Document Number:
SB24-001
Revision #:
v1.0
Date Published:
1/1/2024
2024 Blue Cross and Blue Shield Service Benefit Plan - Standard and Basic Option
Table of Contents
Page 1
Table of Contents
Page 1
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
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
Go to Inside cover. Go to page 2.