2024 Blue Cross and Blue Shield Service Benefit Plan - Standard and Basic Option
Section 5(f). Prescription Drug Benefits
Page 120
Section 5(f). Prescription Drug Benefits
Page 120
Benefits Description
For members covered under our regular pharmacy drug program:
Note: Benefits for certain auto-immune infusion medications (limited to Remicade, Renflexis and Inflectra) are covered only when they are obtained by a non-pharmacy provider, such as a physician or facility (hospital or ambulatory surgical center). Members covered under the FEP Medicare Prescription Drug Program may obtain these drugs under their pharmacy benefits.
Standard Option - You Pay
Preferred: 10% of the Plan allowance (deductible applies)
Participating professional provider: 15% of the Plan allowance (deductible applies)
Non-participating professional provider: 15% of the Plan allowance (deductible applies), plus any difference between our allowance and the billed amount
Member facilities: 15% of the Plan allowance (deductible applies)
Non-member facilities: 15% of the Plan allowance (deductible applies), plus any difference between our allowance and billed amount.
Basic Option - You Pay
Preferred: 15% of the Plan allowance
Participating professional provider: You pay all charges
Non-participating professional provider: You pay all charges
Member/Non-member facilities: You pay all charges
For members covered under our regular pharmacy drug program:
- Auto-immune infusion medications: Remicade, Renflexis and Inflectra
Note: Benefits for certain auto-immune infusion medications (limited to Remicade, Renflexis and Inflectra) are covered only when they are obtained by a non-pharmacy provider, such as a physician or facility (hospital or ambulatory surgical center). Members covered under the FEP Medicare Prescription Drug Program may obtain these drugs under their pharmacy benefits.
Standard Option - You Pay
Preferred: 10% of the Plan allowance (deductible applies)
Participating professional provider: 15% of the Plan allowance (deductible applies)
Non-participating professional provider: 15% of the Plan allowance (deductible applies), plus any difference between our allowance and the billed amount
Member facilities: 15% of the Plan allowance (deductible applies)
Non-member facilities: 15% of the Plan allowance (deductible applies), plus any difference between our allowance and billed amount.
Basic Option - You Pay
Preferred: 15% of the Plan allowance
Participating professional provider: You pay all charges
Non-participating professional provider: You pay all charges
Member/Non-member facilities: You pay all charges