2020 FEP Blue Focus Benefits Chart

Below is an overview of available benefits for FEP Blue Focus members using a Preferred provider.

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Download the 2020 Blue Cross and Blue Shield Service Benefit Plan - FEP Blue Focus brochure.


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2020 FEP Blue Focus Rates

Non-Postal Premium Postal Premium

Bi-weekly Monthly Bi-weekly
Category 1
Bi-weekly
Category 2
Self Only (131) $53.14 $115.15 $51.02 $44.11
Self + 1 (133) $114.25 $247.55 $109.68 $94.83
Self & Family (132) $125.67 $272.29 $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.


2020 Preventive Care

Preventive care is important at any age.
It helps to identify any health concerns or conditions in the early stages of development, making them easier to treat. Any related complications may also be easier to treat.

2020 Preventive Care
Services FEP Blue Focus PPO Benefit* – You Pay:
Preventive care services for adults age 22 and older including the preventive services recommended by the U.S. Preventive Services Taskforce. Services include but are not limited to:
  • Visits or exams for preventive care, including a history and risk assessment, chest X-ray, EKG, urinalysis, CBC, fasting lipid profile, cholesterol tests and metabolic and general health panel tests
  • Preventive screenings: Pap smears, mammograms, colorectal cancer tests, prostate cancer tests, STD screenings, genetic counseling in certain situations, and related office visits
Nothing for covered services
Routine immunizations for adults age 22 and older [as licensed by the U.S. Food and Drug Administration (FDA)], limited to:
  • Hepatitis (Types A and B) 
  • Herpes Zoster (shingles)
  • Human Papillomavirus (HPV)
  • Influenza (flu)
  • Measles, Mumps, Rubella
  • Meningococcal
  • Pneumococcal
  • Tetanus-diphtheria, pertussis booster
  • Varicella 
Many Preferred retail pharmacies participate in our vaccine network. Review pharmacy benefits for our coverage of these vaccines when provided by pharmacies in the vaccine network.
Nothing for covered services
Preventive care services for children up to age 22, including preventive services recommended under the Affordable Care Act and the American Academy of Pediatrics. These services include but are not limited to visits or exams for preventive care, routine hearing and vision screenings, laboratory tests, immunizations, and nutritional counseling. Nothing for covered services

* Under FEP Blue Focus, benefits are not available for services performed by Non-preferred providers, except in certain situations such as emergency care.


2020 Professional Provider’s Care

Almost one million strong, our network of Preferred providers includes surgical experts and specialists.

2020 Professional Provider’s Care
Services FEP Blue Focus PPO Benefit* - You Pay:
Office visits and outpatient consultations

$10 per visit for your first 10 professional services visits

Routine exams and other preventive care services

Nothing for covered services

Surgical care

30% of the our allowance1

* Under FEP Blue Focus, benefits are not available for services performed by Non-preferred providers, except in certain situations such as emergency care.
1 Deductible applies. $500 for Self Only and $1,000 for Self + One and Self & Family.


2020 Pharmacy

Under FEP Blue Focus, there are two covered drug tiers. The amount you pay for your drug depends on the tier it’s in. Members can purchase Tier 1 drugs at a Preferred retail pharmacy. You buy Tier 2 drugs at a Preferred retail pharmacy, or in some cases, through the Specialty Drug Pharmacy Program. FEP Blue Focus benefits are not available when you use Non-preferred pharmacies.

2020 Pharmacy
Tier Characteristics FEP Blue Focus PPO Benefit - You Pay:
Tier 1 - Preferred generics
  • Most affordable drug type
  • Equal to brand name counterparts in quality, performance and intended use
$5 copay for up to 30-day supply; $15 copay for a 31 to 90-day supply*
Tier 2 – Preferred brand name, Preferred generic specialty and Preferred brand name specialty
  • Preferred brand: Brand name drugs that are safe and effective
  • Specialty: Drugs used to treat complex health conditions (e.g., cancer treatment drugs)
40% of our allowance ($350 maximum for up to a 30-day supply; $1,050 maximum for 31 to 90-day supply)*

* Specialty drugs are limited to a 30-day supply.


2020 Accidental Injury / Medical Emergency

FEP Blue Focus members are encouraged to seek care from Preferred providers in cases of accidental injury or medical emergency.

However, if you need care immediately and cannot access a Preferred provider, we will provide benefits for the initial treatment provided in the emergency room of any hospital — even if the hospital is not a Preferred facility.

2020 Accidental Injury / Medical Emergency
Services FEP Blue Focus PPO Benefit* – You Pay:
Accidental Injury $0 within 72 hours for professional providers,outpatient hospital and urgent care center               
Medical Emergency $25 copay for urgent care center
Medical Emergency 30% of our allowance1

*Under FEP Blue Focus, benefits are not available for services performed by Non-preferred providers, except in certain situations such as emergency care.

1Deductible applies. $500 for Self Only and $1,000 for Self + One and Self & Family.


2020 Mental Health and Substance Use Disorder

Under FEP Blue Focus, services for mental health and substance use disorder range from inpatient hospital/facility treatment to outpatient professional care. FEP Blue Focus members must use Preferred providers.

2020 Mental Health and Substance Use Disorder
Services FEP Blue Focus PPO Benefit* – You Pay:
Inpatient Hospital/Facility 

Precertification is required
30% of our allowance1
Outpatient Hospital/Facility Care 30% of our allowance1
Inpatient Professional Care 30% of our allowance1
Outpatient Professional Care $10 copay for each of your first 10 combined professional visits, then 30% of our allowance2

*Under FEP Blue Focus, benefits are not available for services performed by Non-preferred providers, except in certain situations such as emergency care.

1Deductible applies. $500 for Self Only and $1,000 for Self + One and Self & Family.

2Professional charges for facility-based intensive outpatient treatment and professional charges for outpatient diagnostic tests to include psychological testing are not part of the 10 for $10 benefit.


2020 Maternity

A variety of benefits are available for a healthy pregnancy — from prenatal to postpartum.

2020 Maternity
Services FEP Blue Focus PPO Benefit* – You Pay:
Obstetrical care performed by a physician or nurse midwife, such as prenatal care (including ultrasound, lab, diagnostic tests), delivery, postpartum care $0 pre-/postnatal professional care
$1,500 for facility care

* Under FEP Blue Focus, benefits are not available for services performed by Non-preferred providers, except in certain situations such as emergency care.


2020 Hospital and Facility Care

The chart to the right provides an at-a-glance overview of your hospital and facility care benefits under FEP Blue Focus.

2020 Hospital/Facility Care
Services FEP Blue Focus PPO Benefit* – You Pay:
Hospital Inpatient
Precertification is required
30% of our allowance1
Outpatient facility care/facility care 30% of our allowance1

* Under FEP Blue Focus, benefits are not available for services performed by Non-preferred providers, except in certain situations such as emergency care.

1 Deductible applies. $500 for Self Only and $1,000 for Self + One and Self & Family.


2020 Other Benefits


2020 Other Benefits
Services FEP Blue Focus PPO Benefit* – You Pay: 
Catastrophic Protection Preferred Provider Services: Your out-of-pocket maximum is $6,500 for Self Only and $13,000 for Self Plus One and Self & Family contracts

* Under FEP Blue Focus, benefits are not available for services performed by Non-preferred providers, except in certain situations such as emergency care. 

Certain cost sharing amounts do not apply if Medicare is your primary coverage for medical services (it pays first). 

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 brochure (RI 71-017). All benefits are subject to the definitions, limitations, and exclusions set forth in the federal brochure.


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