Compare Our Plans
See the differences between benefits and coverage for our three plan options side by side.
FEP will waive any copays or deductibles for medically necessary diagnostic tests or treatment that are consistent with CDC guidance if diagnosed with COVID-19.
Get the Details
Get a convenient summary of these coverage options.
Standard Option
- Has a deductible
- Can see any provider, even outside the network
- Out-of-pocket costs include deductible, copays and coinsurance
- Access to Mail Service Pharmacy Program
- Earn up to $170 in rewards with the Wellness Incentive Program
Basic Option
- Has no deductible
- Must see Preferred providers
- Most out-of-pocket costs are copays
- Can get Medicare Part B premium reimbursement
- Earn up to $170 in rewards with the Wellness Incentive Program
FEP Blue Focus
- Has a deductible
- Must see Preferred providers
- Out-of-pocket costs include deductible, copays and coinsurance
- Earn a reward for getting annual physical
2021 Plan Rates
Standard Option
| Enrollment code | Bi-weekly | Monthly |
|---|---|---|
| Self (104) |
$123.45 | $267.48 |
| Self + 1 (106) |
$280.81 | $608.43 |
| Self & Family (105) |
$300.12 | $650.26 |
Basic Option
| Enrollment code | Bi-weekly | Monthly |
|---|---|---|
| Self (111) |
$78.60 | $170.31 |
| Self + 1 (113) |
$189.17 | $409.87 |
| Self & Family (112) |
$201.27 | $436.08 |
FEP Blue Focus
| Enrollment code | Bi-weekly | Monthly |
|---|---|---|
| Self (131) |
$53.14 | $115.15 |
| Self + 1 (133) |
$114.25 | $247.55 |
| Self & Family (132) |
$125.67 | $272.29 |
Standard Option
| Enrollment code | Bi-weekly Category 1 | Bi-weekly Category 2 |
|---|---|---|
| Self (104) |
$120.09 | $110.03 |
| Self + 1 (106) |
$273.62 | $252.06 |
| Self & Family (105) |
$292.31 | $268.89 |
Basic Option
| Enrollment code | Bi-weekly Category 1 | Bi-weekly Category 2 |
|---|---|---|
| Self (111) |
$75.46 | $65.24 |
| Self + 1 (113) |
$181.98 | $160.42 |
| Self & Family (112) |
$193.46 | $170.04 |
FEP Blue Focus
| Enrollment code | Bi-weekly Category 1 | Bi-weekly Category 2 |
|---|---|---|
| Self (131) |
$51.02 | $44.11 |
| Self + 1 (133) |
$109.68 | $94.83 |
| Self & Family (132) |
$120.65 | $104.31 |
Compare Benefit Options
See costs for typical services when you use Preferred providers.
| Standard Option | Basic Option | FEP Blue Focus | |
|---|---|---|---|
| Preventive Care | You pay nothing | You pay nothing | You pay nothing |
| Physician Care |
$25 for primary care $35 for specialists |
$30 for primary care1 $40 for specialists1 |
$10 per visit for your first 10 primary and/or specialty care visits combined medical and mental health substance use1 |
| 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 |
| Urgent Care Center |
Accidental Injury: $0 Medical Emergency: $30 copay |
$35 copay | $25 copay |
| Prescription Drugs |
Preferred Retail Pharmacy^: If you have Medicare Part B primary, your costs for prescription drugs may be lower. 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): $65 copay Tier 5 (Non-preferred specialty): $85 copay |
Preferred Retail Pharmacy^:
If you have Medicare Part B primary, your costs for prescription drugs may be lower. 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. Tier 1 (Generics): $20 Tier 2 (Preferred brand): $100 copay Tier 3 (Non-preferred brand): $125 copay
Specialty Pharmacy: Tier 4 (Preferred specialty): $85 copay Tier 5 (Non-preferred specialty): $110 copay |
Preferred Retail Pharmacy^: Tier 1 (Generics): $5 copay Tier 2 (Preferred brand): 40% of our allowance ($350 max)
Mail Service Pharmacy: Not a benefit
Specialty Pharmacy: Tier 2 (Preferred Generic specialty, and Preferred brand specialty): 40% of our allowance ($350 maximum) |
| Maternity Care | $0 copay |
$175 inpatient $0 outpatient |
$0 for doctor's visits $1,500 for facility care |
| Hospital Care |
Inpatient (Precertification is required): $350 per admission Outpatient: 15% of our allowance* |
Inpatient (Precertification is required): $175 per day; up to $875 per admission Outpatient: $100 per day per facility1 |
Inpatient (Precertification is required): 30% of our allowance* Outpatient: 30% of our allowance* |
| Surgery |
15% of our allowance* |
$150 in an office setting1 $200 in a non-office setting1 |
30% of our allowance* |
| ER (accidental injury) | $0 within 72 hours | $175 per day per facility | $0 within 72 hours |
| ER (medical emergency) | 15% of our allowance* | $175 per day per facility | 30% of our allowance* |
| Lab work (such as blood tests) | 15% of our allowance* | $0 copay1 | $0 for first 10 specific lab tests** |
| Diagnostic services (such as sleep studies, CT scans) | 15% of our allowance* |
Up to $100 in an office1 Up to $150 in a hospital1 |
30% of our allowance* |
| Chiropractic Care | $25 per visit; up to 12 visits per year | $30 per visit; up to 20 visits per year1 | $25 per visit; for up to 10 visits a year1,2 |
| Dental Care | The difference between the fee schedule amount and the Maximum Allowable Charge (MAC) |
$30 per evaluation; up to 2 evaluations per year |
Not a benefit |
| Rewards Program |
Earn $50 for completing the Blue Health Assessment3 Earn up to $120 for completing three eligible Online Health Coach goals3 |
Earn $50 for completing the Blue Health Assessment3 Earn up to $120 for completing three eligible Online Health Coach goals3 |
Earn a reward, such as a Fitbit®, at no out-of-pocket cost for getting an annual physical4 |
| Network Coverage | 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 |
| 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: $7,500 Self + One and Self & Family: $15,000 |
| Annual Deductible |
Self Only: $350 Self + One and Self & Family: $700 |
No deductible |
Self Only: $500 Self + One and Self & Family: $1,000 |
Certain medical services and treatments must be pre-approved (also known as prior approval or precertification) before you receive care. Learn more here.
Cost sharing may not apply or may be different if Medicare is your primary coverage (it pays first).
* Deductible applies.
** Please see brochure for covered lab services.
^ What you’ll pay for a 30-day supply of covered drugs.
1 You pay 30% of our allowance for agents, drugs and/or supplies you receive during your care.
2 Up to 10 visits combined for chiropractic care and acupuncture.
3 You must be the contract holder or spouse, 18 or older, on a Standard or Basic Option plan to earn incentive rewards.
4 You must be the contract holder or spouse, 18 or older, on an FEP Blue Focus plan to earn this reward.
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.