2025 Blue Cross and Blue Shield Service Benefit Plan - Standard and Basic Option
Index
Index
Index
Do not rely only on this page; it is for your convenience and may not show all pages where the terms appear. This Index is not an official statement of benefits.
Abortion - 46-47, 134-135
Accidental injury - 19-20, 89-92, 121-122, 152, 163, 165
Acupuncture - 59, 72-73
Affordable Care Act (ACA) - 114-119, 163, 165
Allergy care - 50-51
Allogeneic transplants - 68-71
Alternative treatments - 59
Ambulance - 31, 87-88
Ambulatory surgical center - 17-19, 77-81
Anesthesia - 72-73
Angiographies - 39-40, 77-81
Appeals - 26
Applied behavior analysis (ABA) - 51-52, 77-81
Assistant surgeon - 19-20, 62-63
Autism spectrum disorder - 51-52, 77-81
Autologous transplants - 68-71
Average wholesale price (AWP) - 156-157
Biopsies - 41-43, 62-63, 77-81
Birthing centers - 17-19
Blood and blood plasma - 57-58, 77-81
Blood or marrow stem cell transplants - 67-70
Blue Distinction CentersBlue Distinction Specialty Care - 17-19
Blue Health Assessment - 125-126
Bone density tests - 39-40, 77-81
Brand-name drugs - 103-107, 111-114
Breast pump and supplies - 46-47, 56-57
Breast reconstruction - 63-65Breastfeeding support and supplies - 46-47, 57-58
Cancer tests - 41-43
Cardiac rehabilitation - 51-52, 77-81
Cardiovascular monitoring - 39-40, 77-81
Care Management Programs - 127-128
Case management - 127-128
Casts - 62-63, 75-81
Catastrophic protection - 32-33, 150-151, 164, 166
Cervical cancer screening - 41-45
CHAMPVA - 142-143
Changes for 2025 - 15-16
Chemotherapy - 51-52, 77-81
Children’s Equity Act - 10-11
Chiropractic manipulative treatment - 58-59
Cholesterol tests - 41-43
Circumcision - 46-47, 62-63
Claims and claims filing - 24-25, 127, 131-132, 136-138
Clinic visits - 38-39, 94-95
Clinical trials - 70, 145
Cognitive rehabilitation - 52-53, 77-81
Coinsurance - 28
Colorectal cancer tests - 41-43Confidentiality - 13-14
Congenital anomalies - 62-63, 153
Consultations - 38-39, 94-95
Contact lenses - 53-54
Contraceptive devices and drugs - 48-49, 103-107, 111-119
Coordination of benefits - 142-151
Copayments - 27
Cosmetic surgery - 62-66, 153
Cost-sharing - 27
Costs for covered services - 27-33
Coverage information - 9
Covered facility providers - 17-19
Covered professional providers - 17
CT scans - 39-40, 77-81
Custodial care - 75-77, 134-135, 153
Daily Habits - 114-119, 125
Deductible - 27, 163
Definitions - 152-160
Dental care - 121-124
Diabetes Management Program - 125
Diabetic education - 59-60, 77-81
Diabetic supplies
Diagnostic tests - 39-40, 93-97
Dialysis - 51-52, 56-57, 77-81
Disease Management - 127-128
Disputed claims process - 139-141
Divorce - 12
DNA analysis of stool samples - 41-43
Donor expenses (transplants) - 70-72
Drugs (see: Prescription drugs)
Durable medical equipment (DME) - 56-57Educational classes and programs - 59-60
EEGs - 39-40, 77-81
EKGs - 39-40, 77-81
Emergency - 19-20, 25, 31, 89-92, 163, 165
Enrollment - 9-10, 17
Exception situations - 19-21
Exclusions - 134-135
Experimental or investigational - 134-135, 153-154
Extended care benefits - 83-84
Eyeglasses - 53-54
Facility providers - 17-19
Family planning - 48-49
Fecal occult blood test - 41-43
FEDVIP - 33, 145
fepblue mobile application - 129
fepblue.org - 4
Flexible benefits option - 128-129
Foot care - 54-55
Formulary/Preferred drug list - 99-102, 108-111
Foundation for the Accreditation of Cellular Therapy (FACT) accredited facility - 17-19, 67
Fraud - 4
Freestanding ambulatory facilities - 17-19
Gender affirming care - 17, 21, 63-65
Generic drugs - 99-102, 108-111
Generic Incentive Program - 102-103
Genetic screening/testing - 39-40, 77-81
Health Insurance Marketplace - 12
Health tools - 125
Healthy Families - 125
Hearing aids and hearing services - 53, 55-56, 133
Home health services - 58
Home nursing care (maternity) - 58
Hospice care - 84-86
HospitalHuman papillomavirus (HPV) tests - 41-45
Hypertension Management Program - 126
Immunizations - 41-45, 114-119
Inpatient hospital benefits - 75-77
Inpatient professional services - 38-39, 94-95
Insulin - 103-107, 111-114
Insulin pumps - 56-57
Laboratory and pathology services - 39-40, 75-81, 89-92
Low-dose CT screening - 158
Mail Service Prescription Drug Program - 99-107, 111-119, 131-132, 137-138, 163-166
Mammograms - 41-43
Manipulative treatment - 58-59, 77-81
Maternity care - 25, 46-47, 75-77
Maxillofacial surgery - 66, 164, 166
Medicaid - 143
Medical emergency - 19-20, 75-77, 89-92, 163, 165
Medical foods - 57-58, 102-103, 108-111, 155
Medical supplies - 57-58
Medically necessary - 155
Medicare - 1, 142-151
Member facilities - 13-14
Mental health/substance use disorder - 93-97, 163, 165
MRIs - 39-40, 77-81
Multiple procedures - 62-63
MyBlue Customer eService - 127
National Doctor & Hospital Finder - 127
Neurological testing - 39-40, 77-81
Never Events - 6-8, 155
Newborn care - 25, 46-47
No Surprises Act (NSA) - 31
Non-member facilities - 13-14, 156-157
Non-participating providers - 13-14, 24, 28-31, 156-158
Non-preferred providers - 28-31
Nurse - 58, 84-86, 125
Nutritional counseling - 38-39, 41-45
Observation care - 155
Obstetrical care - 46-47
Occupational therapy - 52-53
Office visits - 38-39, 94-95
Oral surgery - 66
Organ/tissue transplants - 61-73
Orthopedic devices - 55-56, 77-81
Osteopathic manipulative treatment - 58-59
Osteoporosis screening - 158
Ostomy and catheter supplies - 57-58
Out-of-pocket expenses - 28-33
Outpatient facility services - 77-81
Outpatient professional services - 38-39
Overpayments - 33
Overseas Assistance Center - 130
Overseas services, drugs, supplies and claims - 130-132
Oxygen - 56-58, 84-86
Pap tests - 41-45
Participating providers - 13-14, 156-157
Patient Safety and Quality Monitoring (PSQM) Program - 99-102
Personal Health Record - 125
PET scans - 39-40, 77-81
Pharmacotherapy - 38-39, 51-52
Physical examination - 41-45
Physical therapy - 52-53, 84-86
Physician - 154
Plan allowance - 156-157
PPO - 13-14, 156-158
Pre-admission testing - 75-77
Precertification - 21, 24, 158
Preferred providers - 13-14, 19-20, 28-31
Pregnancy (see: Maternity care)
Pregnancy Care Incentive Program - 126-127
Prescription drugs
Prior approval - 20-24, 158
Professional providers - 17
Prostate cancer tests - 41-43
Prosthetic devices - 55-56, 75-77
Psychotherapy - 93-97
Pulmonary rehabilitation - 51-52, 77-81
Radiation therapy - 51-52, 77-81
Reconsiderations - 26, 139-141
Renal dialysis - 51-52, 77-81
Replacement coverage - 12
Reproductive services - 49-50Residential Treatment Center (RTC) - 17-19, 21, 24, 82-83, 95-96
Retail Pharmacy Program - 98-99, 102-103, 131-132, 163-166
Rights and responsibilities - 13-14
Room and board - 75-77, 82-83, 95-96
Screening services - 158
Second surgical opinion - 38-39
Self-injectable drugs - 98-102
Skilled nursing facility (SNF) care - 17-19, 83-84
Smoking cessation - 59-60, 114-119, 125
Social worker - 127-128
Specialty Drug Pharmacy Program - 98-107, 137-138, 163-166
Specialty drugs - 99-111, 137-138, 159
Speech therapy - 52-53, 77-81, 84-86
Speech-Generating Devices - 56-57
Stem Cell Transplants - 67-70
Sterilization procedures - 48-49, 62-63
Subrogation - 143-144, 159
Substance use disorder - 93-97, 163, 165
Surgery
Telehealth
Tobacco cessation - 59-60, 114-119, 125
Transplants - 61-73
Travel benefit - 71-72, 125
Treatment therapies - 51-52
TRICARE - 142-143
Ultrasounds - 39-40, 77-81
Urgent care center - 90-92
Urgent care claims - 25, 159-160
VA facilities - 33, 150
Vision services - 53-54, 145
Waivers - 28
Weight control - 125-126, 133-135
Wheelchairs - 56-57
Wigs - 55-56
X-rays - 39-40, 77-81
Accidental injury - 19-20, 89-92, 121-122, 152, 163, 165
Acupuncture - 59, 72-73
Affordable Care Act (ACA) - 114-119, 163, 165
Allergy care - 50-51
Allogeneic transplants - 68-71
Alternative treatments - 59
Ambulance - 31, 87-88
Ambulatory surgical center - 17-19, 77-81
Anesthesia - 72-73
Angiographies - 39-40, 77-81
Appeals - 26
Applied behavior analysis (ABA) - 51-52, 77-81
Assistant surgeon - 19-20, 62-63
Autism spectrum disorder - 51-52, 77-81
Autologous transplants - 68-71
Average wholesale price (AWP) - 156-157
Biopsies - 41-43, 62-63, 77-81
Birthing centers - 17-19
Blood and blood plasma - 57-58, 77-81
Blood or marrow stem cell transplants - 67-70
Blue Distinction CentersBlue Distinction Specialty Care - 17-19
Blue Health Assessment - 125-126
Bone density tests - 39-40, 77-81
Brand-name drugs - 103-107, 111-114
Breast pump and supplies - 46-47, 56-57
Breast reconstruction - 63-65Breastfeeding support and supplies - 46-47, 57-58
Cancer tests - 41-43
Cardiac rehabilitation - 51-52, 77-81
Cardiovascular monitoring - 39-40, 77-81
Care Management Programs - 127-128
Case management - 127-128
Casts - 62-63, 75-81
Catastrophic protection - 32-33, 150-151, 164, 166
Cervical cancer screening - 41-45
CHAMPVA - 142-143
Changes for 2025 - 15-16
Chemotherapy - 51-52, 77-81
Children’s Equity Act - 10-11
Chiropractic manipulative treatment - 58-59
Cholesterol tests - 41-43
Circumcision - 46-47, 62-63
Claims and claims filing - 24-25, 127, 131-132, 136-138
Clinic visits - 38-39, 94-95
Clinical trials - 70, 145
Cognitive rehabilitation - 52-53, 77-81
Coinsurance - 28
Colorectal cancer tests - 41-43Confidentiality - 13-14
Congenital anomalies - 62-63, 153
Consultations - 38-39, 94-95
Contact lenses - 53-54
Contraceptive devices and drugs - 48-49, 103-107, 111-119
Coordination of benefits - 142-151
Copayments - 27
Cosmetic surgery - 62-66, 153
Cost-sharing - 27
Costs for covered services - 27-33
Coverage information - 9
Covered facility providers - 17-19
Covered professional providers - 17
CT scans - 39-40, 77-81
Custodial care - 75-77, 134-135, 153
Daily Habits - 114-119, 125
Deductible - 27, 163
Definitions - 152-160
Dental care - 121-124
Diabetes Management Program - 125
Diabetic education - 59-60, 77-81
Diabetic supplies
Diabetic Meter Program - 103-107
Insulin pumps - 56-57, 103-107, 111-114
Insulin, test strips, and lancets - 103-107, 111-114, 125
Needles and disposable syringes - 103-107, 111-114
Diagnostic and treatment services - 38-39, 77-81Insulin pumps - 56-57, 103-107, 111-114
Insulin, test strips, and lancets - 103-107, 111-114, 125
Needles and disposable syringes - 103-107, 111-114
Diagnostic tests - 39-40, 93-97
Dialysis - 51-52, 56-57, 77-81
Disease Management - 127-128
Disputed claims process - 139-141
Divorce - 12
DNA analysis of stool samples - 41-43
Donor expenses (transplants) - 70-72
Drugs (see: Prescription drugs)
Durable medical equipment (DME) - 56-57Educational classes and programs - 59-60
EEGs - 39-40, 77-81
EKGs - 39-40, 77-81
Emergency - 19-20, 25, 31, 89-92, 163, 165
Enrollment - 9-10, 17
Exception situations - 19-21
Exclusions - 134-135
Experimental or investigational - 134-135, 153-154
Extended care benefits - 83-84
Eyeglasses - 53-54
Facility providers - 17-19
Family planning - 48-49
Fecal occult blood test - 41-43
FEDVIP - 33, 145
fepblue mobile application - 129
fepblue.org - 4
Flexible benefits option - 128-129
Foot care - 54-55
Formulary/Preferred drug list - 99-102, 108-111
Foundation for the Accreditation of Cellular Therapy (FACT) accredited facility - 17-19, 67
Fraud - 4
Freestanding ambulatory facilities - 17-19
Gender affirming care - 17, 21, 63-65
Generic drugs - 99-102, 108-111
Generic Incentive Program - 102-103
Genetic screening/testing - 39-40, 77-81
Health Insurance Marketplace - 12
Health tools - 125
Healthy Families - 125
Hearing aids and hearing services - 53, 55-56, 133
Home health services - 58
Home nursing care (maternity) - 58
Hospice care - 84-86
HospitalHuman papillomavirus (HPV) tests - 41-45
Hypertension Management Program - 126
Immunizations - 41-45, 114-119
Inpatient hospital benefits - 75-77
Inpatient professional services - 38-39, 94-95
Insulin - 103-107, 111-114
Insulin pumps - 56-57
Laboratory and pathology services - 39-40, 75-81, 89-92
Low-dose CT screening - 158
Mail Service Prescription Drug Program - 99-107, 111-119, 131-132, 137-138, 163-166
Mammograms - 41-43
Manipulative treatment - 58-59, 77-81
Maternity care - 25, 46-47, 75-77
Maxillofacial surgery - 66, 164, 166
Medicaid - 143
Medical emergency - 19-20, 75-77, 89-92, 163, 165
Medical foods - 57-58, 102-103, 108-111, 155
Medical supplies - 57-58
Medically necessary - 155
Medicare - 1, 142-151
Reimbursement account - 127
Medications and supplies - 103-107, 111-120Member facilities - 13-14
Mental health/substance use disorder - 93-97, 163, 165
MRIs - 39-40, 77-81
Multiple procedures - 62-63
MyBlue Customer eService - 127
National Doctor & Hospital Finder - 127
Neurological testing - 39-40, 77-81
Never Events - 6-8, 155
Newborn care - 25, 46-47
No Surprises Act (NSA) - 31
Non-member facilities - 13-14, 156-157
Non-participating providers - 13-14, 24, 28-31, 156-158
Non-preferred providers - 28-31
Nurse - 58, 84-86, 125
Nutritional counseling - 38-39, 41-45
Observation care - 155
Obstetrical care - 46-47
Occupational therapy - 52-53
Office visits - 38-39, 94-95
Oral surgery - 66
Organ/tissue transplants - 61-73
Orthopedic devices - 55-56, 77-81
Osteopathic manipulative treatment - 58-59
Osteoporosis screening - 158
Ostomy and catheter supplies - 57-58
Out-of-pocket expenses - 28-33
Outpatient facility services - 77-81
Outpatient professional services - 38-39
Overpayments - 33
Overseas Assistance Center - 130
Overseas services, drugs, supplies and claims - 130-132
Oxygen - 56-58, 84-86
Pap tests - 41-45
Participating providers - 13-14, 156-157
Patient Safety and Quality Monitoring (PSQM) Program - 99-102
Personal Health Record - 125
PET scans - 39-40, 77-81
Pharmacotherapy - 38-39, 51-52
Physical examination - 41-45
Physical therapy - 52-53, 84-86
Physician - 154
Plan allowance - 156-157
PPO - 13-14, 156-158
Pre-admission testing - 75-77
Precertification - 21, 24, 158
Preferred providers - 13-14, 19-20, 28-31
Pregnancy (see: Maternity care)
Pregnancy Care Incentive Program - 126-127
Prescription drugs
Brand-name drugs - 103-107, 111-114
Drugs from other sources - 119-120
Generic drugs - 99-102, 108-111
Mail Service Prescription Drug Program - 103-107, 111-119, 131-132, 137-138
Preferred retail pharmacies - 103-107, 137-138
Retail Pharmacy Program - 102-103, 131-132, 163-166
Self-injectable drugs - 98-99
Specialty Drug Pharmacy Program - 103-107, 137-138, 163-166
Specialty drugs - 99-107, 137-138, 159
Preventive carePrimary care provider - 17, 163, 165Drugs from other sources - 119-120
Generic drugs - 99-102, 108-111
Mail Service Prescription Drug Program - 103-107, 111-119, 131-132, 137-138
Preferred retail pharmacies - 103-107, 137-138
Retail Pharmacy Program - 102-103, 131-132, 163-166
Self-injectable drugs - 98-99
Specialty Drug Pharmacy Program - 103-107, 137-138, 163-166
Specialty drugs - 99-107, 137-138, 159
Prior approval - 20-24, 158
Professional providers - 17
Prostate cancer tests - 41-43
Prosthetic devices - 55-56, 75-77
Psychotherapy - 93-97
Pulmonary rehabilitation - 51-52, 77-81
Radiation therapy - 51-52, 77-81
Reconsiderations - 26, 139-141
Renal dialysis - 51-52, 77-81
Replacement coverage - 12
Reproductive services - 49-50Residential Treatment Center (RTC) - 17-19, 21, 24, 82-83, 95-96
Retail Pharmacy Program - 98-99, 102-103, 131-132, 163-166
Rights and responsibilities - 13-14
Room and board - 75-77, 82-83, 95-96
Screening services - 158
Second surgical opinion - 38-39
Self-injectable drugs - 98-102
Skilled nursing facility (SNF) care - 17-19, 83-84
Smoking cessation - 59-60, 114-119, 125
Social worker - 127-128
Specialty Drug Pharmacy Program - 98-107, 137-138, 163-166
Specialty drugs - 99-111, 137-138, 159
Speech therapy - 52-53, 77-81, 84-86
Speech-Generating Devices - 56-57
Stem Cell Transplants - 67-70
Sterilization procedures - 48-49, 62-63
Subrogation - 143-144, 159
Substance use disorder - 93-97, 163, 165
Surgery
Assistant surgeon - 19-20, 62-63
Eye: cataract, amblyopia, strabismus - 53-54, 62-63
Gender affirming - 63-65
Multiple procedures - 62-63
Oral and maxillofacial - 66
Outpatient - 77-82
Reconstructive - 63-65
Sterilization, reversal of voluntary - 48-49, 62-63
Surgical implants - 55-56, 77-81
Surgical treatment of severe obesity - 21-24, 62-63
Syringes - 103-107, 111-114Eye: cataract, amblyopia, strabismus - 53-54, 62-63
Gender affirming - 63-65
Multiple procedures - 62-63
Oral and maxillofacial - 66
Outpatient - 77-82
Reconstructive - 63-65
Sterilization, reversal of voluntary - 48-49, 62-63
Surgical implants - 55-56, 77-81
Surgical treatment of severe obesity - 21-24, 62-63
Telehealth
Dermatology - 17, 129, 159
Mental health/substance use disorder - 17, 94-95, 129
Minor acute conditions - 17, 129, 155
Nutritional counseling - 17, 41-45, 129
Temporary Continuation of Coverage (TCC) - 12Mental health/substance use disorder - 17, 94-95, 129
Minor acute conditions - 17, 129, 155
Nutritional counseling - 17, 41-45, 129
Tobacco cessation - 59-60, 114-119, 125
Transplants - 61-73
Travel benefit - 71-72, 125
Treatment therapies - 51-52
TRICARE - 142-143
Ultrasounds - 39-40, 77-81
Urgent care center - 90-92
Urgent care claims - 25, 159-160
VA facilities - 33, 150
Vision services - 53-54, 145
Waivers - 28
Weight control - 125-126, 133-135
Wheelchairs - 56-57
Wigs - 55-56
X-rays - 39-40, 77-81