Blue Cross and Blue Shield Service Benefit Plan.
2008 Service Benefit Plan Benefit Changes.
This page provides a summary of the benefit changes for 2008. For a complete description of benefits please refer to Section 2 of the 2008 Blue Cross and Blue Shield Service Benefit Plan brochure (RI 71-005) online or you can call your local Blue Cross and Blue Shield Plan at the number on the back of your ID card to request one.
Click on the links that follow or scroll down to learn about Service Benefit Plan benefit changes in 2008.
Standard Option And Basic Option Benefit Changes.
The states designated as medically underserved areas have changed. For 2008 Texas and West Virginia have been removed. See Section 3 of the 2008 Blue Cross and Blue Shield Service Benefit Plan brochure for more information about these areas.
In 2008, benefits are available for hearing aides, including bone anchored hearing aids, for children up to the age of 22. Benefits are limited to $1,000 per ear per calendar year. In addition, benefits are available in 2008 for bone anchored hearing aids for adults when medically necessary due to traumatic injury or malformation of the external or middle ear. Benefits for these hearing aids are also limited to $1,000 per ear per calendar year. Please see Section 5(a) in the 2008 Service Benefit Plan brochure for more information. Previously, benefits were not available for hearing aids.
We now provide benefits for inpatient and outpatient hospital care related to the treatment of children up to the age of 22 with severe dental caries. For more information about this benefit change, see Sections 5(c) and 5(g) of the 2008 Service Benefit Plan brochure.
Under our home hospice benefit, benefits are available in 2008 for pre-enrollment visits when provided by a physician employed by the hospice agency. Benefits were not available for this service in the past. In addition, we have clarified the prior approval process for home hospice care and the types of services covered under this benefit. Please refer to Section 5(c) for more information about benefits for hospice care.
There are two benefit changes for ambulance transportation in 2008. Under both Standard and Basic Option, benefits for ambulance transportation are paid in full, after a $50 per day co-payment. Previously, you were responsible for a $50 per trip co-payment. In addition, benefits are now available for medically necessary emergency care provided at the scene when ambulance transport is not required. Benefits were not provided for this care in the past. For more information about benefits for ambulance transportation, please refer to Sections 5(c) and 5(d) in the 2008 Service Benefit Plan brochure.
In 2008, benefits are available for office visits and diagnostic tests related to the treatment of morbid obesity. Benefits were not previously available for these types of services for the treatment of morbid obesity.
The address for filing claims for care you receive outside of the US has changed. The new address is Mail Administrator, FEP Overseas Claims, P.O. Box 14113, Lexington, Kentucky 40512-4113.
We have clarified information for 2008 in the Service Benefit Plan brochure for:
• genetic testing benefits.
• benefits for meningococcal vaccines for adults.
• benefit limitations for refractions.
• how we determine the Plan allowance for Non-member inpatient hospital care and the definition in Section 10 of the 2008 Service Benefit Plan has been changed to reflect this clarification.
• that the Service Benefit Plan is the primary payer for services covered by any Federal Employees Dental/Vision Insurance Program (FEDVIP) coverage you may have.
• Our rights of recovery and subrogation.
Standard Option Only Benefit Changes.
• Medco is now the Pharmacy Benefit Manager for the Mail Service Prescription Drug Program. Benefits for the Mail Service Program have not changed.
• The calendar year deductible for 2008 has increased from $250 to $300 for Self Only coverage and from $500 to $600 for Self and Family coverage.
• The Catastrophic Protection Benefit, the maximum in out-of-pocket expenses you pay for deductibles, coinsurance and co-payments, is $4,500 per year when you use Preferred providers and $6,500 per year when you use Non-preferred providers. Previously the maximum was $4,000 for Preferred Provider expenses and $6,000 for Non-preferred provider expenses.
• The coinsurance amount you pay for outpatient care in a Preferred hospital has increased from 10 percent to 15 percent. Benefits for outpatient facility care, except for accidental injury and maternity care, are now paid at 85 percent when the care is provided in the outpatient department of a Preferred hospital. In the past, these benefits were paid at 90 percent.
• In addition, the coinsurance amount you pay for outpatient care in a Non-preferred hospital has increased from 25 percent to 30 percent. In 2008, benefits for these services provided in the outpatient department of a Non-preferred hospital are now paid at 70 percent of our Plan allowance.
Basic Option Only Benefit Changes.
In 2008, we offer a High Deductible Health Plan (HDHP) called Basic Consumer Option for members who live or work in the states of Tennessee, Ohio and Minnesota, and in certain counties in the Kansas City, Missouri area. For more information about this new coverage, click on the Basic Consumer Option icon on our home page.