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Compare Our Plans

See the differences between benefits and coverage for our three plan options side by side.

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Get a convenient summary of these options.

 Download the 2024 Benefit Summary Book

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

FEP Blue Basic™

  • 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 Standard™

  • 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

2024 Plan Rates

FEP Blue Focus™
Enrollment code Bi-weekly Monthly
Self
(131)		 $55.30 $119.83
Self + 1
(133)		 $118.88 $257.58
Self & Family
(132)		 $130.76 $283.32
FEP Blue Basic™
Enrollment code Bi-weekly Monthly
Self
(111)		 $95.74 $207.44
Self + 1
(113)		 $238.63 $517.03
Self & Family
(112)		 $262.60 $568.96
FEP Blue Standard™
Enrollment code Bi-weekly Monthly
Self
(104)		 $150.79 $326.71
Self + 1
(106)		 $336.84 $729.82
Self & Family
(105)		 $370.68 $803.14
These rates do not apply to all enrollees. If you are in a special enrollment category, contact the agency or Tribal employer that manages your health benefits enrollment.

2024 Compare Benefits Chart

See costs for typical services when you use Preferred providers.

  Download the 2024 Benefits at a Glance Brochure

FEP Blue Focus™ FEP Blue Basic™ FEP Blue Standard™
Preventive Care You pay nothing You pay nothing You pay nothing
Physician Care

$10 per visit for your first 10 primary and/or specialty care visits combined medical and mental health substance use1

  • $35 copay for primary care1
  • $45 copay for specialists1
  • $35 copay for mental health visits
  • $30 copay for primary care
  • $40 copay for specialists
  • $30 copay for mental health visits
Virtual doctor visits by Teladoc®
  • $0 for first 2 visits and all nutrition visits
  • $10 all additional visits
  • $0 for first 2 visits and all nutrition visits
  • $15 all additional visits
  • $0 for first 2 visits and all nutrition visits
  • $10 all additional visits
Urgent Care Center $25 copay $35 copay

 

 $30 copay
Prescription Drugs

Preferred Retail Pharmacy^:

  • Tier 1 (Generics): $5 copay

  • Tier 2 (Preferred brand): 40% of our allowance ($350 maximum)


Mail Service Pharmacy:

Not a benefit


Specialty Pharmacy^:

  • Tier 2 (Preferred 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 Medicarepage for more information.

  • Tier 1 (Generics): $20 copay

  • 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:

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
FEP Medicare Prescription Drug Program

Preferred Retail Pharmacy^:

  • Tier 1 (Generics): $5 copay

  • Tier 2 (Preferred brand): 40% of our allowance ($350 maximum)

  • Tier 3 (Non-preferred brand): 40% of our allowance ($350 maximum)

  • Tier 4 (Specialty): 40% of our allowance ($350 maximum)

Preferred Retail Pharmacy^:

  • Tier 1 (Generics): $10 copay

  • Tier 2 (Preferred brand): $45 copay

  • Tier 3 (Non-preferred brand): 50% of our allowance ($60 minimum)

  • Tier 4 (Specialty): $75 copay


  • Mail Service Pharmacy:

  • Tier 1 (Generics): $15 copay

  • Tier 2 (Preferred brand): $95 copay

  • Tier 3 (Non-preferred brand): $125 copay

  • Tier 4 (Specialty): $150 copay

Preferred Retail Pharmacy^:

  • Tier 1 (Generics): $5 copay

  • Tier 2 (Preferred brand): 15% of our allowance

  • Tier 3 (Non-preferred brand): 50% of our allowance

  • Tier 4 (Specialty): $60 copay


Mail Service Pharmacy:

  • Tier 1 (Generics): $5 copay

  • Tier 2 (Preferred brand): $85 copay

  • Tier 3 (Non-preferred brand): $125 copay

  • Tier 4 (Specialty): $150 copay
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 per surgeon in an office1
  • $200 per surgeon in other settings1
 15%  of our allowance*
ER (accidental injury) $0 within 72 hours $250 per day per facility $0 within 72 hours
ER (medical emergency) 30% of our allowance*
 $250 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 for up to 10 visits a year 1 2 $35 for up to 20 visits a year $30 for up to 12 visits a year
Dental Care Not a benefit

$35 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, such as a $150 MyBlue Wellness Card, 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 Daily Habits goals.3

  • Earn $50 for completing the Blue Health Assessment3

  • Earn up to $120 for completing three eligible Daily Habits goals.3
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: $9,000
  • Self + One and Self & Family: $18,000
  • Self Only: $6,500
  • Self + One and Self & Family: $13,000
  • Self Only: $6,000
  • Self + One and Self & Family: $12,000
FEP Medicare Prescription Drug Program Out-of-Pocket Maximum $3,250 per member $3,250 per member $2,000 per member
Annual Deductible
  • Self Only: $500
  • Self + One and Self & Family: $1,000

No deductible
  • Self Only: $350
  • Self + One and Self & Family: $700

FEP Blue Focus Plan Page

FEP Blue Basic Plan Page

FEP Blue Standard Plan Page

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 FEP Blue Standard OR FEP Blue Basic 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 (FEP Blue Standard and FEP Blue Basic: 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.

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