2026 Blue Cross and Blue Shield Service Benefit Plan - FEP Blue Focus
Section 5(b). Surgical and Anesthesia Services Provided by Physicians and Other Healthcare Professionals
Page 60

 

Benefit Description

Organ/Tissue Transplants (cont.)

The blood or marrow stem cell transplants (adult and pediatric) listed below and on the following pages must be performed at a Blue Distinction Center for Transplants. You must obtain prior approval from the Local Plan for the procedure and precertification for the facility admission. See Section 3 (How You Get Care). Benefits are limited to the diagnoses and stages listed.


You Pay
Preferred: 30% of the Plan allowance (deductible applies)

Non-preferred (Participating/Non-participating): You pay all charges

 

Benefits for Allogeneic blood or marrow stem cell transplants are only available for the diagnoses indicated below:
 
  • Acute lymphocytic or myeloid (e.g., AML promyelocytic) leukemia
     
  • Blastic plasmacytoid dendritic cell neoplasm
     
  • Chronic lymphocytic leukemia (e.g., T cell prolymphocytic leukemia, B cell prolymphocytic leukemia, hairy cell leukemia)
     
  • Chronic myeloid leukemia
     
  • Hemoglobinopathy (e., sickle cell anemia, thalassemia)
     
  • Hodgkin lymphoma
     
  • Inherited metabolic disorders: Adrenoleukodystrophy, Globoid cell leukodystrophy (Krabbe's leukodystrophy), Metachromatic leukodystrophy, and Mucopolysaccharidosis type I (Hurler syndrome)
     
  • IPEX - immune dysregulation, polyendocrinopathy, enteropathy, X-linked syndrome
     
  • Marrow failure (e.g., severe aplastic anemia, Fanconi’s anemia, paroxysmal nocturnal hemoglobinuria (PNH), pure red cell aplasia, congenital thrombocytopenia, Dyskeratosis congenita)
     
  • MDS/MPN (e.g., chronic myelomonocytic leukemia (CMML))
     
  • Myelodysplastic syndromes (MDS)
     
  • Myeloproliferative neoplasms (MPN) (e.g., polycythemia vera, essential thrombocythemia, primary myelofibrosis, Hypereosinophilic syndromes)
     
  • Non-Hodgkin lymphoma (e.g., Waldenstrom’s macroglobulinemia, B-cell lymphoma, Burkitt lymphoma)
     
  • Osteopetrosis
     
  • Plasma cell disorders (e.g., multiple myeloma, amyloidosis, plasma cell leukemia, POEMS – (polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy, and skin changes syndrome)
     
  • Primary immunodeficiencies (e.g., severe combined immunodeficiency, Wiskott-Aldrich syndrome, hemophagocytic disorders, X-linked lymphoproliferative syndrome, severe congenital neutropenia, leukocyte adhesion deficiencies, common variable immunodeficiency, chronic granulomatous disease/phagocytic cell disorders)
     
  • Systemic mastocytosis, aggressive
 

Benefits for Autologous blood or marrow stem cell transplants are only available for the diagnoses indicated below:
 
  • Acute myeloid leukemia
     
  • Autoimmune - limited to: Idiopathic (juvenile) rheumatoid arthritis, multiple sclerosis (treatment-refractory relapsing with high risk of future disability) and Scleroderma/systemic sclerosis
     
  • Central nervous system (CNS) embryonal tumors (e.g., atypical teratoid/rhabdoid tumor, primitive neuroectodermal tumors (PNETs), medulloblastoma, pineoblastoma, ependymoblastoma)
     
  • Chronic lymphocytic leukemia (e.g., T cell prolymphocytic leukemia, B cell prolymphocytic leukemia, hairy cell leukemia)
     
  • Ewing sarcoma
     
  • Germ cell tumors (e.g., testicular germ cell tumors)
     
  • High-risk or relapsed neuroblastoma