2013 Benefits & Rates
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You can count on the Blue Cross and Blue Shield Service Benefit Plan, comprehensive coverage that brings value to you and your family including:
- A Preferred provider network of almost one million hospitals, physicians, pharmacies and other health care providers.
- A free nurse triage phone line and online nurse chat through Blue Health Connection.
- Free online tools that let you take charge of your health and health care decisions.
- Help when you need it under MyBlue® Customer eService.
- MyBlue® Incentives that reward you for healthy behaviors.
Changes for 2013
Hearing Aids and Related Services
- Benefits for bone-anchored hearing aids for adults and children have increased from $2,500 to $5,000 per calendar year. The benefit per ear has been eliminated.
- Benefits for adult hearing aids and related services are available for up to $2,500 every three calendar years. The benefit per ear has been eliminated.
- For children’s hearing aids and related services, benefits are available for up to $2,500 per calendar year. The per ear distinction has been eliminated.
- The per admission copayments under Standard Option and Basic Option for inpatient hospice care at a Preferred hospice facility have been eliminated.
- Under both options, the inpatient hospice stay day limit has been increased to 30 days per admission.
- Under Standard Option, the copayment for continuous home hospice care by a Preferred provider has increased from $200 to $250 per episode.
Urgent Care Center Services
- You will pay a $40 copayment, with no deductible, for all services provided by a Preferred urgent care center under Standard Option.
- Under Basic Option, you will still pay a $50 copayment. However, the 30% coinsurance amount applied for drugs and supplies has been eliminated.
Basic Option Only Changes
- The $75 copayment for outpatient physical therapy, occupational therapy, speech therapy and other rehabilitative services performed by a Preferred hospital has decreased to $25 per day.
- The copayment for outpatient cardiac, cognitive and pulmonary rehabilitation has also been decreased for 2013 from $75 to $25 per day when you use a Preferred hospital.
- The copayment for other types of outpatient services billed by a Preferred facility, such as outpatient surgical care, radiation therapy and chemotherapy and renal dialysis has been increased for 2013 from $75 to $100 per facility per day for care.
- Benefits for diagnostic tests related to an accidental injury performed in a setting other than an emergency room or urgent care center will be subject to a $25 or $75 per day copayment depending on the type of test performed. Currently, benefits for these tests are paid in full regardless of the place of service.
Affordable Care Act Changes
Beginning January 1, 2013, the Affordable Care Act (ACA) requires the following changes to your Service Benefit Plan coverage.
Human Papillomavirus (HPV) Testing: In 2013, benefit will be available for both a cervical cancer screening or PAP test and one HPV test every year for all women when performed by a Preferred provider. Benefits under both options are paid in full.
Breastfeeding Support: Benefits will be provided in full for a breastfeeding pump kit obtained through our Pharmacy Benefits Manager, CVS Caremark in 2013. Benefits are available for one pump per year for women who are nursing and/or pregnant. Breastfeeding pumps obtained elsewhere are not eligible for benefits.
Contraceptive Methods and Counseling: (1) Benefits for certain contraceptive services and voluntary sterilization procedures for women will be paid in full when performed by a Preferred provider. (2) Benefits will be paid in full for generic contraceptive drugs and devices obtained at a Preferred retail pharmacy and for Standard Option, at the Mail Service Pharmacy. (3) Benefits are paid in full for over-the-counter contraceptive methods used by women only when these contraceptives meet FDA standards for over-the-counter products when you use a Preferred Retail pharmacy only and present a physician’s prescription to the pharmacist.
Medical Loss Ratio Notice: The ACA initiated new medical loss ratio criteria and requires premium rebates each year that they are not met. The Service Benefit Plan met all of the criteria for 2011 and will not issue rebates.
Notice of Summary of Benefits and Coverage: Availability of Summary Health Information: The Federal Employees Health Benefits (FEHB) Program offers numerous health benefits plans and coverage options. Choosing a health plan and coverage option is an important decision. To help you make an informed choice, each FEHB plan makes available a Summary of Benefits and Coverage (SBC) about each of its health coverage options, online in early October. The SBC summarizes important information in a standard format to help you compare plans and options. A paper copy is available, free of charge, by calling 1.800.411.BLUE beginning October 22. To find out more information about plans available under the FEHB Program, including SBCs for other FEHB plans, please visit www.opm.gov/insure.
Open Season Dates
The 2012 Open Season for health insurance changes is scheduled for November 12 through December 10, 2012.
2013 PREMIUMS — YOUR SHARE
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Non-Postal rates apply to most non-Postal employees. If you are in a special enrollment category, refer to the Guide to Federal Benefits for that category or contact the agency that maintains your health benefits enrollment. Career non-law enforcement employees may also refer to the Guide to Federal Benefits for United States Postal Service Employees, RI 70-2, to determine their rates. Different rates apply and a special Guide is published for Postal Service Inspectors and Office of Inspector General (OIG) employees (see RI 70-21N). For additional assistance, Postal Service employees can call the Human Resources Shared Service Center at 1.877.477.3273 and select option 5. Postal rates do not apply to non-career postal employees, postal retirees or associate members of any postal employee organization who are non-career postal employees. Refer to the applicable Guide to Federal Benefits.
You Can Get More Information
Although we discuss specific benefit changes in this article, we urge you to also read the complete list of benefit changes in Section 2 of the 2013 Service Benefit Plan brochure which will be available in early October. Also in October, you can view and download a copy of the 2013 Service Benefit Plan brochure, visit www.opm.gov/insure, or request a printed copy of the 2013 brochure and call our Open Season Information Center.
Beginning October 22 through December 28, 2012, you can call our Open Season Information Center at 1.800.411.BLUE (1.800.411.2583) for information about 2013 benefits. The Center is open between 7 am ET and 11 pm ET Monday through Friday, and from 9 am ET to 3 pm ET on Saturday and Sunday. It is closed Thanksgiving and Christmas.
Page last updated: October 01, 2012