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2024 Blue Cross and Blue Shield Service Benefit Plan - Standard and Basic Option
Table of Contents
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Table of Contents

Introduction - 4
Plain Language - 4
Stop Healthcare Fraud! - 4
Discrimination is Against the Law - 5
Preventing Medical Mistakes - 6
FEHB Facts - 8

Coverage information - 8

• No pre-existing condition limitation - 8

• Minimum essential coverage (MEC) - 8

• Minimum value standard - 8

• Where you can get information about enrolling in the FEHB Program - 8

• Enrollment types available for you and your family - 8

• Family member coverage - 9

• Children’s Equity Act - 9

• When benefits and premiums start - 10

• When you retire - 10

When you lose benefits - 10

• When FEHB coverage ends - 10

• Upon divorce - 11

• Temporary Continuation of Coverage (TCC) - 11

• Finding replacement coverage - 11

• Health Insurance Marketplace - 11

Section 1. How This Plan Works - 12

General features of our Standard and Basic Options - 12

We have a Preferred Provider Organization (PPO) - 12

How we pay professional and facility providers - 12

Your rights and responsibilities - 13

Your medical and claims records are confidential - 13

Section 2. Changes for 2024 - 14

Changes to our Standard Option only - 14

Changes to our Basic Option only - 14

Changes to both our Standard and Basic Options - 15

Section 3. How You Get Care - 17

Identification cards - 17

Where you get covered care - 17

Balance Billing Protection - 17

• Covered professional providers - 17

• Covered facility providers - 18

What you must do to get covered care - 20

• Transitional care - 20

• If you are hospitalized when your enrollment begins - 20

You need prior Plan approval for certain services - 21

• Inpatient hospital admission, inpatient residential treatment center admission, or skilled nursing facility admission - 21

• Other services - 21

• Surgery by Non-participating providers under Standard Option - 24

How to request precertification for an admission or get prior approval for Other services - 24

• Non-urgent care claims - 25

• Urgent care claims - 25

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