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Cover Page and Inside Cover
Table of Contents
Introduction/Plain Language/Advisory
FEHB Facts
Section 1
Section 2
Section 3
Section 4
Section 5
5(a). Medical Services and Supplies Provided by Physicians and Other Healthcare Professionals
5(b). Surgical and Anesthesia Services Provided by Physicians and Other Healthcare Professionals
5(c). Services Provided by a Hospital or Other Facility, and Ambulance Services
5(d). Emergency Services/Accidents
5(e). Mental Health and Substance Use Disorder Benefits
5(f). Prescription Drug Benefits
5(g). Dental Benefits
5(h). Wellness and Other Special Features
5(i). Services, Drugs, and Supplies Provided Overseas
Non-FEHB Benefits Available to Plan Members
Section 6
Section 7
Section 8
Section 9
Section 10
Index
Summary of Benefits – Standard Option
Summary of Benefits – Basic Option
2025 Rate Information
Entire brochure in page-number order
 
Blue Cross Blue Shield Federal Employee Program logo
 
 

 

Blue Cross® and Blue Shield® Service Benefit Plan
www.fepblue.org

Blue Cross Blue Shield logo
 
 

2025

A Fee-For-Service Plan (FEP Blue Standard and
FEP Blue Basic Options) with a Preferred Provider Organization
 
IMPORTANT
  • Rates: Back Cover
  • Changes for 2025: Page 15 
  • Summary of Benefits: Page 163 

This Plan’s health coverage qualifies as minimum essential coverage and meets the minimum value standard for the benefits it provides. See our FEHB Facts for details. This Plan is accredited. See Section 1.

Sponsored and administered by: The Blue Cross and Blue Shield Association and participating Blue Cross and Blue Shield Plans


Who may enroll in this Plan: All Federal employees, Tribal employees, and annuitants who are eligible to enroll in the Federal Employees Health Benefits Program

Postal Employees and Annuitants are no longer eligible for this plan (unless currently under Temporary Continuation of Coverage)

Enrollment codes for this Plan:
104 Standard Option - Self Only
106 Standard Option - Self Plus One
105 Standard Option - Self and Family
111 Basic Option - Self Only
113 Basic Option - Self Plus One
112 Basic Option - Self and Family


FEHB logo and the words Federal Employees Health Benefits Program

Office of Personnel Management logo and the words Authorized for distribution by the: United States Office of Personnel Management Healthcare and Insurance http://www.opm.gov/insure
 
RI 71-005
 

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