2024 Blue Cross and Blue Shield Service Benefit Plan - Standard and Basic Option
Index
Index
Index
Do not rely only on this page; it is for your convenience and may not show all pages where the terms appear. This Index is not an official statement of benefits.
Abortion - 46-48, 134-135
Accidental injury - 75-77, 87-92, 121-122, 152
Acupuncture - 59, 72-73
Affordable Care Act (ACA) - 8, 11, 44-46
Allergy care - 50
Allogeneic transplants - 72
Alternative treatments - 59
Ambulance - 20, 87-88, 92
Ambulatory surgical center - 18-19, 77-81
Anesthesia - 72-73, 75-77
Angiographies - 40-41, 77-81
Appeals - 25, 27, 139-141
Applied behavior analysis (ABA) - 21-24, 51-52, 77-81
Assistant surgeon - 20
Autism spectrum disorder - 51-52, 77-81
Autologous transplants -
Average wholesale price (AWP) - 114-119, 164
Biopsies - 42-44, 62-63, 77-81
Birthing centers - 18-19
Blood and blood plasma - 57-58, 77-81
Blood or marrow stem cell transplants - 71-72
Blue Distinction Centers - 18-19, 71-72, 81-82Blue Distinction Specialty Care - 18-19
Blue Health Assessment - 125-126
Bone density tests - 40-41, 77-81
Brand-name drugs - 99-102
Breast pump and supplies - 46-48
Breast reconstruction - 63-65Breastfeeding support and supplies - 46-48, 57-58
Cancer tests - 42-44
Cardiac rehabilitation - 51-52, 77-81
Cardiovascular monitoring - 40-41, 77-81
Care Management Programs - 127-128
Case management - 82-86, 95-96, 127-128
Casts - 62-63, 75-81
Catastrophic protection - 33, 164, 166
Cervical cancer screening - 42-46
CHAMPVA - 142-145
Changes for 2024 - 14-16
Chemotherapy - 51-52, 77-81
Children’s Equity Act - 9-10
Chiropractic manipulative treatment - 51-52, 58-59
Cholesterol tests - 42-44, 114-119
Circumcision -46-48, 62-63
Claims and claims filing - 12-13, 25-27, 127, 131-132, 136-141, 153, 158-160
Clinic visits - 39-40, 77-81, 94-95
Clinical trials - 21-24, 134-135, 145, 152-154
Cognitive rehabilitation - 52-53, 77-81, 83-84
Coinsurance - 12-13, 20, 29, 33, 153
Colorectal cancer tests - 42-44Confidentiality - 12-13, 154
Congenital anomalies - 21-24, 62-63, 74, 153
Consultations - 39-40, 94-95
Contact lenses - 53-54, 133
Contraceptive devices and drugs - 48, 114-119
Coordination of benefits - 114-119, 142
Copayments - 12-13, 28, 33, 142, 145-147
Cosmetic surgery - 62-65, 153
Cost-sharing - 28, 33, 153
Costs for covered services - 28-34
Coverage information - 8
Covered facility providers - 18-19
Covered professional providers - 17
CT scans - 40-41, 77-81, 152
Custodial care - 18-19
Deductible - 28, 37
Definitions - 152-160
Dental care - 66, 121-124, 164
Diabetes Management Program - 125
Diabetic education - 59-60, 77-81
Diabetic supplies
Diagnostic tests - 40-41, 46-49, 95-96
Dialysis - 51-52, 56-57, 77-81, 83-84
Disease Management - 127-128
Disputed claims process - 139-141
Divorce - 8-9, 11
DNA analysis of stool samples - 42-44
Donor expenses (transplants) - 72
Drugs (see: Prescription drugs)
Durable medical equipment (DME) - 56-57, 153Educational classes and programs - 59-60
EEGs - 40-41, 77-81
EKGs - 40-41, 77-81
Emergency - 20, 26, 87-92, 121-122
Enrollment - 8, 10-11
Exception situations - 20-21
Exclusions - 134-135
Experimental or investigational - 153-154
Extended care benefits - 83-84
Eyeglasses - 53-54
Facility providers - 18-19
Family planning - 48
Fecal occult blood test - 42-44
FEDVIP - 121, 145
fepblue mobile application - 129
fepblue.org - 4
Flexible benefits option - 128-129
Foot care - 54-55
Formulary/Preferred drug list - 98-120
Foundation for the Accreditation of Cellular Therapy (FACT) accredited facility -
Fraud - 4
Freestanding ambulatory facilities - 18-19
Gender affirming care - 21-24, 55-56, 62-63
Generic drugs - 99-102
Generic Incentive Program - 102-103
Genetic screening/testing - 40-41
Health Insurance Marketplace - 11
Health tools - 125
Healthy Families - 125
Hearing aids and hearing services - 53, 55-56
Home health services - 58
Home nursing care (maternity) - 46-48
Hospice care - 84-86
HospitalHuman papillomavirus (HPV) tests - 42-46
Hypertension Management Program - 126
Immunizations - 42-46, 77-81, 114-119
Inpatient hospital benefits - 75-77, 81-82
Inpatient professional services - 21, 26, 39-40, 75-77
Insulin - 114-119
Insulin pumps - 56-57, 114-119
Laboratory and pathology services - 20
Low-dose CT screening - 158
Mail Service Prescription Drug Program - 99-103, 114-119, 131-132, 137-138, 164, 166
Mammograms - 42-44
Manipulative treatment - 58-59, 77-81
Maternity care - 26, 46-48
Maxillofacial surgery - 66
Medicaid - 143
Medical emergency - 20, 89, 91-92
Medical foods - 57-58, 114-119, 155
Medical supplies - 57-58, 75-81, 84-86
Medically necessary - 21, 26, 134-135, 145, 155
Medicare - 1, 21, 83-84, 127, 142-151
Member facilities - 12-13, 18-19, 156-157
Mental health/substance use disorder - 46-48, 82-83, 93-97, 155
MRIs - 40-41, 77-81, 152
Multiple procedures - 62-63
MyBlue Customer eService - 127
National Doctor & Hospital Finder - 127
Neurological testing - 40-41, 77-81
Never Events - 6-7, 155
Newborn care - 26, 39-40, 44-48
No Surprises Act (NSA) - 32
Non-member facilities - 12-13, 156-157
Non-participating providers - 12-13, 24, 32
Non-preferred providers - 29-33
Nurse - 18-19, 58, 84-86, 125, 127-128
Nutritional counseling - 42-46, 129
Observation care - 155
Obstetrical care - 46-48
Occupational therapy - 52-53, 84-86
Office visits - 37, 39-40, 94-95, 158, 164
Online Health Coach (OHC) - 125
Oral surgery - 66
Organ/tissue transplants - 21-24, 72
Orthopedic devices - 55-56, 77-81
Osteopathic manipulative treatment - 58-59
Osteoporosis screening - 158
Ostomy and catheter supplies - 57-58
Out-of-pocket expenses - 33, 37, 157-158
Outpatient facility services - 77-81
Outpatient professional services - 39-40
Overpayments - 34
Overseas Assistance Center - 130
Overseas services, drugs, supplies and claims - 130-132
Oxygen - 56-58
Pap tests - 42-44
Participating providers - 39-60, 62-66, 72-73, 89-92, 94-95, 124
Patient Safety and Quality Monitoring (PSQM) Program - 99-102
Personal Health Record - 125
PET scans - 40-41, 77-81, 152
Pharmacotherapy - 39-40, 51-52
Physical examination - 77-81, 134-135
Physical therapy - 39-40, 52-53, 84-86
Physician - 17, 21, 146, 150, 154, 163-166
Plan allowance - 156-157
PPO - 12-13, 158
Pre-admission testing - 75-77
Precertification - 21, 24-26, 154, 158
Preferred providers - 12-13, 20, 29-32
Pregnancy (see: Maternity care)
Pregnancy Care Incentive Program - 126-127
Prescription drugs - 114-119
Prior approval - 21-25, 51-52, 61-66, 74, 84-86, 98-102, 114-119, 137-138, 153-154, 158
Professional providers - 17
Prostate cancer tests - 42-44
Prosthetic devices - 55-56, 62-65, 74-81
Psychotherapy - 94-97
Pulmonary rehabilitation - 51-52, 77-81
Radiation therapy - 51-52, 77-81
Reconsiderations - 27, 139-141
Renal dialysis - 18-19, 51-52, 77-81
Replacement coverage - 11
Reproductive services - 49, 152Residential Treatment Center (RTC) - 18-19, 21, 24-25, 82-83, 95-96, 127-128, 153
Retail Pharmacy Program - 37, 98-102, 114-119, 131-132, 136-138, 158, 164, 166
Rights and responsibilities - 12-13
Room and board - 21, 26, 39-40, 75-77, 82-84, 95-96
Screening services - 158
Second surgical opinion - 39-40
Self-injectable drugs - 114-119, 159
Skilled nursing facility (SNF) care - 18-19, 153
Smoking cessation - 59-60, 114-119, 125
Social worker - 127-128
Specialty Drug Pharmacy Program - 98-99, 114-119, 131-132, 137-138
Specialty drugs - 114-119, 159
Speech therapy - 52-53, 77-81, 84-86
Speech-Generating Devices - 56-57
Stem Cell Transplants -
Sterilization procedures - 48, 62-63
Subrogation - 143-144, 159
Substance use disorder - 93-97, 164-165
Surgery - 24, 53-54, 61-73, 81-82, 153
Telehealth - 159
Tobacco cessation - 59-60, 114-119, 125
Transplants - 18-19, 21-24, 51-52, 72
Travel benefit - 71-72, 125
Treatment therapies - 51-52
TRICARE - 142-143
Ultrasounds - 40-41, 77-81
Urgent care center - 90-92
Urgent care claims - 25, 159-160
VA facilities - 150
Vision services - 53-54, 145
Waivers - 29
Weight control - 125, 134-135
Wheelchairs - 56-57, 83-84, 87-88
Wigs - 55-56
X-rays - 40-41, 145
Accidental injury - 75-77, 87-92, 121-122, 152
Acupuncture - 59, 72-73
Affordable Care Act (ACA) - 8, 11, 44-46
Allergy care - 50
Allogeneic transplants - 72
Alternative treatments - 59
Ambulance - 20, 87-88, 92
Ambulatory surgical center - 18-19, 77-81
Anesthesia - 72-73, 75-77
Angiographies - 40-41, 77-81
Appeals - 25, 27, 139-141
Applied behavior analysis (ABA) - 21-24, 51-52, 77-81
Assistant surgeon - 20
Autism spectrum disorder - 51-52, 77-81
Autologous transplants -
Average wholesale price (AWP) - 114-119, 164
Biopsies - 42-44, 62-63, 77-81
Birthing centers - 18-19
Blood and blood plasma - 57-58, 77-81
Blood or marrow stem cell transplants - 71-72
Blue Distinction Centers - 18-19, 71-72, 81-82Blue Distinction Specialty Care - 18-19
Blue Health Assessment - 125-126
Bone density tests - 40-41, 77-81
Brand-name drugs - 99-102
Breast pump and supplies - 46-48
Breast reconstruction - 63-65Breastfeeding support and supplies - 46-48, 57-58
Cancer tests - 42-44
Cardiac rehabilitation - 51-52, 77-81
Cardiovascular monitoring - 40-41, 77-81
Care Management Programs - 127-128
Case management - 82-86, 95-96, 127-128
Casts - 62-63, 75-81
Catastrophic protection - 33, 164, 166
Cervical cancer screening - 42-46
CHAMPVA - 142-145
Changes for 2024 - 14-16
Chemotherapy - 51-52, 77-81
Children’s Equity Act - 9-10
Chiropractic manipulative treatment - 51-52, 58-59
Cholesterol tests - 42-44, 114-119
Circumcision -46-48, 62-63
Claims and claims filing - 12-13, 25-27, 127, 131-132, 136-141, 153, 158-160
Clinic visits - 39-40, 77-81, 94-95
Clinical trials - 21-24, 134-135, 145, 152-154
Cognitive rehabilitation - 52-53, 77-81, 83-84
Coinsurance - 12-13, 20, 29, 33, 153
Colorectal cancer tests - 42-44Confidentiality - 12-13, 154
Congenital anomalies - 21-24, 62-63, 74, 153
Consultations - 39-40, 94-95
Contact lenses - 53-54, 133
Contraceptive devices and drugs - 48, 114-119
Coordination of benefits - 114-119, 142
Copayments - 12-13, 28, 33, 142, 145-147
Cosmetic surgery - 62-65, 153
Cost-sharing - 28, 33, 153
Costs for covered services - 28-34
Coverage information - 8
Covered facility providers - 18-19
Covered professional providers - 17
CT scans - 40-41, 77-81, 152
Custodial care - 18-19
Deductible - 28, 37
Definitions - 152-160
Dental care - 66, 121-124, 164
Diabetes Management Program - 125
Diabetic education - 59-60, 77-81
Diabetic supplies
Diabetic Meter Program - 114-119
Insulin pumps - 56-57
Insulin, test strips, and lancets - 114-119
Needles and disposable syringes - 114-119
Diagnostic and treatment services - 42-46, 77-81Insulin pumps - 56-57
Insulin, test strips, and lancets - 114-119
Needles and disposable syringes - 114-119
Diagnostic tests - 40-41, 46-49, 95-96
Dialysis - 51-52, 56-57, 77-81, 83-84
Disease Management - 127-128
Disputed claims process - 139-141
Divorce - 8-9, 11
DNA analysis of stool samples - 42-44
Donor expenses (transplants) - 72
Drugs (see: Prescription drugs)
Durable medical equipment (DME) - 56-57, 153Educational classes and programs - 59-60
EEGs - 40-41, 77-81
EKGs - 40-41, 77-81
Emergency - 20, 26, 87-92, 121-122
Enrollment - 8, 10-11
Exception situations - 20-21
Exclusions - 134-135
Experimental or investigational - 153-154
Extended care benefits - 83-84
Eyeglasses - 53-54
Facility providers - 18-19
Family planning - 48
Fecal occult blood test - 42-44
FEDVIP - 121, 145
fepblue mobile application - 129
fepblue.org - 4
Flexible benefits option - 128-129
Foot care - 54-55
Formulary/Preferred drug list - 98-120
Foundation for the Accreditation of Cellular Therapy (FACT) accredited facility -
Fraud - 4
Freestanding ambulatory facilities - 18-19
Gender affirming care - 21-24, 55-56, 62-63
Generic drugs - 99-102
Generic Incentive Program - 102-103
Genetic screening/testing - 40-41
Health Insurance Marketplace - 11
Health tools - 125
Healthy Families - 125
Hearing aids and hearing services - 53, 55-56
Home health services - 58
Home nursing care (maternity) - 46-48
Hospice care - 84-86
HospitalHuman papillomavirus (HPV) tests - 42-46
Hypertension Management Program - 126
Immunizations - 42-46, 77-81, 114-119
Inpatient hospital benefits - 75-77, 81-82
Inpatient professional services - 21, 26, 39-40, 75-77
Insulin - 114-119
Insulin pumps - 56-57, 114-119
Laboratory and pathology services - 20
Low-dose CT screening - 158
Mail Service Prescription Drug Program - 99-103, 114-119, 131-132, 137-138, 164, 166
Mammograms - 42-44
Manipulative treatment - 58-59, 77-81
Maternity care - 26, 46-48
Maxillofacial surgery - 66
Medicaid - 143
Medical emergency - 20, 89, 91-92
Medical foods - 57-58, 114-119, 155
Medical supplies - 57-58, 75-81, 84-86
Medically necessary - 21, 26, 134-135, 145, 155
Medicare - 1, 21, 83-84, 127, 142-151
Reimbursement account - 127
Medications and supplies - 114-119Member facilities - 12-13, 18-19, 156-157
Mental health/substance use disorder - 46-48, 82-83, 93-97, 155
MRIs - 40-41, 77-81, 152
Multiple procedures - 62-63
MyBlue Customer eService - 127
National Doctor & Hospital Finder - 127
Neurological testing - 40-41, 77-81
Never Events - 6-7, 155
Newborn care - 26, 39-40, 44-48
No Surprises Act (NSA) - 32
Non-member facilities - 12-13, 156-157
Non-participating providers - 12-13, 24, 32
Non-preferred providers - 29-33
Nurse - 18-19, 58, 84-86, 125, 127-128
Nutritional counseling - 42-46, 129
Observation care - 155
Obstetrical care - 46-48
Occupational therapy - 52-53, 84-86
Office visits - 37, 39-40, 94-95, 158, 164
Online Health Coach (OHC) - 125
Oral surgery - 66
Organ/tissue transplants - 21-24, 72
Orthopedic devices - 55-56, 77-81
Osteopathic manipulative treatment - 58-59
Osteoporosis screening - 158
Ostomy and catheter supplies - 57-58
Out-of-pocket expenses - 33, 37, 157-158
Outpatient facility services - 77-81
Outpatient professional services - 39-40
Overpayments - 34
Overseas Assistance Center - 130
Overseas services, drugs, supplies and claims - 130-132
Oxygen - 56-58
Pap tests - 42-44
Participating providers - 39-60, 62-66, 72-73, 89-92, 94-95, 124
Patient Safety and Quality Monitoring (PSQM) Program - 99-102
Personal Health Record - 125
PET scans - 40-41, 77-81, 152
Pharmacotherapy - 39-40, 51-52
Physical examination - 77-81, 134-135
Physical therapy - 39-40, 52-53, 84-86
Physician - 17, 21, 146, 150, 154, 163-166
Plan allowance - 156-157
PPO - 12-13, 158
Pre-admission testing - 75-77
Precertification - 21, 24-26, 154, 158
Preferred providers - 12-13, 20, 29-32
Pregnancy (see: Maternity care)
Pregnancy Care Incentive Program - 126-127
Prescription drugs - 114-119
Brand-name drugs - 99-102, 114-119
Drugs from other sources - 119-120
Generic drugs - 114-119
Mail Service Prescription Drug Program - 114-119, 131-132, 137-138
Preferred retail pharmacies - 114-119, 137-138
Retail Pharmacy Program - 99-102, 114-119, 131-132, 137-138
Self-injectable drugs - 98-99
Specialty Drug Pharmacy Program - 114-119, 131-132
Specialty drugs - 99-102, 114-119, 159
Preventive carePrimary care provider - 17, 37, 39-40, 44-46, 49-55, 59-60, 84-86Drugs from other sources - 119-120
Generic drugs - 114-119
Mail Service Prescription Drug Program - 114-119, 131-132, 137-138
Preferred retail pharmacies - 114-119, 137-138
Retail Pharmacy Program - 99-102, 114-119, 131-132, 137-138
Self-injectable drugs - 98-99
Specialty Drug Pharmacy Program - 114-119, 131-132
Specialty drugs - 99-102, 114-119, 159
Prior approval - 21-25, 51-52, 61-66, 74, 84-86, 98-102, 114-119, 137-138, 153-154, 158
Professional providers - 17
Prostate cancer tests - 42-44
Prosthetic devices - 55-56, 62-65, 74-81
Psychotherapy - 94-97
Pulmonary rehabilitation - 51-52, 77-81
Radiation therapy - 51-52, 77-81
Reconsiderations - 27, 139-141
Renal dialysis - 18-19, 51-52, 77-81
Replacement coverage - 11
Reproductive services - 49, 152Residential Treatment Center (RTC) - 18-19, 21, 24-25, 82-83, 95-96, 127-128, 153
Retail Pharmacy Program - 37, 98-102, 114-119, 131-132, 136-138, 158, 164, 166
Rights and responsibilities - 12-13
Room and board - 21, 26, 39-40, 75-77, 82-84, 95-96
Screening services - 158
Second surgical opinion - 39-40
Self-injectable drugs - 114-119, 159
Skilled nursing facility (SNF) care - 18-19, 153
Smoking cessation - 59-60, 114-119, 125
Social worker - 127-128
Specialty Drug Pharmacy Program - 98-99, 114-119, 131-132, 137-138
Specialty drugs - 114-119, 159
Speech therapy - 52-53, 77-81, 84-86
Speech-Generating Devices - 56-57
Stem Cell Transplants -
Sterilization procedures - 48, 62-63
Subrogation - 143-144, 159
Substance use disorder - 93-97, 164-165
Surgery - 24, 53-54, 61-73, 81-82, 153
Assistant surgeon - 20, 62-63
Eye: cataract, amblyopia, strabismus - 53-54, 62-63
Gender affirming - 21-24, 62-63
Multiple procedures - 62-63
Oral and maxillofacial - 66
Outpatient - 21-24, 51-52, 62-63, 77-81, 96, 155-156
Reconstructive - 63-65
Sterilization, reversal of voluntary - 48, 62-63
Surgical implants - 55-56, 77-81
Surgical treatment of severe obesity - 21-24, 62-63
Transplants -
Syringes - 114-119Eye: cataract, amblyopia, strabismus - 53-54, 62-63
Gender affirming - 21-24, 62-63
Multiple procedures - 62-63
Oral and maxillofacial - 66
Outpatient - 21-24, 51-52, 62-63, 77-81, 96, 155-156
Reconstructive - 63-65
Sterilization, reversal of voluntary - 48, 62-63
Surgical implants - 55-56, 77-81
Surgical treatment of severe obesity - 21-24, 62-63
Transplants -
Telehealth - 159
Dermatology - 129, 159
Mental health/substance use disorder - 38
Minor acute conditions - 129, 155, 159
Nutritional counseling - 129, 159
Temporary Continuation of Coverage (TCC) - 10-11Mental health/substance use disorder - 38
Minor acute conditions - 129, 155, 159
Nutritional counseling - 129, 159
Tobacco cessation - 59-60, 114-119, 125
Transplants - 18-19, 21-24, 51-52, 72
Travel benefit - 71-72, 125
Treatment therapies - 51-52
TRICARE - 142-143
Ultrasounds - 40-41, 77-81
Urgent care center - 90-92
Urgent care claims - 25, 159-160
VA facilities - 150
Vision services - 53-54, 145
Waivers - 29
Weight control - 125, 134-135
Wheelchairs - 56-57, 83-84, 87-88
Wigs - 55-56
X-rays - 40-41, 145