory?

The Blue Cross and Blue Shield Service Benefit Plan is going even greener with the help of our members. Because of your encouragement, and that of the Office of Personnel Management, FEP we will no longer produce printed Overseas Provider directories. The online provider directory, at www.fepblue.org, is your best source for provider information. It’s updated frequently and offers detailed, fully searchable information about our overseas network. You can also call the Worldwide Assistance Center to print a list of hospitals and providers in your area. If you are overseas, please call 1-804-673- 1678. Members in the United States, Puerto Rico, of the U.S. Virgin Islands should call 1-800-699-4337.

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How can I get a directory if I don’t have a computer?

If you don’t have internet access, please contact the Worldwide Assistance Center to locate a hospital or physician in your area. If you are overseas, please call the center collect at 1-804-673-1678. Members in the United States, Puerto Rico, or the U.S. Virgin Islands should call 1-800-699-4337 or email the Worldwide Assistance Center at fepoverseas@axa-assistance.us.

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My provider is not listed in the directory. Do I need to change providers?

You can maintain your existing provider relationship. You can confirm your out-of-pocket costs by calling the Worldwide Assistance Center. If you are overseas, please call the center at 1-804-673-1678. Members in the United States, Puerto Rico, or the U.S. Virgin Islands should call 1-800-699-4337.

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Can my Provider join AXA’s network?

The Blue Cross and Blue Shield Service Benefit Plan is committed to expanding our Overseas Provider network. If you would like to nominate your doctor, please complete a Provider Nomination Form and email your form to medical.network@axa-assistance.us, or fax to 305-893-5055, Attn. International Medical Network. Click the link to download and save the form to your computer.

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Is precertification required when a member is hospitalized?

No, precertification is not required for inpatient services provided outside the U.S.

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Will I be expected to pay out-of-pocket for inpatient care?

If the member is hospitalized at a participating facility, our Worldwide Assistance Center will arrange for cashless access to set up direct billing and payment to the provider. When cashless access is arranged, you will not pay upfront for medical services. You will only pay the usual out-of-pocket expenses, such as deductible, coinsurance and copayment amounts. If you are hospitalized at a non-participating hospital, our Worldwide Assistance Center will try to negotiate this same cashless access but may not get the hospital to agree. In this case, you may be required to pay a deposit at the time of admission and all charges upon discharge. To request help with this type of care, contact our Worldwide Assistance Center directly at 800-699-4337 if you are in the U.S. or collect at 804-673-1678, if you are calling from outside the U.S.

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Page last updated: January 10, 2014

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