This index was last updated on: 10/3/2025

 
Document Number Document Name Version Date Published
FSB25.00.1.1 Cover page v1.0 01/01/2025
FSB25.00.1.2 Inside cover v1.0 01/01/2025
FSB25.00.1.3 Table of Contents v1.0 01/01/2025
FSB25.00.2.1 Introduction v1.0 01/01/2025
FSB25.00.2.2 Plain Language v1.0 01/01/2025
FSB25.00.2.3 Stop Healthcare Fraud! v1.0 01/01/2025
FSB25.00.2.4 Discrimination is Against the Law v1.0 01/01/2025
FSB25.00.2.5 Preventing Medical Mistakes v1.0 01/01/2025
FSB25.00.3.1.1 No pre-existing condition limitation v1.0 01/01/2025
FSB25.00.3.1.2 Minimum essential coverage (MEC) v1.0 01/01/2025
FSB25.00.3.1.3 Minimum value standard v1.0 01/01/2025
FSB25.00.3.1.4 Where you can get information about enrolling in the FEHB Program v1.0 01/01/2025
FSB25.00.3.1.5 Enrollment types available for you and your family v1.0 01/01/2025
FSB25.00.3.1.6 Family member coverage v1.0 01/01/2025
FSB25.00.3.1.7 Children's Equity Act v1.0 01/01/2025
FSB25.00.3.1.8 When benefits and premiums start v1.0 01/01/2025
FSB25.00.3.1.9 When you retire v1.0 01/01/2025
FSB25.00.3.2.1 When FEHB coverage ends v1.0 01/01/2025
FSB25.00.3.2.2 Upon divorce v1.0 01/01/2025
FSB25.00.3.2.3 Temporary Continuation of Coverage (TCC) v1.0 01/01/2025
FSB25.00.3.2.4 Finding replacement coverage v1.0 01/01/2025
FSB25.00.3.2.5 Health Insurance Marketplace v1.0 01/01/2025
FSB25.01.0 Section 1. How This Plan Works v1.0 01/01/2025
FSB25.01.1 General features of our Standard and Basic Options//We have a Preferred Provider Organization (PPO) v1.0 01/01/2025
FSB25.01.2 How we pay professional and facility providers v1.0 01/01/2025
FSB25.01.3 Your rights and responsibilities v1.0 01/01/2025
FSB25.01.4 Your medical and claims records are confidential v1.0 01/01/2025
FSB25.02.0 Section 2. Changes for 2025 v1.0 01/01/2025
FSB25.02.1 Changes to our Standard Option only v1.0 01/01/2025
FSB25.02.2 Changes to our Basic Option only v1.0 01/01/2025
FSB25.02.3 Changes to both our Standard and Basic Options v1.0 01/01/2025
FSB25.03.1 Identification cards v1.0 01/01/2025
FSB25.03.2.0 Where you get covered care v1.0 01/01/2025
FSB25.03.2.05 Balance Billing Protection v1.0 01/01/2025
FSB25.03.2.1 Covered professional providers v1.0 01/01/2025
FSB25.03.2.2 Covered facility providers v1.0 01/01/2025
FSB25.03.3.0 What you must do to get covered care v1.0 01/01/2025
FSB25.03.3.1 Transitional care v1.0 01/01/2025
FSB25.03.3.2 If you are hospitalized when your enrollment begins v1.0 01/01/2025
FSB25.03.4.00 You need prior Plan Approval for certain services v1.0 01/01/2025
FSB25.03.4.01 Inpatient hospital, residential treatment center, or skilled nursing facility admission v1.0 01/01/2025
FSB25.03.4.02 Other services v1.0 01/01/2025
FSB25.03.4.03 Surgery by Non-participating providers under Standard Option v1.0 01/01/2025
FSB25.03.4.04 How to request precertification for an admission or get approval for Other services v1.0 01/01/2025
FSB25.03.4.05 Non-urgent care claims v1.0 01/01/2025
FSB25.03.4.06 Urgent care claims v1.0 01/01/2025
FSB25.03.4.07 Concurrent care claims v1.0 01/01/2025
FSB25.03.4.08 Emergency inpatient admission v1.0 01/01/2025
FSB25.03.4.09 Maternity care v1.0 01/01/2025
FSB25.03.4.10 If your facility stay needs to be extended v1.0 01/01/2025
FSB25.03.4.11 If your treatment needs to be extended v1.0 01/01/2025
FSB25.03.5.0 If you disagree with our pre-service claim decision v1.0 01/01/2025
FSB25.03.5.1 To reconsider a non-urgent care claim v1.0 01/01/2025
FSB25.03.5.2 To reconsider an urgent care claim v1.0 01/01/2025
FSB25.03.5.3 To file an appeal with OPM v1.0 01/01/2025
FSB25.04.01 Cost share/Cost-sharing v1.0 01/01/2025
FSB25.04.02 Copayment v1.0 01/01/2025
FSB25.04.03 Deductible v1.0 01/01/2025
FSB25.04.04 Coinsurance v1.0 01/01/2025
FSB25.04.05 If your provider routinely waives your cost v1.0 01/01/2025
FSB25.04.06 Waivers v1.0 01/01/2025
FSB25.04.07 Differences between our allowance and the bill v1.0 01/01/2025
FSB25.04.08 Important Notice About Surprise Billing — Know Your Rights v1.0 01/01/2025
FSB25.04.09 Your costs for other care v1.0 01/01/2025
FSB25.04.10 Your catastrophic protection out-of-pocket maximum for deductibles, coinsurance, and copayments v1.0 01/01/2025
FSB25.04.11 Carryover v1.0 01/01/2025
FSB25.04.12 If we overpay you v1.0 01/01/2025
FSB25.04.13 When Government facilities bill us v1.0 01/01/2025
FSB25.04.14 The Federal Flexible Spending Account Program – FSAFEDS v1.0 01/01/2025
FSB25.05.01 Section 5. Benefits v1.0 01/01/2025
FSB25.05.02 Section 5. Standard and Basic Option Overview v1.0 01/01/2025
FSB25.05a.0 Section 5(a). Overview v1.0 01/01/2025
FSB25.05a.01 Diagnostic and Treatment Services v1.0 01/01/2025
FSB25.05a.02 Lab, X-ray and Other Diagnostic Tests v1.0 01/01/2025
FSB25.05a.03 Preventive Care, Adult v1.0 01/01/2025
FSB25.05a.04 Preventive Care, Child v1.0 01/01/2025
FSB25.05a.05 Maternity Care v1.0 01/01/2025
FSB25.05a.06 Family Planning v1.0 01/01/2025
FSB25.05a.07 Reproductive Services v1.0 01/01/2025
FSB25.05a.08 Allergy Care v1.0 01/01/2025
FSB25.05a.09 Treatment Therapies v1.0 01/01/2025
FSB25.05a.10 Physical Therapy, Occupational Therapy, Speech Therapy, and Cognitive Rehabilitation Therapy v1.0 01/01/2025
FSB25.05a.11 Hearing Services (Testing, Treatment, and Supplies) v1.0 01/01/2025
FSB25.05a.12 Vision Services (Testing, Treatment, and Supplies) v1.0 01/01/2025
FSB25.05a.13 Foot Care v1.0 01/01/2025
FSB25.05a.14 Orthopedic and Prosthetic Devices v1.0 01/01/2025
FSB25.05a.15 Durable Medical Equipment (DME) v1.0 01/01/2025
FSB25.05a.16 Medical Supplies v1.0 01/01/2025
FSB25.05a.17 Home Health Services v1.0 01/01/2025
FSB25.05a.18 Manipulative Treatment v1.0 01/01/2025
FSB25.05a.19 Alternative Treatments v1.0 01/01/2025
FSB25.05a.20 Educational Classes and Programs v1.0 01/01/2025
FSB25.05b.0 Section 5(b). Overview v1.0 01/01/2025
FSB25.05b.1 Surgical Procedures v1.0 01/01/2025
FSB25.05b.2 Reconstructive Surgery v1.0 01/01/2025
FSB25.05b.3 Oral and Maxillofacial Surgery v1.0 01/01/2025
FSB25.05b.4 Organ/Tissue Transplants v1.0 01/01/2025
FSB25.05b.5 Anesthesia v1.0 01/01/2025
FSB25.05c.0 Section 5(c). Overview v1.0 01/01/2025
FSB25.05c.1 Inpatient Hospital v1.0 01/01/2025
FSB25.05c.2 Outpatient Hospital or Ambulatory Surgical Center v1.0 01/01/2025
FSB25.05c.3 Blue Distinction Specialty Care v1.0 01/01/2025
FSB25.05c.4 Residential Treatment Center v1.0 01/01/2025
FSB25.05c.5 Extended Care Benefits/Skilled Nursing Care Facility Benefits v1.0 01/01/2025
FSB25.05c.6 Hospice Care v1.0 01/01/2025
FSB25.05c.7 Ambulance v1.0 01/01/2025
FSB25.05d.0 Section 5(d). Overview v1.0 01/01/2025
FSB25.05d.1 Accidental Injury v1.0 01/01/2025
FSB25.05d.2 Medical Emergency v1.0 01/01/2025
FSB25.05d.3 Ambulance v1.0 01/01/2025
FSB25.05e.0 Section 5(e). Overview v1.0 01/01/2025
FSB25.05e.1 Professional Services v1.0 01/01/2025
FSB25.05e.2 Inpatient Hospital or Other Covered Facility v1.0 01/01/2025
FSB25.05e.3 Residential Treatment Center v1.0 01/01/2025
FSB25.05e.4 Outpatient Hospital or Other Covered Facility v1.0 01/01/2025
FSB25.05e.5 Not Covered (Inpatient or Outpatient) v1.0 01/01/2025
FSB25.05f.0 Section 5(f). Overview v1.0 01/01/2025
FSB25.05f.01 There are important features you should be aware of v1.0 01/01/2025
FSB25.05f.02 Who can write your prescriptions v1.0 01/01/2025
FSB25.05f.03 Where you can obtain them v1.0 01/01/2025
FSB25.05f.04 What is covered v1.0 01/01/2025
FSB25.05f.05 Generic equivalents v1.0 01/01/2025
FSB25.05f.06 Disclosure of information v1.0 01/01/2025
FSB25.05f.07 These are the dispensing limitations v1.0 01/01/2025
FSB25.05f.08 Patient Safety and Quality Monitoring (PSQM) v1.0 01/01/2025
FSB25.05f.09 Prior Approval v1.0 01/01/2025
FSB25.05f.10 Standard Option Generic Incentive Program v1.0 01/01/2025
FSB25.05f.11 Medical Foods v1.0 01/01/2025
FSB25.05f.12 Here is how to obtain your prescription drugs and supplies v1.0 01/01/2025
FSB25.05f.13 Preferred Retail Pharmacies v1.0 01/01/2025
FSB25.05f.14 Non-preferred Retail Pharmacies v1.0 01/01/2025
FSB25.05f.15 Mail Service Prescription Drug Program v1.0 01/01/2025
FSB25.05f.16 Specialty Drug Pharmacy Program v1.0 01/01/2025
FSB25.05f.17 Asthma Medications v1.0 01/01/2025
FSB25.05f.18 Other Preferred Diabetic Medications, Test Strips, and Supplies v1.0 01/01/2025
FSB25.05f.19 Diabetic Meter Program v1.0 01/01/2025
FSB25.05f.20 Section 5(f). MPDP Overview v1.0 01/01/2025
FSB25.05f.21 MPDP There are important features you should be aware of v1.0 01/01/2025
FSB25.05f.22 MPDP Who can write your prescriptions v1.0 01/01/2025
FSB25.05f.23 MPDP Where you can obtain them v1.0 01/01/2025
FSB25.05f.24 MPDP What is covered v1.0 01/01/2025
FSB25.05f.25 MPDP Generic equivalents v1.0 01/01/2025
FSB25.05f.26 MPDP Disclosure of information v1.0 01/01/2025
FSB25.05f.27 MPDP These are the dispensing limitations v1.0 01/01/2025
FSB25.05f.28 MPDP Important Contact Information v1.0 01/01/2025
FSB25.05f.29 MPDP Prior Approval v1.0 01/01/2025
FSB25.05f.30 MPDP Medical Foods v1.0 01/01/2025
FSB25.05f.31 MPDP Here is how to obtain your prescription drugs and supplies v1.0 01/01/2025
FSB25.05f.32 MPDP Catastrophic Maximums v1.0 01/01/2025
FSB25.05f.33 MPDP Retail Pharmacies v1.0 01/01/2025
FSB25.05f.34 MPDP Mail Service Prescription Drug Program v1.0 01/01/2025
FSB25.05f.35 MPDP Asthma Medications v1.0 01/01/2025
FSB25.05f.36 MPDP Other Preferred Diabetic Medications, Test Strips, and Supplies v1.0 01/01/2025
FSB25.05f.37 Smoking and Tobacco Cessation Medications v1.0 01/01/2025
FSB25.05f.38 Anti-hypertensive Medications v1.0 01/01/2025
FSB25.05f.39 Over-the-counter (OTC) contraceptive drugs and devices v1.0 01/01/2025
FSB25.05f.40 Immunizations when provided by a Preferred retail pharmacy that participates in our vaccine network v1.0 01/01/2025
FSB25.05f.41 Metformin and metformin extended release (excluding osmotic and modified release generic drugs) v1.0 01/01/2025
FSB25.05f.42 Medications to promote better health as recommended under the ACA v1.0 01/01/2025
FSB25.05f.43 Generic medications to reduce breast cancer risk for women v1.0 01/01/2025
FSB25.05f.44 Bowel preparation medications and antiretroviral therapy medications for HIV v1.0 01/01/2025
FSB25.05f.45 Opioid Reversal Agents: Tier 1 medications limited to generic naloxone spray and injectable v1.0 01/01/2025
FSB25.05f.46 Not Covered v1.0 01/01/2025
FSB25.05f.47 Drugs From Other Sources v1.0 01/01/2025
FSB25.05g.0 Section 5(g). Overview v1.0 01/01/2025
FSB25.05g.1 Accidental Injury Benefit v1.0 01/01/2025
FSB25.05g.2 Dental Benefits v1.0 01/01/2025
FSB25.05h.01 Health Tools v1.0 01/01/2025
FSB25.05h.02 Services for the Deaf and Hearing Impaired v1.0 01/01/2025
FSB25.05h.03 Web Accessibility for the Visually Impaired v1.0 01/01/2025
FSB25.05h.04 Travel Benefit/Services Overseas v1.0 01/01/2025
FSB25.05h.05 Healthy Families v1.0 01/01/2025
FSB25.05h.06 Diabetes Management Program v1.0 01/01/2025
FSB25.05h.07 Blue Health Assessment v1.0 01/01/2025
FSB25.05h.08 Hypertension Management Program v1.0 01/01/2025
FSB25.05h.09 Pregnancy Care Incentive Program v1.0 01/01/2025
FSB25.05h.10 Annual Incentive Limitation v1.0 01/01/2025
FSB25.05h.11 Reimbursement Account for Basic Option Members Enrolled in Medicare Part A and Part B v1.0 01/01/2025
FSB25.05h.12 MyBlue Customer eService v1.0 01/01/2025
FSB25.05h.13 National Doctor & Hospital Finder v1.0 01/01/2025
FSB25.05h.14 Care Management Programs v1.0 01/01/2025
FSB25.05h.15 Flexible Benefits Option v1.0 01/01/2025
FSB25.05h.16 Telehealth Services v1.0 01/01/2025
FSB25.05h.17 The fepblue Mobile Application v1.0 01/01/2025
FSB25.05i.0 Section 5(i). Services, Drugs, and Supplies Provided Overseas v1.0 01/01/2025
FSB25.05N.0 Non-FEHB Benefits Available to Plan Members v1.0 01/01/2025
FSB25.06 Section 6. General Exclusions - Services, Drugs, and Supplies We Do Not Cover v1.0 01/01/2025
FSB25.07 Section 7. Filing a Claim for Covered Services v1.0 01/01/2025
FSB25.08 Section 8. The Disputed Claims Process v1.0 01/01/2025
FSB25.09.1.0 When you have other health coverage v1.0 01/01/2025
FSB25.09.1.1 TRICARE and CHAMPVA v1.0 01/01/2025
FSB25.09.1.2 Workers' Compensation v1.0 01/01/2025
FSB25.09.1.3 Medicaid v1.0 01/01/2025
FSB25.09.2 When other Government agencies are responsible for your care v1.0 01/01/2025
FSB25.09.3 When others are responsible for injuries v1.0 01/01/2025
FSB25.09.4 When you have Federal Employees Dental and Vision Insurance Plan (FEDVIP) v1.0 01/01/2025
FSB25.09.5 Clinical trials v1.0 01/01/2025
FSB25.09.6.1 When you have Medicare v1.0 01/01/2025
FSB25.09.6.2 The Original Medicare Plan (Part A or Part B) v1.0 01/01/2025
FSB25.09.6.3 Tell us about your Medicare coverage v1.0 01/01/2025
FSB25.09.6.4 Private contract with your physician v1.0 01/01/2025
FSB25.09.6.5 Medicare Advantage (Part C) v1.0 01/01/2025
FSB25.09.6.6 Medicare prescription drug coverage (Part D) v1.0 01/01/2025
FSB25.09.6.6.1 Medicare Prescription Drug Plan Employer Group Waiver Plan (PDP EGWP) v1.0 01/01/2025
FSB25.09.6.7 Medicare prescription drug coverage (Part B) v1.0 01/01/2025
FSB25.09.6.8 Primary payor chart v1.0 01/01/2025
FSB25.09.7 When you are age 65 or over and do not have Medicare v1.0 01/01/2025
FSB25.09.8 Physicians Who Opt-Out of Medicare v1.0 01/01/2025
FSB25.09.9 When you have the Original Medicare Plan (Part A, Part B, or both) v1.0 01/01/2025
FSB25.09.95 Cost-share when Medicare is your primary payor v1.0 01/01/2025
FSB25.10 Section 10. Definitions of Terms We Use in This Brochure v1.0 01/01/2025
FSB25.11 Index v1.0 01/01/2025
FSB25.12.1 Summary of Benefits for the Blue Cross and Blue Shield Service Benefit Plan Standard Option - 2025 v1.0 01/01/2025
FSB25.12.2 Summary of Benefits for the Blue Cross and Blue Shield Service Benefit Plan Basic Option - 2025 v1.0 01/01/2025
FSB25.13 2025 Rate Information for the Blue Cross and Blue Shield Service Benefit Plan v1.0 01/01/2025
FSB25.QL Quick Links v1.0 01/01/2025