Blue Cross and Blue Shield Service Benefit Plan.
2008 Basic Option Benefits At-A-Glance.
For a complete explanation of your benefits please see the 2008 Service Benefit Plan brochure. If you do not have a 2008 brochure, you can call your local Blue Cross and Blue Shield Plan at the number on the back of your ID card to request one.
Please Note: The following items are explanations and definitions of language terms and procedures that define benefits mentioned in the Basic Option Benefits At-A-Glance information that follows. For an accurate understanding of your Basic Option Benefits, please read and familiarize yourself with these definitions and procedures.
Under Basic Option, benefits are not available for care that is performed by a Non-preferred provider, except in certain situations such as emergency care.
Benefits for the treatment of mental conditions and substance abuse are not paid differently. However, all care for the treatment of mental conditions and substance abuse must have Prior Approval from your local Blue Cross and Blue Shield Plan. Call the number on the back of your ID card for assistance.
Certain cost sharing amounts do not apply if Medicare is your primary coverage for medical services, it pays first.
Preferred Provider Allowance or PPA is the amount accepted as payment in full by most Preferred professionals and pharmacies.
On limited occasions, such as for certain drugs requiring prior approval, you will need to file a claim for services received from Preferred providers.
This is a summary of the Service Benefit Plan benefits. For a complete description, see the 2008 Service Benefit Plan brochure.
Click on any of the section links that follow or scroll down to learn about the 2008 Basic Option benefits At-A-Glance.
Basic Option Benefits At-A-Glance.
Preventive Services.
1. Preventive Screenings.
Preventive screenings, related office visit charge and routine physical exams.
Under The Basic Option Network Benefit:
You pay the $20 office visit co-payment for the primary care provider.
You pay the $30 office visit co-payment for specialists.
You pay nothing for covered preventive screenings billed by your doctor.
2. Preventive Well Child Care.
Well child care up to age 22, including routine physical examinations, routine hearing tests, laboratory tests, immunizations and related office visits.
Under The Basic Option Network Benefit:
You pay nothing for covered charges.
3. Preventive Dental Care.
Under The Basic Option Network Benefit:
You pay the $20 office visit charge.
Benefits are available for 2 exams and cleanings per year,
Annual X-rays, and,
Sealants for children up to age 16.
Physician's Care.
1. Physician Surgical.
Surgical care.
Under The Basic Option Network Benefit:
You pay the $100 co-payment per surgeon.
2. Physician Home And Office Visits.
Home and office visits, second surgical opinions and consultations.
Under The Basic Option Network Benefit:
You pay the $20 office visit charge for the primary care provider.
You pay the $30 office visit co-payment for specialists.
Maternity Care.
1. Maternity Care Inpatient Hospital And Physician Care.
Inpatient hospital and physician care, precertification is not required.
Under The Basic Option Network Benefit:
You pay nothing for professional charges for Pre-natal and Post-natal care, and the delivery.
You pay a $100 co-payment per admission for inpatient hospital care.
Prescription Drugs.
1. Prescription Drugs Mail Service Pharmacy.
Prescription Drugs Mail Service Pharmacy.
Under The Basic Option Network Benefit:
Not a benefit under Basic Option.
2. Prescription Drugs Retail Pharmacy.
Up to an initial 34-day supply.
Under The Basic Option Network Benefit:
You pay the $10 co-payment for generic drugs.
You pay the $30 co-payment for formulary brand name drugs.
You pay the 50% coinsurance or the $35 minimum for non-formulary, Non-preferred brand name drugs.
To Determine Your Prescription Drug co-payment Levels. (Please Note: When you choose this link, you are leaving fepblue.org and going to a new web site. This web site is owned and updated by our Business Partner, Caremark, to provide information about Service Benefit Plan prescription drug benefits. Protection of your privacy at the new site is governed by the privacy policy of that site. Therefore, please take time to read the privacy policy of the new site.)
Hospital/Facility Care.
1. Hospital/Facility Inpatient Hospital.
Precertification required.
Under The Basic Option Network Benefit:
You pay $100 per day up to $500.
2. Hospital/Facility Outpatient Facility.
Outpatient Facility Care, excluding laboratory and X-ray services.
Under The Basic Option Network Benefit:
You pay $40 per day per facility co-payment.
3. Hospital/Facility Outpatient Facility.
For laboratory and X-ray services.
Under The Basic Option Network Benefit:
You pay nothing for covered services.
4. Hospital/Facility Outpatient Surgery.
Outpatient Surgery.
Under The Basic Option Network Benefit:
You pay the $40 co-payment.
Accidental Injury/Emergency Care.
1. Accidental Injury Care.
Emergency room.
Under The Basic Option Network Benefit:
You pay the $50 co-payment.
Physician care.
Under The Basic Option Network Benefit:
You pay the $50 co-payment.
2. Medical Emergency.
Emergency room.
Under The Basic Option Network Benefit:
You pay the $50 co-payment.
Physician care.
Under The Basic Option Network Benefit:
You pay the $50 co-payment.
Chiropractic Care.
1. Chiropractic Care Spinal Manipulations.
Spinal manipulations.
Under the Basic Option PPO Benefit:
You pay the $20 co-payment for up to 20 spinal manipulations per year.
Other Services.
1. Other Services Catastrophic Benefits.
Catastrophic Benefits.
Under The Basic Option Network Benefit:
100% payment level begins after you pay $5000 out-of-pocket in coinsurance and co-payment expenses.