Frequently asked questions, related to the FEP Blue Focus benefit plan.
You will receive a New Member Welcome Kit with your Blue Cross and Blue Shield Service Benefit Plan member ID card approximately 10 business days from the date we receive your enrollment information. You can also access a digital version of your member ID card via the fepblue app or online once you register for a MyBlue account.
If you enroll in a Self Only plan, you will receive one physical member ID card. For Self Plus One and Self and Family enrollments, you will receive two physical ID cards (all ID cards are in the contract holder’s name). If you need cards for additional covered family members, you can request them via your MyBlue® account or by calling the customer service number on the back of your member ID card.
For active employees, your effective date is the first day of the first full pay period in January. For annuitants, this date will always be January 1.
Yes, it qualifies for MEC and satisfies the Patient Protection and Affordable Care Act’s (ACA) individual shared responsibility requirement. FEP Blue Focus meets the minimum value standard of 60% established by the ACA.
FEP Blue Focus is a national PPO product but with no out-of-network benefits. The Preferred network is the same as Standard and Basic Option. Members must use Preferred providers to receive benefits. Use our National Doctor and Hospital Finder to search the directory.
No, we will cover conditions you had prior to enrollment.
All federal employees, annuitants and their dependents who qualify for coverage through the Federal Employees Health Benefits (FEHB) Program.
If you are new to the Blue Cross and Blue Shield Service Benefit Plan or need to make changes to your current plan, follow these steps to get started.
1. Confirm who you will cover with your plan (Self Only, Self Plus One or Self & Family) and the product of your choice. Make note of the corresponding Federal Employees Health Benefits (FEHB) Program enrollment code:
corresponding Federal Employees Health Benefits (FEHB) Program enrollment code:
Self & Family
FEP Blue Focus
2. Retired federal employees (annuitants) can learn about enrolling here. Active employees can enroll online using your agency’s preferred method:
3. Otherwise, you must fill out and submit the SF 2809 Form to your Human Resources office. Please do not submit the form anywhere else.
No. FEP Blue Focus is a national program that uses the same network of Preferred providers as Standard and Basic Option. Use our National Doctor and Hospital Finder to search the directory.
Core benefits are the base of the program. These benefits have a low or no copayment and are not subject to a deductible or coinsurance. These benefits are most commonly used to receive general care and to maintain your overall health and well-being, in addition to coverage for accidental injuries.
Non-core benefits provide coverage for any unexpected medical costs you may incur during the calendar year. All of these services are subject to an annual deductible and coinsurance. When you have met the catastrophic out-of-pocket maximum, then we pay 100% of the Plan allowance for services for the remainder of the calendar year.
Wrap benefits provide the final layer of protection and complete or “wrap-up” the FEP Blue Focus benefit package. These are benefits you may or may not have a need to use during the year. These benefits have visit limitations and/or different copayments or coinsurance than the Core and Non-core benefit levels. The calendar year deductible does not apply to these benefits.
You pay $10 per visit for the first 10 visits when you see a primary care provider, specialist or other healthcare provider, such as a mental health doctor. Visits to these professional providers are combined to meet the 10-visit limit per calendar year. Each member on your contract receives 10 visits per calendar year.
On the eleventh visit per calendar year, your cost share will change to include the deductible and 30% of our allowance (known as coinsurance). Preventive care visits, such as an annual physical, do not count toward the 10-visit limit and are at no cost to you.
Yes, the annual deductible is $500 for Self Only and $1,000 for Self Plus One and Self and Family. The coinsurance is 30% of the Plan allowance. This deductible and coinsurance only applies to Non-core services.
The out-of-pocket maximum, also known as catastrophic maximum, is $6,500 for Self Only and $13,000 for Self Plus One and Self and Family. Once met, we will pay the entire cost of your covered benefits until the end of the year.
Some transplants are limited to services received in a Blue Distinction Center. You’ll also need to receive prior authorization. You can find the transplants that require use of a Blue Distinction Center in section 3 of the FEP Blue Focus brochure.
Yes, the transplant travel benefit is up to $5,000 per transplant if you live at least 50 miles away from the Blue Distinction Center.
Yes, you must use our contracted telehealth services vendor, Teladoc®. You’ll receive two free telehealth visits per year. Then, there is a $10 copay per visit. There is no limit on the number of telehealth visits you can use per calendar year. Go to the Telehealth Services page to learn more.
Only the diagnosis of fertility is a covered benefit.
Yes, there is a $25 copay per visit and a combined visit limitation of 10 visits per calendar year.
There is a $25 copay per visit and a combined visit limitation of 25 per calendar year. Inpatient care is subject to the deductible and 30% coinsurance.
Dental and Vision Coverage
Medical eye diagnoses, such as glaucoma, are covered under the medical benefits of FEP Blue Focus. You must use Preferred providers.
No, there is no coverage for routine eye exams and eyewear. Federal employees and retirees can purchase supplemental vision insurance through the Federal Employees Dental and Vision Insurance Program. Learn more at opm.gov/fedvip.
No, there is no coverage for routine dental exams or other dental services. Federal employees and retirees can purchase supplemental dental insurance through the Federal Employees Dental and Vision Insurance Program. Learn more at opm.gov/fedvip.
Yes, care must be received from Preferred providers within 72 hours of the oral injury to receive accidental injury dental benefits. If you receive treatment after the 72-hour time frame, coverage will be subject to the deductible and coinsurance.
Applied Behavior Analysis (ABA)
ABA for the treatment of an autism spectrum disorder is limited to 200 hours per person, per calendar year.
No, services provided by a school or educational system or as a replacement are not covered under this medical plan.
Yes, it is a medical benefit (treatment therapy) available only for members with a diagnosis of autism spectrum disorder. Prior approval is required for ABA and all related services, including assessments, evaluations and treatment.
Yes. We coordinate FEP Blue Focus benefits with your Medicare coverage. If Medicare is your primary coverage (meaning Medicare pays first), you receive the benefits outlined below.
If you have Medicare Part A primary:
We will waive our calendar year deductible and coinsurance.
Once you have exhausted your Medicare Part A benefits, you must then pay the coinsurance once you satisfy the calendar year deductible for an inpatient admission.
Precertification is required.
If you also have Medicare Part B primary coverage:
We will waive our calendar year deductible, coinsurance and copayments for inpatient and outpatient services and supplies provided by physicians and other covered healthcare professional and outpatient facility services.
We do not waive benefit limitations, such as the 10-visit limit for home skilled nursing visits.
We do not waive your coinsurance or copayments for prescription drugs.
No, there is no MRA with FEP Blue Focus. The $600 MRA is only for Basic Option.
Yes, the FEP Blue Focus prescription benefit is considered “creditable coverage” under Medicare Part D.