Compare Benefit Options for 2020

Discover some of the main differences between Standard Option, Basic Option and FEP Blue Focus.

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Our Plans

Standard Option Basic Option FEP Blue Focus
Has a deductible Has no deductible Has a deductible
Can see any provider, even outside the network Must see Preferred providers Must see Preferred providers
Out-of-pocket costs include copayments and coinsurance Most out-of-pocket costs are copayments Out-of-pocket costs include copayments and coinsurance

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2020 Plan Rates


Standard Option

Enrollment code Bi-weeklyMonthly
Self Only 104$116.91$253.30
Self + 1 106$267.15$578.83
Self & Family 105$286.74$621.27

Basic Option

Enrollment code Bi-weeklyMonthly
Self Only 111$75.94$164.55
Self + 1 113$178.61$386.99
Self & Family 112$191.22$414.31

FEP Blue Focus

Enrollment code Bi-weeklyMonthly
Self Only 131$53.14$115.15
Self + 1 133$114.25$247.55
Self & Family 132$125.67$272.29

Standard Option

Enrollment code Category 1Category 2
Self Only 104$113.63$103.81
Self + 1 106$260.15$239.14
Self & Family 105$279.15$256.39

Basic Option

Enrollment code Category 1Category 2
Self Only 111$72.91$63.03
Self + 1 113$171.61$150.60
Self & Family 112$183.63$160.87

FEP Blue Focus

Enrollment code Category 1Category 2
Self Only 131$51.02$44.11
Self + 1 133$109.68$94.83
Self & Family 132$120.65$104.31
These rates do not apply to all enrollees. If you are in a special enrollment category, contact the agency or Tribal employer that manages your health benefits enrollment.

Compare Benefit Options for 2020

See costs for typical services when you use Preferred providers.
View all benefits options

Download the 2020 Benefits at a Glance brochure

Benefits Standard OptionBasic OptionFEP Blue Focus
Rewards Program Contract holders and covered spouses can earn $50 for completing the Blue Health Assessment. Then, earn up to $120 for achieving three eligible Online Health Coach goals.

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Contract holders and covered spouses can earn $50 for completing the Blue Health Assessment. Then, earn up to $120 for achieving three eligible Online Health Coach goals.

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Contract holders and covered spouses can earn a reward, such as a Fitbit®, at no out-of-pocket cost for getting an annual physical.



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Preventive Care, including Nutritional Counseling You pay nothingYou pay nothingYou pay nothing
Physician Care

$25 for primary care

$35 for specialists

$30 for primary care

$40 for specialists

$10 for each for your first 10 combined professional visits

Virtual doctor visits by Teladoc®

$0 for first 2 visits

$10 all additional visits

$0 for first 2 visits

$15 all additional visits

$0 for first 2 visits

$10 all additional visits

Lab work
(such as blood tests)
15% of our allowance*

$0 copay1

$0 for first 10 specific lab tests**
Hospital Care

Inpatient: $350 per admission

Outpatient: 15% of our allowance*

Inpatient: $175 per day; up to $875 per admission

Outpatient: $100 per day per facility2

Inpatient: 30% of our allowance*

Outpatient: 30% of our allowance*

Professional Surgical Services 15% of our allowance*

$150 in an office setting2

$200 in a non-office setting2

30% of our allowance*
Maternity Care $0 copay

$175 inpatient

$0 outpatient

$0 pre-/postnatal professional care; $1,500 for facility care
Urgent Care Center

$30 copay

$35 copay

$25 copay

ER (accidental injury)

$0 within 72 hours

$125 per day per facility

$0 within 72 hours

ER (medical emergency)

15% of our allowance*

$125 per day per facility

30% of our allowance*

Prescription Drugs

See the 2020 Blue Cross and Blue Shield Service Benefit Plan brochures for information on supply and refill limits

Preferred Retail Pharmacy3:

Tier 1 (Generics): $7.50 copay

Tier 2 (Preferred brand): 30% of our allowance

Tier 3 (Non-preferred brand): 50% of our allowance

Tier 4 (Preferred specialty): 30% of our allowance

Tier 5 (Non-preferred specialty): 30% of our allowance


Mail Service Pharmacy:

Tier 1 (Generics): $15 copay

Tier 2 (Preferred brand): $90 copay

Tier 3 (Non-preferred brand): $125 copay


Specialty Pharmacy:

Tier 4 (Preferred specialty): $50 copay

Tier 5 (Non-preferred specialty): $70 copay

Preferred Retail Pharmacy3:

Tier 1 (Generics): $10 copay

Tier 2 (Preferred brand): $55 copay

Tier 3 (Non-preferred brand): 60% of our allowance ($75 minimum)

Tier 4 (Preferred specialty): $65 copay

Tier 5 (Non-preferred specialty): $90 copay


Mail Service Pharmacy:

Available to members with Medicare Part B primary only. Visit the Medicare page for more information.


Specialty Pharmacy:

Tier 4 (Preferred specialty): $70 copay

Tier 5 (Non-preferred specialty): $95 copay

Preferred Retail Pharmacy3:

Tier 1 (Generics): $5 copay3

Tier 2 (Preferred brand): 40% of our allowance ($350 max)3


Mail Service Pharmacy

Not a benefit


Specialty Pharmacy

Tier 2 (Preferred Generic specialty, and Preferred brand specialty): 40% of our allowance ($350 maximum)3

Chiropractic Care $25 per visit; up to 12 visits per year$30 per visit; up to 20 visits per year$25 per visit; for up to 10 visits a year1
Dental Care The difference between the fee schedule amount and the Maximum Allowable Charge (MAC)$30 copay per evaluation; up to 2 per yearNot a benefit
Provider Care

In-network and out-of-network care

In-network care only, except in certain situations like emergency care

In-network care only, except in certain situations like emergency care

How You Pay for Services Deductible + mixture of copayments and coinsuranceSet copayments for most servicesDeductible + mixture of copayments and coinsurance
Out-of-Pocket Maximum (PPO)

Self Only: $5,000

Self + One and Self & Family: $10,000

Self Only: $5,500

Self + One and Self & Family: $11,000

Self Only: $6,500

Self + One and Self & Family: $13,000

Annual Deductible

$350 per individual

$700 per family

No deductible

$500 per individual

$1,000 per family

*Deductible applies. 

1Up to 10 visits combined for chiropractic care and acupuncture. 

2Under Basic Option, you pay 30% of our allowance for agents, drugs and/or supplies you receive during your care. 

3What you’ll pay for a 30-day supply of covered drugs.

If you have Medicare primary, different cost share amounts may apply.

This is a summary of the features of the Blue Cross and Blue Shield Service Benefit Plan. Before making a final decision, please read the Plan’s Federal brochures (Standard Option and Basic Option: RI 71-005; FEP Blue Focus: 71-017). All benefits are subject to the definitions, limitations and exclusions set forth in the Federal brochures.


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