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Document Number:
FSB25-003
Revision #:
v1.0
Date Published:
1/1/2025
 

 

2025 Blue Cross and Blue Shield Service Benefit Plan - Standard and Basic Option
Table of Contents
Page 3

 

Summary of Benefits for the Blue Cross and Blue Shield Service Benefit Plan Standard Option – 2025 - 163 
Summary of Benefits for the Blue Cross and Blue Shield Service Benefit Plan Basic Option – 2025 - 165 
2025 Rate Information for the Blue Cross and Blue Shield Service Benefit Plan - 170 

 

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Blue Cross Blue Shield Federal Employee Program
Confidential - Internal Plan use only