2026 Blue Cross and Blue Shield Service Benefit Plan - FEP Blue Focus
Section 2. Changes for 2026
Page 16

 

Section 2. Changes for 2026

 

Do not rely only on these change descriptions; this Section is not an official statement of benefits. For that, go to Section 5 (Benefits). Also, we edited and clarified language throughout the brochure; any language change not shown here is a clarification that does not change benefits.

 

Changes to our FEP Blue Focus
 
  • Prior approval for genetic testing will be required when the test is being performed to assess the risk of passing a genetic condition to a child, or when the member has no active disease or signs or symptoms of the disease that is being screened. Prior approval is not required when a member has an active disease, signs and symptoms of a genetic condition that could be passed to a child, or when the test is needed to determine a course of treatment for a disease. If you are unsure whether your genetic test requires prior authorization, call the customer service number on the back of your ID card before scheduling. (See page 21.)
     
  • For Self Only contracts, the calendar year deductible is now $750. For Self Plus One, and Self and Family contracts, the deductible is now $1,500. (See page 28.)
     
  • For Self only contracts, your Preferred Provider catastrophic out-of-pocket maximum is now $10,000. For Self Plus One and Self and Family contracts, your Preferred Provider catastrophic out-of-pocket maximum is now $20,000. (See page 30.)
     
  • Your cost-share for oral and transdermal contraceptives when related to contraception will now be $0 when obtained from a source other than the pharmacy drug program. (See page 44.)
     
  • Surgical and pharmacy services related to sex-trait modifications are no longer covered under this program. (See page 106.)
     
  • Your copayment for maternity services billed by a Preferred facility is now $2,500. (See page 66.)
     
  • Prior approval for outpatient hospice services will no longer be required. (See pages 72-74.)
     
  • Your copayment for a Tier 2 Preferred Brand-Name Drugs purchased at a Preferred retail pharmacy is now 40% of the Plan allowance, with a maximum of $500 for a 30-day supply ($1,300 maximum for up to a 90-day supply.) (See page 88.)
     
  • Your copayment for a Tier 2 Preferred Specialty Drugs (generic and brand-name) purchased at Preferred retail pharmacies and through the Specialty Drug Pharmacy Program for generic and brand-name drugs is now 40% of the Plan allowance, with a maximum of a $500 for a 30-day supply ($1,300 maximum for up to a 31 to 90-day supply). (See page 89.)
     
  • We will no longer be offering a separate Medicare Prescription Drug Program. Those who have Medicare primary will have the same drug benefits as those who are not enrolled in Medicare.