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2014 Benefits & Rates

It’s that time of year again—Open Season, when you will be seeing a lot of information from health plans. The Blue Cross and Blue Shield Service Benefit Plan remains a great value and an ideal choice for millions of federal employees and their families.

Plan changes for 2014

You will see some new benefits for 2014, and some changes to existing benefits. In order to keep rates as low as possible, some copayment amounts are increasing. The following is a summary of changes to the Service Benefit Plan in 2014. This is not an official statement of benefits. Please read Section 5 of the 2014 Service Benefit Plan brochure (RI 71-005) when it is available in October.

Changes to Standard Option

  • Catastrophic maximum amounts will be different for Self Only contracts versus Self and Family contracts. For Self Only contracts, the catastrophic out-of-pocket maximum is $5,000 per year when you use Preferred providers and $7,000 per year when you use a combination of Preferred and Non-preferred providers. For Self and Family contracts, the catastrophic out-of-pocket maximum is $6,000 per year when you use Preferred providers and $8,000 per year when you use a combination of Preferred and Non-preferred providers.
  • The catastrophic out-of-pocket maximum includes the calendar year deductible, in addition to coinsurance and copayments.
  • The maximum number of home nursing care visits allowed is increasing to 50 visits per calendar year.
  • Mail Service Pharmacy Program copayment changes:
    • The copayment for Tier 2 preferred brand name drugs is $80 per prescription for up to a 90-day supply.
    • The copayment for Tier 3 non-preferred brand name drugs is $105 per prescription for up to a 90-day supply.
  • Specialty drug benefit changes:
    • New prescriptions of Tier 4 or Tier 5 specialty drugs may be filled at a Preferred retail pharmacy or through the Specialty Pharmacy Program. You must use the Specialty Pharmacy Program for any refills of the same specialty drug. We will cover supplies of up to 30 days for your first three fills of the same Tier 4 or Tier 5 prescription. You may receive supplies of up to 90 days beginning with your fourth fill. 
    • The copayment for Tier 4 preferred specialty drugs dispensed by the Specialty Pharmacy Program is $35 for up to a 30-day supply, and $95 for a 90-day supply. Benefits for the first three fills are limited to a 30-day supply. You may receive up to a 90-day supply beginning with your fourth fill.
    • You pay 30% of our Plan allowance for Tier 5 non-preferred specialty drugs dispensed by a Preferred retail pharmacy. Benefits are limited to one 30-day supply for each prescription filled. After the first fill of a Tier 5 drug from a Preferred retail pharmacy, all refills must be dispensed through the Specialty Pharmacy Program.
    • The copayment for Tier 5 non-preferred specialty drugs dispensed by the Specialty Pharmacy Program is $55 for up to a 30-day supply, and $155 for a 90-day supply. Benefits for the first three fills are limited to a 30-day supply. You may receive up to a 90-day supply beginning with your fourth fill.

Changes to Basic Option

  • Catastrophic maximum amounts will be different for Self Only contracts versus Self and Family contracts. The maximum out-of-pocket cost is $5,500 per year for Self Only contracts and $7,000 per year for Self and Family contracts when you use Preferred providers.
  • Coinsurance for non-preferred brand name drugs purchased at Preferred retail pharmacies will apply towards the annual catastrophic protection out-of-pocket maximum.
  • The copayment for surgical procedures performed outside the office setting is $200 per performing surgeon.
  • The copayment for an inpatient admission to a Preferred facility is $175 per day up to a maximum of $875 for unlimited days.
  • The copayment for a maternity inpatient admission to a Preferred facility is $175.
  • The copayment for diagnostic tests such as EEGs, ultrasounds and X-rays performed by a Preferred professional provider is $40.
  • The copayment for diagnostic tests and radiological services such as MRIs, CT scans, genetic tests, and nuclear medicine is $100 when performed by a Preferred professional provider.
  • The copayment for diagnostic tests and radiological services such as MRIs, CT scans, genetic tests, and nuclear medicine is $150 when performed by a Preferred, Member or Non-member facility.
  • The copayment for neurological testing is $40 when performed by a Preferred professional provider.
  • Prescription drug benefit changes:
    • The copayment for Tier 2 preferred brand name drugs purchased at a Preferred retail pharmacy is $45 for each 30-day supply.
    • You will pay 50% of the Plan allowance or a minimum $55 copayment for Tier 3 non-preferred brand name drugs purchased at a Preferred retail pharmacy for each 30-day supply.
    • New prescriptions of Tier 4 or Tier 5 specialty drugs may be filled at a Preferred retail pharmacy or through the Specialty Pharmacy Program. You must use the Specialty Pharmacy Program for any refills of the same specialty drug. We will cover supplies of up to 30 days for your first three fills of the same Tier 4 or Tier 5 prescription. You may receive supplies of up to 90 days beginning with your fourth fill. 
    • The copayment for Tier 4 preferred specialty drugs dispensed by a Preferred retail pharmacy is $60, and benefits are limited to one 30-day supply for each prescription filled. After the first fill of a Tier 4 drug from a Preferred retail pharmacy, all refills must be dispensed through the Specialty Pharmacy Program. 
    • The copayment for Tier 5 non-preferred specialty drugs dispensed by a Preferred retail pharmacy is $80, and benefits are limited to one 30-day supply for each prescription filled. After the first fill of a Tier 5 drug from a Preferred retail pharmacy, all refills must be dispensed through the Specialty Pharmacy Program.
    • The copayment for Tier 4 preferred specialty drugs dispensed through the Specialty Pharmacy Program is $50 for up to a 30-day supply, and $140 for a 90-day supply. Benefits for the first three fills are limited to a 30-day supply. 
    • The copayment for Tier 5 non-preferred specialty drugs dispensed through the Specialty Pharmacy Program is $70 for up to a 30-day supply, and $195 for a 90-day supply. Benefits for the first three fills are limited to a 30-day supply.

Changes to Standard and Basic Options

  • The maximum amount possible to earn with the Wellness Incentive Program is increased to $75 for completing online programs (an extra $25).
  • We now cover any licensed medical practitioner for covered services performed within the scope of that license, as required by Section 2706(a) of the Public Health Service Act (PHSA).  Previously, benefits for certain medical practitioners were limited to services performed in Medically Underserved Areas.
  • New preventive care benefits are available for BRCA testing for females when certain criteria are met. Benefits are limited to one BRCA test per lifetime.
  • Benefits will be provided, in full, for vitamin D supplements for adults, age 65 and over, limited to the recommended daily allowance of 600-800 international units (I.U.s) per day. To receive benefits, you must use a Preferred retail pharmacy and present a written prescription from your physician to the pharmacist.
  • Insulin and diabetic supplies must be obtained from a retail pharmacy, or for Standard Option only, from the Mail Service Pharmacy Program for members who do not have Medicare Part B as primary.
  • Benefits are provided for wigs for hair loss due to cancer treatment, limited to a maximum of $350 for one wig per lifetime.
  • When a Non-participating provider bills for drugs, we will use the Medicare Part B Average Sale Price (ASP) in the calculation to determine our Plan allowance.
  • For claims from overseas professional providers, an Overseas Fee Schedule will be used to determine our Plan allowance.

Open Season Dates

The 2013 Open Season for health insurance changes is scheduled for November 11 through December 9, 2013.

2014 Medical Premiums

2014 Standard Option2014 Basic Option
Non-Postal Premium
Biweekly
  • Self Only (104): $87.82
  • Family (105): $204.98
  • Self Only (111): $60.96
  • Family (112): $142.75
Non-Postal Premium
Monthly
  • Self Only (104): $190.28
  • Family (105): $444.12
  • Self Only (111): $132.09
  • Family (112): $309.30 
 Category 1Category 2Category 1Category 2
Postal Premium
Biweekly
  • Self Only (104): $65.96
  • Family (105): $156.36
  • Self Only (104): $79.62
  • Family (105): $186.75
  • Self Only (111): $40.24
  • Family (112): $94.22
  • Self Only (111): $53.04
  • Family (112): $124.20

2014 Dental Benefits

In 2014, the Blue Cross Blue Shield Association is pleased to announce it will be adding FEP BlueDental to the existing portfolio of benefits available to federal employees through the Federal Employees Dental and Vision Insurance Program (FEDVIP).

2014 Vision Benefits

In 2014, the Blue Cross Blue Shield Association is pleased to announce it will continue to offer FEP BlueVision through the Federal Employees Dental and Vision Program (FEDVIP).

For More Information

In addition to the benefit changes listed above, you should also read the complete list of benefit changes in Section 2 of the 2014 Service Benefit Plan brochure. This brochure will be available in October online and in print form.

To view or download a copy of the 2014 Service Benefit Plan brochure in October, visit http://fepblue.org/benefitplans/sbp-brochure/index.jsp .

Beginning Monday, October 21 through Friday, December 20, 2013, you can call our Open Season Information Center at 1.800.411.BLUE (1.800.411.2583) for information about 2014 benefits. The Center is open between 7 a.m. and 11 p.m. Eastern time (ET) Monday through Friday. The Center is closed Thanksgiving.


September 2013.  Aaron Eskridge, Blue Cross Blue Shield Association.  Resource: 2014 Blue Cross and Blue Shield Service Benefit Plan brochure.

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Benefits and Services

Page last updated: February 14, 2014

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