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.
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
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
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
2023 Plan Rates
FEP Blue Focus
| Enrollment code | Bi-weekly | Monthly |
|---|---|---|
| Self (131) |
$54.21 | $117.46 |
| Self + 1 (133) |
$116.54 | $252.51 |
| Self & Family (132) |
$128.19 | $277.75 |
Basic Option
| Enrollment code | Bi-weekly | Monthly |
|---|---|---|
| Self (111) |
$86.67 | $187.78 |
| Self + 1 (113) |
$217.90 | $472.12 |
| Self & Family (112) |
$237.91 | $515.48 |
Standard Option
| Enrollment code | Bi-weekly | Monthly |
|---|---|---|
| Self (104) |
$142.40 | $308.53 |
| Self + 1 (106) |
$318.85 | $690.84 |
| Self & Family (105) |
$347.89 | $753.77 |
Compare Benefits Chart
See costs for typical services when you use Preferred providers.
| FEP Blue Focus | Basic Option | Standard Option | |
|---|---|---|---|
| Preventive Care | You pay nothing | You pay nothing | You pay nothing |
| Physician Care |
$10 copay per visit for your first 10 primary and/or specialty care visits combined |
$30 copay for primary care1 $40 copay for specialists1 |
$25 copay for primary care $35 copay for specialists |
| Mental Health Visits | $10 copay per visit for your first 10 primary and/or specialty care visits combined | $30 copay | $25 copay |
| Virtual doctor visits by Teladoc® |
$0 for first 2 visits $10 copay all additional visits |
$0 for first 2 visits $15 copay all additional visits |
$0 for first 2 visits $10 copay all additional visits |
| Urgent Care Center | $25 copay |
$35 copay
|
Accidental Injury: $0 Medical Emergency: $30 copay |
| Prescription Drugs |
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 4 (Preferred Generic specialty, and Preferred brand specialty): 40% of our allowance ($350 maximum) |
Preferred Retail Pharmacy^:
If you have Medicare Part B primary, your costs for prescription drugs may be lower. Tier 1 (Generics): $15 copay Tier 2 (Preferred brand): $60 copay Tier 3 (Non-preferred brand): 60% of our allowance ($90 minimum) Tier 4 (Preferred specialty): $85 copay Tier 5 (Non-preferred specialty): $110 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: |
| Maternity Care |
$0 for doctor's visits $1,500 for facility care |
$250 inpatient $0 outpatient |
$0 copay |
| Hospital Care |
Inpatient (Precertification is required): 30% of our allowance* Outpatient: 30% of our allowance* |
Inpatient (Precertification is required): $250 per day; up to $1,500 per admission Outpatient: $150 per day per facility1 |
Inpatient (Precertification is required): $350 per admission Outpatient: 15% of our allowance* |
| Surgery |
30% of our allowance* |
$150 in an office setting1 $200 in a non-office setting1 |
15% of our allowance* |
| ER (accidental injury) | $0 within 72 hours | $250 copay per day per facility | $0 within 72 hours |
| ER (medical emergency) | 30% of our allowance* |
$250 copay per day per facility
|
15% of our allowance* |
| Lab work (such as blood tests) | $0 for first 10 specific lab tests** |
15% of our allowance1
|
15% of our allowance* |
| Diagnostic services (such as sleep studies, CT scans) | 30% of our allowance* |
Up to $100 in an office1 Up to $200 in a hospital1 |
15% of our allowance* |
| Chiropractic Care | $25 per visit; for up to 10 visits a year1,2 | $30 per visit; up to 20 visits per year | $25 per visit; up to 12 visits per year |
| Dental Care | Not a benefit |
$30 per evaluation; up to 2 evaluations per year |
The difference between the fee schedule amount and the Maximum Allowable Charge (MAC) |
| Rewards Program |
Earn a reward at no out-of-pocket cost for getting an annual physical4 |
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 |
| Network Coverage | In-network care only, except in certain situations like emergency care | In-network care only, except in certain situations like emergency care | In-network and out-of-network care |
| Out-of-Pocket Maximum (PPO) |
Self Only: $8,500 Self + One and Self & Family: $17,000 |
Self Only: $6,500 Self + One and Self & Family: $13,000 |
Self Only: $6,000 Self + One and Self & Family: $12,000 |
| Annual Deductible |
Self Only: $500 Self + One and Self & Family: $1,000 |
No deductible |
Self Only: $350 Self + One and Self & Family: $700 |
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: RI 71-017). All benefits are subject to the definitions, limitations and exclusions set forth in the Federal brochures.