2025 Blue Cross and Blue Shield Service Benefit Plan - Standard and Basic Option
Section 5. Benefits
Section 5. Benefits
Section 5. Benefits
See Section 2 for how our benefits changed this year and towards the end of the brochure for a benefits summary of each option. Make sure that you review the benefits that are available under the option in which you are enrolled.
Section 5. Standard and Basic Option Overview - 36
Section 5(a). Medical Services and Supplies Provided by Physicians and Other Healthcare Professionals - 37
Non-FEHB Benefits Available to Plan Members - 133
Section 5. Standard and Basic Option Overview - 36
Section 5(a). Medical Services and Supplies Provided by Physicians and Other Healthcare Professionals - 37
Diagnostic and Treatment Services - 38
Lab, X-ray and Other Diagnostic Tests - 39
Preventive Care, Adult - 41
Preventive Care, Child - 44
Maternity Care - 46
Family Planning - 48
Reproductive Services - 49
Allergy Care - 50
Treatment Therapies - 51
Physical Therapy, Occupational Therapy, Speech Therapy, and Cognitive Rehabilitation Therapy - 52
Hearing Services (Testing, Treatment, and Supplies) - 53
Vision Services (Testing, Treatment, and Supplies) - 53
Foot Care - 54
Orthopedic and Prosthetic Devices - 55
Durable Medical Equipment (DME) - 56
Medical Supplies - 57
Home Health Services - 58
Manipulative Treatment - 58
Alternative Treatments - 59
Educational Classes and Programs - 59
Section 5(b). Surgical and Anesthesia Services Provided by Physicians and Other Healthcare Professionals - 61 Lab, X-ray and Other Diagnostic Tests - 39
Preventive Care, Adult - 41
Preventive Care, Child - 44
Maternity Care - 46
Family Planning - 48
Reproductive Services - 49
Allergy Care - 50
Treatment Therapies - 51
Physical Therapy, Occupational Therapy, Speech Therapy, and Cognitive Rehabilitation Therapy - 52
Hearing Services (Testing, Treatment, and Supplies) - 53
Vision Services (Testing, Treatment, and Supplies) - 53
Foot Care - 54
Orthopedic and Prosthetic Devices - 55
Durable Medical Equipment (DME) - 56
Medical Supplies - 57
Home Health Services - 58
Manipulative Treatment - 58
Alternative Treatments - 59
Educational Classes and Programs - 59
Surgical Procedures - 62
Reconstructive Surgery - 63
Oral and Maxillofacial Surgery - 66
Organ/Tissue Transplants - 67
Anesthesia - 72
Section 5(c). Services Provided by a Hospital or Other Facility, and Ambulance Services - 74 Reconstructive Surgery - 63
Oral and Maxillofacial Surgery - 66
Organ/Tissue Transplants - 67
Anesthesia - 72
Inpatient Hospital - 75
Outpatient Hospital or Ambulatory Surgical Center - 77
Blue Distinction® Specialty Care - 81
Residential Treatment Center - 82
Extended Care Benefits/Skilled Nursing Care Facility Benefits - 83
Hospice Care - 84
Ambulance - 87
Section 5(d). Emergency Services/Accidents - 89 Outpatient Hospital or Ambulatory Surgical Center - 77
Blue Distinction® Specialty Care - 81
Residential Treatment Center - 82
Extended Care Benefits/Skilled Nursing Care Facility Benefits - 83
Hospice Care - 84
Ambulance - 87
Section 5(e). Mental Health and Substance Use Disorder Benefits - 93
Professional Services - 94
Inpatient Hospital or Other Covered Facility - 95
Residential Treatment Center - 95
Outpatient Hospital or Other Covered Facility - 96
Not Covered (Inpatient or Outpatient) - 96
Section 5(f). Prescription Drug Benefits - 98 Inpatient Hospital or Other Covered Facility - 95
Residential Treatment Center - 95
Outpatient Hospital or Other Covered Facility - 96
Not Covered (Inpatient or Outpatient) - 96
Covered Medications and Supplies - 114
Section 5(g). Dental Benefits - 121 Section 5(h). Wellness and Other Special Features - 125 Health Tools - 125
Services for the Deaf and Hearing Impaired - 125
Web Accessibility for the Visually Impaired - 125
Travel Benefit/Services Overseas - 125
Healthy Families - 125
Diabetes Management Program - 125
Blue Health Assessment - 125
Hypertension Management Program - 126
Pregnancy Care Incentive Program - 126
Annual Incentive Limitation - 127
Reimbursement Account for Basic Option Members Enrolled in Medicare Part A and Part B - 127
MyBlue® Customer eService - 127
National Doctor & Hospital Finder - 127
Care Management Programs - 127
Flexible Benefits Option - 128
Telehealth Services - 129
The fepblue Mobile Application - 129
Section 5(i). Services, Drugs, and Supplies Provided Overseas - 130 Services for the Deaf and Hearing Impaired - 125
Web Accessibility for the Visually Impaired - 125
Travel Benefit/Services Overseas - 125
Healthy Families - 125
Diabetes Management Program - 125
Blue Health Assessment - 125
Hypertension Management Program - 126
Pregnancy Care Incentive Program - 126
Annual Incentive Limitation - 127
Reimbursement Account for Basic Option Members Enrolled in Medicare Part A and Part B - 127
MyBlue® Customer eService - 127
National Doctor & Hospital Finder - 127
Care Management Programs - 127
Flexible Benefits Option - 128
Telehealth Services - 129
The fepblue Mobile Application - 129
Non-FEHB Benefits Available to Plan Members - 133