FEHB FEP Blue Standard and FEP Blue Basic Options
2027 Blue Cross and Blue Shield Service Benefit Plan
FEP Blue Standard and FEP Blue Basic
FEP Blue Standard and FEP Blue Basic
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 - 135-136
Accidental injury - 89-92, 122-123
Acupuncture - 60-61, 73-74
Affordable Care Act (ACA) - 115-120
Allergy care - 51-52
Allogeneic transplants - 68-71
Alternative treatments - 60-61
Ambulance - 31, 87-88
Ambulatory surgical center - 17-19, 78-82
Anesthesia - 73-74
Angiographies - 39-40, 78-82
Appeals - 26
Applied behavior analysis (ABA) - 52-53, 78-82
Assistant surgeon - 19-20, 64-65
Autism spectrum disorder - 52-53, 78-82
Autologous transplants - 68-71
Average wholesale price (AWP) - 158-160
Biopsies - 64-65, 78-82
Birthing centers - 17-19
Blood and blood plasma - 59, 78-82
Blood or marrow stem cell transplants - 67-71
Blue Distinction Centers - 17-19, 82-83
Blue Health Assessment - 127
Bone density tests - 39-40, 78-82
Brand-name drugs - 99-102, 110-112
Breast pump and supplies - 46-48
Breast reconstruction - 65-66
Cancer tests - 41-44
Cardiac rehabilitation - 52-53, 78-82
Cardiovascular monitoring - 39-40, 78-82
Care Management Programs - 129
Case management - 129
Casts - 64-65, 76-82
Catastrophic protection - 32, 110-112, 167, 169
Cervical cancer screening - 41-46
CHAMPVA - 144-145
Changes for 2027 - 15-16
Chemotherapy - 52-53
Children’s Equity Act - 10-11
Chiropractic manipulative treatment - 60
Cholesterol tests - 41-44
Circumcision - 46-48, 64-65
Claims and claims filing - 36
Clinic visits - 38-39, 94-95
Clinical trials - 21-24, 71, 147
Cognitive rehabilitation - 54, 75-88
Coinsurance - 27-28
Colorectal cancer tests
Congenital anomalies - 64-65
Consultations - 38-39
Contact lenses - 55-56
Contraceptive devices and drugs - 49-50, 103-108, 112-120
Coordination of benefits - 144-153
Copayments - 27
Cosmetic surgery - 64-65
Cost-sharing - 27
Costs for covered services - 27-33
Coverage information - 9
Covered facility providers - 17-19
Covered professional providers - 17
Cryopreservation - 50-51
CT scans - 39-40, 78-82
Custodial care - 17-19
Daily Habits - 126
Deductible - 27
Definitions - 154-163
Dental care - 66-67, 122-125
Diabetes Management Program - 126
Diabetic education - 61-62, 78-82
Diabetic supplies
Diagnostic tests - 39-40, 46-48, 94-96
Dialysis - 17-19, 52-53, 57-58, 78-82, 84-85
Disease Management - 129
Disputed claims process - 141-143
Divorce - 12
DNA analysis of stool samples - 41-44
Donor expenses (transplants) - 71-73
Drugs (see: Prescription drugs)
Durable medical equipment (DME) - 57-58
EEGs - 39-40, 78-82
EKGs - 39-40, 78-82
Emergency - 89-92
Enrollment - 9-10
Exception situations - 19-21
Exclusions - 135-136
Experimental or investigational - 135-136
Extended care benefits - 84-85
Eyeglasses - 55-56
Facility providers - 17-19
Family planning - 49-50
Fecal occult blood test - 41-44
FEDVIP - 147
fepblue mobile application - 130
fepblue.org - 4
Flexible benefits option - 129-130
Foot care - 56
Formulary/Preferred drug list - 99-102, 110-112
Foundation for the Accreditation of Cellular Therapy (FACT) accredited facility - 17-19, 67-68
Fraud - 4-5
Freestanding ambulatory facilities - 17-19
Generic drugs - 99-102, 110-112
Generic Incentive Program - 102-103
Genetic screening/testing - 21-24, 39-40, 78-82
Health Insurance Marketplace - 12
Health tools - 126
Healthy Families - 126
Hearing aids and hearing services - 54-57
Home health services - 59-60
Home nursing care (maternity) - 59-60
Hospice care - 85-87
Hospital
Hypertension Management Program - 127
Iatrogenic infertility - 50-51
Immunizations - 41-46, 115-120
Inpatient hospital benefits - 76-78
Inpatient professional services - 38-39, 94-95
Insulin - 103-108, 112-115
Insulin pumps - 57-58
Laboratory and pathology services - 39-40, 76-82, 90-92
Low-dose CT screening - 161
Mail Service Prescription Drug Program - 98-108, 112-115
Mammograms - 41-44
Manipulative treatment - 60, 78-82
Maternity care - 25, 46-48
Maxillofacial surgery - 66-67
Medicaid - 145
Medical emergency - 89, 91-92
Medical foods - 59, 102-103, 110-112
Medical supplies - 59, 102-103
Medically necessary - 17, 57-58, 87-88, 135-136, 158
Medicare - 1, 144-153
Member facilities - 13-14
Mental health/substance use disorder - 93-97, 130
MRIs - 39-40, 78-82
Multiple procedures - 64-65
MyBlue Customer eService - 128
National Doctor & Hospital Finder - 13-14, 128
Neurological testing - 39-40, 78-82
Never Events - 6-8
Newborn care - 25, 46-48
No Surprises Act (NSA) - 31
Non-member facilities - 13-14
Non-participating providers - 13-14
Non-preferred providers - 28-31
Nurse - 59-60, 126
Nutritional counseling - 41-46
Observation care - 158
Obstetrical care - 46-48
Occupational therapy - 54, 85-87
Office visits - 38-39, 94-95
Oral surgery - 66-67
Organ/tissue transplants - 67, 72-73
Orthopedic devices - 56-57, 78-82
Osteopathic manipulative treatment - 60
Osteoporosis screening - 161
Ostomy and catheter supplies - 59
Out-of-pocket expenses - 28-32
Outpatient facility services - 82-83
Outpatient professional services - 38-39
Overpayments - 33
Overseas Assistance Center - 131
Overseas services, drugs, supplies and claims - 131-133
Oxygen - 57-59
Pap tests - 41-46
Participating providers - 13-14, 28-31
Patient Safety and Quality Monitoring (PSQM) Program - 99-102
Personal Health Record - 126
PET scans - 39-40, 78-82
Pharmacotherapy - 38-39, 52-53
Physical examination - 41-46, 78-82
Physical therapy - 54, 85-87
Physician - 13-14, 17
Plan allowance - 158-160
PPO - 13-14
Pre-admission testing - 76-78
Precertification - 20-21
Preferred providers - 13-14, 28-31
Pregnancy (see: Maternity care)
Pregnancy Care Incentive Program - 128
Prescription drugs
Prior approval - 21-24
Professional providers - 17
Prostate cancer tests - 41-44
Prosthetic devices - 56-57, 78-82
Psychotherapy - 94-96
Pulmonary rehabilitation - 52-53, 78-82
Radiation therapy - 21-24, 52-53, 78-82
Reconsiderations - 26, 141-143
Renal dialysis - 52-53, 78-82
Replacement coverage - 11-12
Reproductive services - 50-51
Retail Pharmacy Program - 98-99, 103-108, 132-133
Rights and responsibilities - 13-14
Room and board - 76-78, 83-84, 95-96
Screening services - 161
Second surgical opinion - 38-39
Self-injectable drugs - 37, 63, 75, 78-82
Skilled nursing facility (SNF) care - 17-19
Smoking cessation - 61-62, 115-120, 126
Social worker - 129
Specialty Drug Pharmacy Program - 98-99, 103-108, 132-133
Specialty drugs - 99-108, 110-112
Speech therapy - 54, 78-82, 85-87
Speech-Generating Devices - 57-58
Stem Cell Transplants - 67-71
Sterilization procedures - 49-50
Subrogation - 145-146
Substance use disorder - 17-19, 93-97, 130
Surgery
Telehealth
Tobacco cessation - 61-62, 115-120, 126
Transplants - 21-24, 64-65, 67-73
Travel benefit - 72-73, 126
Treatment therapies - 52-53
TRICARE - 144-145
Ultrasounds - 39-40, 78-82
Urgent care center - 90-92
Urgent care claims - 25, 163
VA facilities - 33
Vision services - 55-56, 147
Waivers - 28
Weight control - 41-46, 126, 130
Wheelchairs - 57-58
Wigs - 56-57
X-rays - 19-20, 39-40, 78-82
Accidental injury - 89-92, 122-123
Acupuncture - 60-61, 73-74
Affordable Care Act (ACA) - 115-120
Allergy care - 51-52
Allogeneic transplants - 68-71
Alternative treatments - 60-61
Ambulance - 31, 87-88
Ambulatory surgical center - 17-19, 78-82
Anesthesia - 73-74
Angiographies - 39-40, 78-82
Appeals - 26
Applied behavior analysis (ABA) - 52-53, 78-82
Assistant surgeon - 19-20, 64-65
Autism spectrum disorder - 52-53, 78-82
Autologous transplants - 68-71
Average wholesale price (AWP) - 158-160
Biopsies - 64-65, 78-82
Birthing centers - 17-19
Blood and blood plasma - 59, 78-82
Blood or marrow stem cell transplants - 67-71
Blue Distinction Centers - 17-19, 82-83
for Transplants - 72-73
Blue Distinction Specialty Care - 17-19Blue Health Assessment - 127
Bone density tests - 39-40, 78-82
Brand-name drugs - 99-102, 110-112
Breast pump and supplies - 46-48
Breast reconstruction - 65-66
Breast prostheses and surgical bras - 56--57
Breastfeeding support and supplies - 46-48Cancer tests - 41-44
Cardiac rehabilitation - 52-53, 78-82
Cardiovascular monitoring - 39-40, 78-82
Care Management Programs - 129
Case management - 129
Casts - 64-65, 76-82
Catastrophic protection - 32, 110-112, 167, 169
Cervical cancer screening - 41-46
CHAMPVA - 144-145
Changes for 2027 - 15-16
Chemotherapy - 52-53
Children’s Equity Act - 10-11
Chiropractic manipulative treatment - 60
Cholesterol tests - 41-44
Circumcision - 46-48, 64-65
Claims and claims filing - 36
Clinic visits - 38-39, 94-95
Clinical trials - 21-24, 71, 147
Cognitive rehabilitation - 54, 75-88
Coinsurance - 27-28
Colorectal cancer tests
Colonoscopy - 41-44, 64-65, 78-82
Fecal occult blood test - 41-44
Sigmoidoscopy - 41-44
Confidentiality - 13-14Fecal occult blood test - 41-44
Sigmoidoscopy - 41-44
Congenital anomalies - 64-65
Consultations - 38-39
Contact lenses - 55-56
Contraceptive devices and drugs - 49-50, 103-108, 112-120
Coordination of benefits - 144-153
Copayments - 27
Cosmetic surgery - 64-65
Cost-sharing - 27
Costs for covered services - 27-33
Coverage information - 9
Covered facility providers - 17-19
Covered professional providers - 17
Cryopreservation - 50-51
CT scans - 39-40, 78-82
Custodial care - 17-19
Daily Habits - 126
Deductible - 27
Definitions - 154-163
Dental care - 66-67, 122-125
Diabetes Management Program - 126
Diabetic education - 61-62, 78-82
Diabetic supplies
Diabetic Meter Program - 103-108
Insulin pumps - 57-58
Insulin, test strips, and lancets - 103-108, 112-115
Needles and disposable syringes - 103-1-08, 112-115
Diagnostic and treatment services - 38-39, 78-82Insulin pumps - 57-58
Insulin, test strips, and lancets - 103-108, 112-115
Needles and disposable syringes - 103-1-08, 112-115
Diagnostic tests - 39-40, 46-48, 94-96
Dialysis - 17-19, 52-53, 57-58, 78-82, 84-85
Disease Management - 129
Disputed claims process - 141-143
Divorce - 12
DNA analysis of stool samples - 41-44
Donor expenses (transplants) - 71-73
Drugs (see: Prescription drugs)
Durable medical equipment (DME) - 57-58
Prosthetic devices - 56-57, 76-82
Educational classes and programs - 61-62EEGs - 39-40, 78-82
EKGs - 39-40, 78-82
Emergency - 89-92
Enrollment - 9-10
Exception situations - 19-21
Exclusions - 135-136
Experimental or investigational - 135-136
Extended care benefits - 84-85
Eyeglasses - 55-56
Facility providers - 17-19
Family planning - 49-50
Fecal occult blood test - 41-44
FEDVIP - 147
fepblue mobile application - 130
fepblue.org - 4
Flexible benefits option - 129-130
Foot care - 56
Formulary/Preferred drug list - 99-102, 110-112
Foundation for the Accreditation of Cellular Therapy (FACT) accredited facility - 17-19, 67-68
Fraud - 4-5
Freestanding ambulatory facilities - 17-19
Generic drugs - 99-102, 110-112
Generic Incentive Program - 102-103
Genetic screening/testing - 21-24, 39-40, 78-82
Health Insurance Marketplace - 12
Health tools - 126
Healthy Families - 126
Hearing aids and hearing services - 54-57
Home health services - 59-60
Home nursing care (maternity) - 59-60
Hospice care - 85-87
Hospital
Inpatient - 21, 76-78, 95
Outpatient - 78-82, 89-92, 96
Human papillomavirus (HPV) tests - 41-46Outpatient - 78-82, 89-92, 96
Hypertension Management Program - 127
Iatrogenic infertility - 50-51
Immunizations - 41-46, 115-120
Inpatient hospital benefits - 76-78
Inpatient professional services - 38-39, 94-95
Insulin - 103-108, 112-115
Insulin pumps - 57-58
Laboratory and pathology services - 39-40, 76-82, 90-92
Low-dose CT screening - 161
Mail Service Prescription Drug Program - 98-108, 112-115
Mammograms - 41-44
Manipulative treatment - 60, 78-82
Maternity care - 25, 46-48
Maxillofacial surgery - 66-67
Medicaid - 145
Medical emergency - 89, 91-92
Medical foods - 59, 102-103, 110-112
Medical supplies - 59, 102-103
Medically necessary - 17, 57-58, 87-88, 135-136, 158
Medicare - 1, 144-153
Reimbursement account - 128
Medications and supplies - 103-108, 112-115Member facilities - 13-14
Mental health/substance use disorder - 93-97, 130
MRIs - 39-40, 78-82
Multiple procedures - 64-65
MyBlue Customer eService - 128
National Doctor & Hospital Finder - 13-14, 128
Neurological testing - 39-40, 78-82
Never Events - 6-8
Newborn care - 25, 46-48
No Surprises Act (NSA) - 31
Non-member facilities - 13-14
Non-participating providers - 13-14
Non-preferred providers - 28-31
Nurse - 59-60, 126
Nutritional counseling - 41-46
Observation care - 158
Obstetrical care - 46-48
Occupational therapy - 54, 85-87
Office visits - 38-39, 94-95
Oral surgery - 66-67
Organ/tissue transplants - 67, 72-73
Orthopedic devices - 56-57, 78-82
Osteopathic manipulative treatment - 60
Osteoporosis screening - 161
Ostomy and catheter supplies - 59
Out-of-pocket expenses - 28-32
Outpatient facility services - 82-83
Outpatient professional services - 38-39
Overpayments - 33
Overseas Assistance Center - 131
Overseas services, drugs, supplies and claims - 131-133
Oxygen - 57-59
Pap tests - 41-46
Participating providers - 13-14, 28-31
Patient Safety and Quality Monitoring (PSQM) Program - 99-102
Personal Health Record - 126
PET scans - 39-40, 78-82
Pharmacotherapy - 38-39, 52-53
Physical examination - 41-46, 78-82
Physical therapy - 54, 85-87
Physician - 13-14, 17
Plan allowance - 158-160
PPO - 13-14
Pre-admission testing - 76-78
Precertification - 20-21
Preferred providers - 13-14, 28-31
Pregnancy (see: Maternity care)
Pregnancy Care Incentive Program - 128
Prescription drugs
Brand-name drugs - 99-108, 110-112
Drugs from other sources - 120-121
Generic drugs - 99-102, 110-112
Mail Service Prescription Drug Program - 98-108, 112-115, 132-133
Preferred retail pharmacies - 103-108, 115-120
Retail Pharmacy Program - 98-99, 102-108
Self-injectable drugs - 37, 63, 75, 78-82
Specialty Drug Pharmacy Program - 98--108
Specialty drugs - 99-108, 110-112
Preventive careDrugs from other sources - 120-121
Generic drugs - 99-102, 110-112
Mail Service Prescription Drug Program - 98-108, 112-115, 132-133
Preferred retail pharmacies - 103-108, 115-120
Retail Pharmacy Program - 98-99, 102-108
Self-injectable drugs - 37, 63, 75, 78-82
Specialty Drug Pharmacy Program - 98--108
Specialty drugs - 99-108, 110-112
Adult - 41-44
Child - 44-46
Primary care provider - 17Child - 44-46
Prior approval - 21-24
Professional providers - 17
Prostate cancer tests - 41-44
Prosthetic devices - 56-57, 78-82
Psychotherapy - 94-96
Pulmonary rehabilitation - 52-53, 78-82
Radiation therapy - 21-24, 52-53, 78-82
Reconsiderations - 26, 141-143
Renal dialysis - 52-53, 78-82
Replacement coverage - 11-12
Reproductive services - 50-51
Assisted reproductive technology (ART) - 154
Residential Treatment Center (RTC) - 21, 83-84, 95-96Retail Pharmacy Program - 98-99, 103-108, 132-133
Rights and responsibilities - 13-14
Room and board - 76-78, 83-84, 95-96
Screening services - 161
Second surgical opinion - 38-39
Self-injectable drugs - 37, 63, 75, 78-82
Skilled nursing facility (SNF) care - 17-19
Smoking cessation - 61-62, 115-120, 126
Social worker - 129
Specialty Drug Pharmacy Program - 98-99, 103-108, 132-133
Specialty drugs - 99-108, 110-112
Speech therapy - 54, 78-82, 85-87
Speech-Generating Devices - 57-58
Stem Cell Transplants - 67-71
Sterilization procedures - 49-50
Subrogation - 145-146
Substance use disorder - 17-19, 93-97, 130
Surgery
Assistant surgeon - 19-20, 37, 63
Eye: cataract, amblyopia, strabismus - 55-56, 64-65
Multiple procedures - 64-65
Oral and maxillofacial - 66-67
Outpatient - 78-82
Reconstructive - 65-66
Sterilization, reversal of voluntary - 49--50, 64-65
Surgical implants - 56-57, 78-82
Surgical treatment of severe obesity - 41--46
Transplants - 64-65, 67-73
Syringes - 103-108, 112-115Eye: cataract, amblyopia, strabismus - 55-56, 64-65
Multiple procedures - 64-65
Oral and maxillofacial - 66-67
Outpatient - 78-82
Reconstructive - 65-66
Sterilization, reversal of voluntary - 49--50, 64-65
Surgical implants - 56-57, 78-82
Surgical treatment of severe obesity - 41--46
Transplants - 64-65, 67-73
Telehealth
Dermatology - 38-39
Mental health/substance use disorder - 17-19, 93-97, 130
Minor acute conditions - 17, 38-39
Nutritional counseling - 17, 38-39, 41-46
Temporary Continuation of Coverage (TCC) - 12Mental health/substance use disorder - 17-19, 93-97, 130
Minor acute conditions - 17, 38-39
Nutritional counseling - 17, 38-39, 41-46
Tobacco cessation - 61-62, 115-120, 126
Transplants - 21-24, 64-65, 67-73
Travel benefit - 72-73, 126
Treatment therapies - 52-53
TRICARE - 144-145
Ultrasounds - 39-40, 78-82
Urgent care center - 90-92
Urgent care claims - 25, 163
VA facilities - 33
Vision services - 55-56, 147
Waivers - 28
Weight control - 41-46, 126, 130
Wheelchairs - 57-58
Wigs - 56-57
X-rays - 19-20, 39-40, 78-82