2027 Blue Cross and Blue Shield Service Benefit Plan
FEP Blue Standard and FEP Blue Basic
Section 5(a). Medical Services and Supplies Provided by Physicians and Other Healthcare Professionals
Note: For Standard Option, we state whether or not the calendar year deductible applies for each benefit listed in this Section. There is no calendar year deductible under Basic Option.

Benefit Description

Durable Medical Equipment (DME)
Durable medical equipment (DME) is equipment and supplies that are:
 
  • Medically necessary
     
  • Prescribed by the treating physician
     
  • Serves a specific medical purpose in treating illness or injury
     
  • Intended for prolonged use
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We cover rental or purchase of prescribed durable medical equipment, at our option, including repair and adjustment. Covered items include:
 
  • Home dialysis equipment
     
  • Oxygen equipment
     
  • Hospital beds
     
  • Wheelchairs
     
  • Crutches
     
  • Walkers
     
  • Continuous passive motion (CPM) devices
     
  • Dynamic orthotic cranioplasty (DOC) devices
     
  • Insulin pumps
     
  • Other items that we determine to be DME, such as compression stockings

Note: We cover DME at Preferred benefit levels only when you use a Preferred DME provider. Preferred physicians, facilities, and pharmacies are not necessarily Preferred DME providers.


Standard Option - You Pay
Preferred: 15% of the Plan allowance (deductible applies)

Participating: 35% of the Plan allowance (deductible applies)

Non-participating: 35% of the Plan allowance (deductible applies), plus any difference between our allowance and the billed amount

Basic Option - You Pay
Preferred: 35% of the Plan allowance

Participating/Non-participating: You pay all charges
Benefit Description
  • Speech-generating devices, limited to $1,250 per calendar year


Standard Option - You Pay
Any amount over $1,250 per year (no deductible)

Basic Option - You Pay
Any amount over $1,250 per year
Benefit Description

Not covered:
 
  • Exercise and bathroom equipment
     
  • Vehicle modifications, replacements, or upgrades
     
  • Home modifications, upgrades, or additions
     
  • Lifts, such as seat, chair, or van lifts
     
  • Car seats
     
  • Diabetic supplies, except as described in Section 5(f) or when Medicare Part B is primary
     
  • Air conditioners, humidifiers, dehumidifiers, and purifiers
     
  • Breast pumps, except as previously described
     
  • Communications equipment, devices, and aids (including computer equipment) such as “story boards” or other communication aids to assist communication-impaired individuals (except for speech-generating devices as listed above)
     
  • Equipment for cosmetic purposes
     
  • Topical Hyperbaric Oxygen Therapy (THBO)
     
  • Charges associated with separate or extended warranties


Standard Option - You Pay
All charges

Basic Option - You Pay
All charges