2025 Blue Cross and Blue Shield Service Benefit Plan - Standard and Basic Option
Section 5. Benefits
Page 35
Section 5. Benefits
Page 35
Not Covered (Inpatient or Outpatient) - 96
Section 5(f). Prescription Drug Benefits - 98 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