FEP Blue Focus^®

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

Coinsurance (a type of cost sharing) is the percentage of our allowance you pay. We contract with providers to pay them a set rate, or an allowance. Cost sharing may not apply or may be different if Medicare is your primary coverage (it pays first).

*FEP Blue Focus Traditional Pharmacy drug tiers: Tier 1 Preferred Generics, Tier 2 Preferred Brand Name, Preferred Specialty and Preferred Brand Name Specialty. 

• ^{^} What you’ll pay for a 30-day supply of covered drugs.
• ¹ Deductible applies. $500 for Self Only and $1,000 for Self + One and Self & Family.
• ² Specialty drugs are limited to a 30-day supply.
• ³ Professional 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.
• ⁴ Please see brochure for covered lab services.
• ⁵ You pay 30% of our allowance for agents, drugs and/or supplies you receive during your care.
• ⁶ You must be the contract holder or spouse, 18 or older, on a FEP Blue Focus plan to earn incentive rewards.
• ⁷ You still have an overall medical out-of-pocket maximum. Your MPDP pharmacy out-of-pocket maximum is separate.

The FEP Medicare Prescription Drug Program is a prescription drug plan with a Medicare contract. Enrollment in MPDP depends on contract renewal.

The formulary and/or pharmacy network may change at any time. You will receive notice when necessary.

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.