FEHB FEP Blue Focus
2026 Blue Cross and Blue Shield Service Benefit Plan - FEP Blue Focus
Index
Index
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 - 105-106
Accidental injury - 76-79, 95, 123
Acupuncture - 53, 63, 68-71
Affordable Care Act (ACA) - 12-13, 90-93
Allergy care - 45-46
Allogeneic transplants - 60-61
Alternative treatments - 53
Ambulance - 74-75
Ambulatory surgical center - 68-71
Anesthesia - 63
Angiographies - 37, 68-71
Appeals - 27, 110-112
Applied behavior analysis (ABA) - 46-47
Assistant surgeon - 35, 55-57
Autism spectrum disorder - 46-47
Autologous transplants - 59-61
Biopsies - 38-40, 56-57, 68-71
Birthing centers - 17-19
Blood and blood plasma - 51, 68-71
Blood or marrow stem cell - 59-63
Blue Distinction Centers - 17-19, 59-60Blue Distinction Specialty Care - 17-19
Blue Health Assessment - 97
Bone density tests - 37, 68-71
Brand-name drugs - 86, 88-89
Breast pump and supplies - 42-43
Breast reconstruction - 57-58Breastfeeding support and supplies - 42-43, 66-68
Cancer tests - 38-40
Cardiac rehabilitation - 46-47, 68-71
Cardiovascular monitoring - 37, 68-71
Care Management Programs - 98-99
Case management - 98-99
Casts - 55-57, 65-66, 68-71
Catastrophic protection - 30, 136
Cervical cancer screening - 38-42
CHAMPVA - 113-114
Changes for 2026 - 16
Chemotherapy - 46-47, 68-71
Children’s Equity Act - 10-11
Chiropractic manipulative treatment - 53
Cholesterol tests - 37-40
Circumcision - 42-43, 56-57
Claims and claims filingClinic visits - 36-37, 68-71, 80-81
Clinical trials - 60-61, 116, 124
Cognitive rehabilitation - 47, 68-72
Coinsurance - 28
Colonoscopy - 38-40, 56-57, 68-71
Colorectal cancer testsConfidentiality - 14-15
Congenital anomalies - 56-57, 124
Consultations - 36-37, 80-81
Contact lenses - 48-49
Contraceptives - 44, 68-71, 88-93
Coordination of benefits - 113-122
Copayments - 28
CORE benefits - 124
Cosmetic surgery - 56-58, 124
Cost-share/cost-sharing - 28
Costs for covered services - 28-31
Coverage information - 9
Covered facility providers - 17-19
Covered professional providers - 17
Cryopreservation - 45
CT scans - 37
Custodial or long-term care - 65-66, 72, 82, 124
Daily Habits - 97
Deductible - 28
Definitions - 123-131
Dental care - 95-96, 136
Diabetic education - 53-54, 68-71
Diabetic supplies
Diagnostic tests - 37, 42-43, 48-49, 80-83
Dialysis - 46-47, 50-51, 68-71
Disease Management - 98-99
Disputed claims - 110-112
Divorce - 12
DNA analysis of stool samples - 38-40
Donor expenses - 62
Drugs (see: Prescription drugs)
Durable medical equipment - 50-51Educational classes and programs - 53-54
EEGs - 37, 68-71
EKGs - 37, 68-71
Emergency - 76-79
Enrollment - 9-10
Exception situations - 20
Exclusions - 105-106
Experimental or investigational - 125
Extended care benefits - 72
Eyeglasses - 48-49
Facility providers - 17-19
Family planning - 44
Fecal occult blood test - 38-40
FEDVIP - 31, 95, 115
fepblue mobile application - 100
fepblue.org - 4
Flexible benefits option - 99
Foot care - 49
Formulary/Preferred drug list - 85-86
Fraud - 4-5
Generic drugs - 86, 88-89
Generic equivalents - 86
Genetic screening/testing - 20-23, 37, 68-71
Health Insurance Marketplace - 12-13
Health tools - 97
Healthy Families - 97
Hearing aids and hearing services - 47-48
Home health services - 52-53
Home nursing care (maternity) - 52-53
Hospice care - 72-74
HospitalHuman papillomavirus (HPV) tests - 38-42
Hypertension Management Program - 97-98
Iatrogenic infertility - 45
Identification cards - 17
Immunizations - 38-42, 90-93
Inpatient hospital benefits - 65-66
Inpatient professional services - 36-37, 80-81
Insulin - 88-89
Insulin pumps - 50-51
Laboratory and pathology services - 37
Low-dose CT screening - 129
Mammograms - 38-40
Manipulative treatment - 53, 68-71
Maternity care - 25-26, 42-43
Maxillofacial surgery - 58
Medicaid - 114
Medical emergency - 76-79
Medical foods - 51, 87-88, 126
Medical supplies - 51
Medically necessary - 126-127
Medicare - 113-122
Medications and supplies - 84-94
Medications to promote better health - 90-93
Member facilities - 127-128
Mental health/substance use disorder - 80-83
MRIs - 37, 68-71
Multiple procedures - 55-57
MyBlue Customer eService - 98
National Doctor & Hospital Finder - 98
Neurological testing - 37, 68-71
Never Events - 6-8, 127
Newborn care - 26, 36-37, 42-43, 66-68
No Surprises Act (NSA) - 29-30
NON-CORE benefits - 127
Non-member facilities - 127-128
Non-participating providers - 29, 127-128
Non-preferred providers - 14-15, 17, 29
Nurse - 52-53, 72-74, 97
Nutritional counseling - 36-42, 65-68, 99
Observation care - 127
Obstetrical care - 42-43, 66-68
Occupational therapy - 47, 68-74
Office visits - 36-37, 80-81
Oral surgery - 58
Organ/tissue transplants - 58-63
Orthopedic devices - 49-50, 68-71
Osteoporosis screening - 129
Ostomy and catheter supplies - 51
Out-of-pocket expenses - 30, 128
Outpatient facility services - 68-71, 96, 126
Outpatient professional services - 36-37, 80-81
Overpayments - 31
Overseas Assistance Center - 101
Overseas services, drugs, supplies and claims - 101-103
Oxygen - 51, 65-74
Pap tests - 38-42
Participating providers - 127-128
Patient Safety and Quality Monitoring (PSQM) program - 87
Personal Health Record - 97
PET scans - 37, 68-71
Pharmacotherapy - 36-37, 46-47
Physical examinations - 38-42, 100
Physical therapy - 47, 68-74
Physician - 14-15, 129
Plan allowance - 127-128
PPO - 14-15, 17-19, 129
Pre-admission testing - 65-66
Precertification - 20, 129
Preferred providers - 14-15, 17, 19, 29
Pregnancy (see: Maternity care)
Prescription drugs
Prior approval - 20-23, 25, 58-59, 62, 87
Professional providers - 17
Prostate cancer - 38-40
Prosthetic devices - 49-50, 65-66, 68-71
Psychotherapy - 80-83
Pulmonary rehabilitation - 20-23, 46-47, 68-71
Radiation therapy - 20-23, 46-47, 68-71
Reconsiderations - 27, 110-112
Replacement coverage - 12-13
Reproductive services - 20-23, 45Residential treatment center (RTC) - 17-20, 26, 71-72, 82
Rights and responsibilities - 14-15
Room and board - 65-68, 71-72, 82
Routine Annual Physical Incentive Program - 100
Screening services - 129
Second surgical opinion - 36-37
Self-injectable drugs - 35, 55, 64, 68-71
Skilled nursing facility (SNF) care - 51, 72, 124
Smoking cessation - 53-54, 90-93
Social worker - 98-99
Specialty Drug Pharmacy Program - 84-85, 88-89, 94, 108
Specialty drugs - 86, 88-89, 130
Speech therapy - 47, 68-74
Speech-generating devices - 50-51
Stem cell transplants - 59-61
Sterilization procedures - 44
Subrogation - 114-115, 130
Substance use disorder - 17, 35, 80-83
Surgery
Telehealth
Tobacco cessation - 53-54, 90-93
Transplants - 20-23, 58-63
Travel benefit - 62, 97
Treatment therapies - 46-47
TRICARE - 113-114
Ultrasounds - 37, 68-71
Urgent care center - 76-79
Urgent care claims - 26, 130
VA facility - 121
Vaccines - 38-42, 90-93
Verbal statements - 4, 27, 98-99
Vision services - 48-49, 115
Waivers - 29
Weight control - 20-23, 38-42, 100
Wheelchairs - 20-23, 50-51
Wigs - 49-50
WRAP benefits - 131
X-rays - 37, 68-71
Abortion - 105-106
Accidental injury - 76-79, 95, 123
Acupuncture - 53, 63, 68-71
Affordable Care Act (ACA) - 12-13, 90-93
Allergy care - 45-46
Allogeneic transplants - 60-61
Alternative treatments - 53
Ambulance - 74-75
Ambulatory surgical center - 68-71
Anesthesia - 63
Angiographies - 37, 68-71
Appeals - 27, 110-112
Applied behavior analysis (ABA) - 46-47
Assistant surgeon - 35, 55-57
Autism spectrum disorder - 46-47
Autologous transplants - 59-61
Biopsies - 38-40, 56-57, 68-71
Birthing centers - 17-19
Blood and blood plasma - 51, 68-71
Blood or marrow stem cell - 59-63
Blue Distinction Centers - 17-19, 59-60Blue Distinction Specialty Care - 17-19
Blue Health Assessment - 97
Bone density tests - 37, 68-71
Brand-name drugs - 86, 88-89
Breast pump and supplies - 42-43
Breast reconstruction - 57-58Breastfeeding support and supplies - 42-43, 66-68
Cancer tests - 38-40
Cardiac rehabilitation - 46-47, 68-71
Cardiovascular monitoring - 37, 68-71
Care Management Programs - 98-99
Case management - 98-99
Casts - 55-57, 65-66, 68-71
Catastrophic protection - 30, 136
Cervical cancer screening - 38-42
CHAMPVA - 113-114
Changes for 2026 - 16
Chemotherapy - 46-47, 68-71
Children’s Equity Act - 10-11
Chiropractic manipulative treatment - 53
Cholesterol tests - 37-40
Circumcision - 42-43, 56-57
Claims and claims filingClinic visits - 36-37, 68-71, 80-81
Clinical trials - 60-61, 116, 124
Cognitive rehabilitation - 47, 68-72
Coinsurance - 28
Colonoscopy - 38-40, 56-57, 68-71
Colorectal cancer testsConfidentiality - 14-15
Congenital anomalies - 56-57, 124
Consultations - 36-37, 80-81
Contact lenses - 48-49
Contraceptives - 44, 68-71, 88-93
Coordination of benefits - 113-122
Copayments - 28
CORE benefits - 124
Cosmetic surgery - 56-58, 124
Cost-share/cost-sharing - 28
Costs for covered services - 28-31
Coverage information - 9
Covered facility providers - 17-19
Covered professional providers - 17
Cryopreservation - 45
CT scans - 37
Custodial or long-term care - 65-66, 72, 82, 124
Daily Habits - 97
Deductible - 28
Definitions - 123-131
Dental care - 95-96, 136
Diabetic education - 53-54, 68-71
Diabetic supplies
Diabetic Meter Program - 90-93
Insulin pumps - 50-51
Insulin, test strips, and lancets - 88-93
Needles and disposable syringes - 88-89
Diagnostic and treatment services - 36-37Insulin pumps - 50-51
Insulin, test strips, and lancets - 88-93
Needles and disposable syringes - 88-89
Diagnostic tests - 37, 42-43, 48-49, 80-83
Dialysis - 46-47, 50-51, 68-71
Disease Management - 98-99
Disputed claims - 110-112
Divorce - 12
DNA analysis of stool samples - 38-40
Donor expenses - 62
Drugs (see: Prescription drugs)
Durable medical equipment - 50-51Educational classes and programs - 53-54
EEGs - 37, 68-71
EKGs - 37, 68-71
Emergency - 76-79
Enrollment - 9-10
Exception situations - 20
Exclusions - 105-106
Experimental or investigational - 125
Extended care benefits - 72
Eyeglasses - 48-49
Facility providers - 17-19
Family planning - 44
Fecal occult blood test - 38-40
FEDVIP - 31, 95, 115
fepblue mobile application - 100
fepblue.org - 4
Flexible benefits option - 99
Foot care - 49
Formulary/Preferred drug list - 85-86
Fraud - 4-5
Generic drugs - 86, 88-89
Generic equivalents - 86
Genetic screening/testing - 20-23, 37, 68-71
Health Insurance Marketplace - 12-13
Health tools - 97
Healthy Families - 97
Hearing aids and hearing services - 47-48
Home health services - 52-53
Home nursing care (maternity) - 52-53
Hospice care - 72-74
HospitalHuman papillomavirus (HPV) tests - 38-42
Hypertension Management Program - 97-98
Iatrogenic infertility - 45
Identification cards - 17
Immunizations - 38-42, 90-93
Inpatient hospital benefits - 65-66
Inpatient professional services - 36-37, 80-81
Insulin - 88-89
Insulin pumps - 50-51
Laboratory and pathology services - 37
Low-dose CT screening - 129
Mammograms - 38-40
Manipulative treatment - 53, 68-71
Maternity care - 25-26, 42-43
Maxillofacial surgery - 58
Medicaid - 114
Medical emergency - 76-79
Medical foods - 51, 87-88, 126
Medical supplies - 51
Medically necessary - 126-127
Medicare - 113-122
Medications and supplies - 84-94
Medications to promote better health - 90-93
Member facilities - 127-128
Mental health/substance use disorder - 80-83
MRIs - 37, 68-71
Multiple procedures - 55-57
MyBlue Customer eService - 98
National Doctor & Hospital Finder - 98
Neurological testing - 37, 68-71
Never Events - 6-8, 127
Newborn care - 26, 36-37, 42-43, 66-68
No Surprises Act (NSA) - 29-30
NON-CORE benefits - 127
Non-member facilities - 127-128
Non-participating providers - 29, 127-128
Non-preferred providers - 14-15, 17, 29
Nurse - 52-53, 72-74, 97
Nutritional counseling - 36-42, 65-68, 99
Observation care - 127
Obstetrical care - 42-43, 66-68
Occupational therapy - 47, 68-74
Office visits - 36-37, 80-81
Oral surgery - 58
Organ/tissue transplants - 58-63
Orthopedic devices - 49-50, 68-71
Osteoporosis screening - 129
Ostomy and catheter supplies - 51
Out-of-pocket expenses - 30, 128
Outpatient facility services - 68-71, 96, 126
Outpatient professional services - 36-37, 80-81
Overpayments - 31
Overseas Assistance Center - 101
Overseas services, drugs, supplies and claims - 101-103
Oxygen - 51, 65-74
Pap tests - 38-42
Participating providers - 127-128
Patient Safety and Quality Monitoring (PSQM) program - 87
Personal Health Record - 97
PET scans - 37, 68-71
Pharmacotherapy - 36-37, 46-47
Physical examinations - 38-42, 100
Physical therapy - 47, 68-74
Physician - 14-15, 129
Plan allowance - 127-128
PPO - 14-15, 17-19, 129
Pre-admission testing - 65-66
Precertification - 20, 129
Preferred providers - 14-15, 17, 19, 29
Pregnancy (see: Maternity care)
Prescription drugs
Brand-name drugs - 86, 88-89
Drugs from other sources - 94
Generic drugs - 86, 88-89
Preferred retail pharmacies - 85, 88-93, 108
Retail Pharmacy Program - 84-85, 87, 102-103
Self-injectable drugs - 35, 55, 64, 68-71
Specialty Drug Pharmacy Program - 84-86, 88-89, 94, 102-103, 108
Specialty drugs - 84-86, 88-89, 130
Preventive carePrimary care provider (PCP) - 34Drugs from other sources - 94
Generic drugs - 86, 88-89
Preferred retail pharmacies - 85, 88-93, 108
Retail Pharmacy Program - 84-85, 87, 102-103
Self-injectable drugs - 35, 55, 64, 68-71
Specialty Drug Pharmacy Program - 84-86, 88-89, 94, 102-103, 108
Specialty drugs - 84-86, 88-89, 130
Prior approval - 20-23, 25, 58-59, 62, 87
Professional providers - 17
Prostate cancer - 38-40
Prosthetic devices - 49-50, 65-66, 68-71
Psychotherapy - 80-83
Pulmonary rehabilitation - 20-23, 46-47, 68-71
Radiation therapy - 20-23, 46-47, 68-71
Reconsiderations - 27, 110-112
Replacement coverage - 12-13
Reproductive services - 20-23, 45Residential treatment center (RTC) - 17-20, 26, 71-72, 82
Rights and responsibilities - 14-15
Room and board - 65-68, 71-72, 82
Routine Annual Physical Incentive Program - 100
Screening services - 129
Second surgical opinion - 36-37
Self-injectable drugs - 35, 55, 64, 68-71
Skilled nursing facility (SNF) care - 51, 72, 124
Smoking cessation - 53-54, 90-93
Social worker - 98-99
Specialty Drug Pharmacy Program - 84-85, 88-89, 94, 108
Specialty drugs - 86, 88-89, 130
Speech therapy - 47, 68-74
Speech-generating devices - 50-51
Stem cell transplants - 59-61
Sterilization procedures - 44
Subrogation - 114-115, 130
Substance use disorder - 17, 35, 80-83
Surgery
Assistant surgeon - 35, 42-43, 55-57
Eye: cataract, amblyopia, strabismus - 48-49, 56-57
Multiple procedures - 55-57
Oral and maxillofacial - 58
Outpatient - 64, 127
Reconstructive - 57-58
Sterilization, reversal of voluntary - 44, 56-57
Surgical implants - 49-50, 68-71
Surgical treatment of severe obesity - 20-23, 56-57
Transplants - 20-23, 46-47, 58-63
Syringes - 88-89Eye: cataract, amblyopia, strabismus - 48-49, 56-57
Multiple procedures - 55-57
Oral and maxillofacial - 58
Outpatient - 64, 127
Reconstructive - 57-58
Sterilization, reversal of voluntary - 44, 56-57
Surgical implants - 49-50, 68-71
Surgical treatment of severe obesity - 20-23, 56-57
Transplants - 20-23, 46-47, 58-63
Telehealth
Dermatology - 17, 36-37, 99, 130
Mental health/substance use disorder - 17, 80-83, 99
Minor acute conditions - 17, 36-37, 99, 127
Nutritional counseling - 17, 38-42, 99
Temporary Continuation of Coverage (TCC) - 12Mental health/substance use disorder - 17, 80-83, 99
Minor acute conditions - 17, 36-37, 99, 127
Nutritional counseling - 17, 38-42, 99
Tobacco cessation - 53-54, 90-93
Transplants - 20-23, 58-63
Travel benefit - 62, 97
Treatment therapies - 46-47
TRICARE - 113-114
Ultrasounds - 37, 68-71
Urgent care center - 76-79
Urgent care claims - 26, 130
VA facility - 121
Vaccines - 38-42, 90-93
Verbal statements - 4, 27, 98-99
Vision services - 48-49, 115
Waivers - 29
Weight control - 20-23, 38-42, 100
Wheelchairs - 20-23, 50-51
Wigs - 49-50
WRAP benefits - 131
X-rays - 37, 68-71