2025 Blue Cross and Blue Shield Service Benefit Plan - Standard and Basic Option
Section 5(a). Medical Services and Supplies Provided by Physicians and Other Healthcare Professionals
Page 60
Section 5(a). Medical Services and Supplies Provided by Physicians and Other Healthcare Professionals
Page 60
Benefit Description
Educational Classes and Programs (cont.)
Standard Option - You Pay
Preferred: 15% of the Plan allowance (deductible applies)
Participating: 35% of the Plan allowance (deductible applies)
Non-participating: 35% of the Plan allowance (deductible applies), plus any difference between our allowance and the billed amount
Basic Option - You Pay
Preferred primary care provider or other healthcare professional: $35 copayment per visit
Preferred specialist: $50 copayment per visit
Participating/Non-participating: You pay all charges
Educational Classes and Programs (cont.)
- Diabetic education
Note: See earlier references for our coverage of nutritional counseling services that are not part of a diabetic education program.
Standard Option - You Pay
Preferred: 15% of the Plan allowance (deductible applies)
Participating: 35% of the Plan allowance (deductible applies)
Non-participating: 35% of the Plan allowance (deductible applies), plus any difference between our allowance and the billed amount
Basic Option - You Pay
Preferred primary care provider or other healthcare professional: $35 copayment per visit
Preferred specialist: $50 copayment per visit
Participating/Non-participating: You pay all charges
Benefit Description
Not covered:
Standard Option - You Pay
All charges
Basic Option - You Pay
All charges
Not covered:
- Educational, or other counseling or training services, or applied behavior analysis (ABA), when performed as part of an educational class or program
- Premenstrual syndrome (PMS), lactation, headache, eating disorder, and other educational clinics unless described earlier in this section as being covered
- Recreational or educational therapy, and any related diagnostic testing except as provided by a hospital as part of a covered inpatient stay
- Services performed or billed by a school or halfway house or a member of its staff
Standard Option - You Pay
All charges
Basic Option - You Pay
All charges