Blue Cross and Blue Shield Service Benefit Plan.
Welcome To The Blue Cross and Blue Shield Service Benefit Plan Basic Option.
We're delighted to have you as a new member and want to provide you with some important information about your health care benefits. Following is an at-a-glance benefit overview of your coverage, so please take a few moments to review it and familiarize yourself with your new benefits. You'll find a complete explanation of your benefits in 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 Overview and Basic Option Benefits At-A-Glance. 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.
Overview.
Service Benefit Plan Identification Cards.
By now, you should have received your Blue Cross and Blue Shield Service Benefit Plan identification card or cards. You'll find the most important telephone numbers you need right on the back of your ID card or cards, including customer service, precertification for hospital admissions, prescription drug program and Blue Health Connection telephone numbers. If you haven't received your card or cards, please notify your local Blue Cross and Blue Shield Plan so they can send your new ID card or cards right away.
Value Added Benefits.
Blue Health Connection.
Blue Health Connection is your resource for around-the-clock health information. Whenever you or a family member has a health care question, registered nurses are available to assess your symptoms and provide health information. You can also get long-term health counseling, listen to a wide range of topics on the audio library or get help locating a Preferred provider after normal business hours. You can access Blue Health Connection online or by calling 1.888.Blue.432.
Davis Vision Care.
Davis Vision Care offers savings for eye exams and eyewear to Service Benefit Plan members when you use one of their more than 26,000 participating providers nationwide. There are no claims to file. Just show your Service Benefit Plan ID card to get the discount. You can access information about Vision Care And Eyewear Affinity Discount Program online or call 1.800.551.3337.
Complementary Health Care Benefits.
You may purchase a $23 per member yearly membership to gain access to a national network of wellness practitioners and nutritional supplements. You can call providers directly to schedule appointments and a physician referral is not required. There are no claim forms for this program, and all charges are handled directly between you and the WholeHealth Networks providers.
For more information, call 1.877.258.7283 from 8:00 a.m. to 8:00 p.m. eastern time, Monday through Friday or go to the WholeHealth Networks web site. (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 a company that provides a discount program for our Service Benefit Plan members. These services are not part of the FEHB contract or premium, nor are the services eligible for FEHB 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.)
Prescription Drug Discount Program.
We also offer a Discount Drug Program that lets you purchase certain prescription drugs not covered by the regular prescription drug benefit at a discount. For more information about the types of drugs covered, please see Prescription Drug Discount Program and the 2008 Service Benefit Plan Brochure.
Preferred Network Providers.
Basic Option benefits are only available when you use Preferred network hospitals, physicians, dentists, pharmacies and other health care providers. Preferred network providers accept the Preferred Provider Allowance or PPA as payment in full. They also take care of claims filing for you. Call your local Blue Cross and Blue Shield Plan to find out if a specific provider is a Preferred network provider or to request a copy of the 2008 Directory of Preferred Network Providers. You can also use our online directory in the Provider Directory feature. Currently the Provider Directory feature is not available in Web Accessibility format.
We're glad you chose the Blue Cross and Blue Shield Service Benefit Plan.
We Look Forward To Helping You Stay Healthy.
Basic Option Benefits At-A-Glance.
Preventive Services.
1. Adult 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 services.
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 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.
Outpatient Facility Care, 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.
2. Medical Emergency.
Emergency room.
Under The Basic Option Network Benefit:
You pay the $50 co-payment.
3. Accidental Injury And Medical Emergency.
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.