2026 Blue Cross and Blue Shield Service Benefit Plan - FEP Blue Focus
Section 5(a). Medical Services and Supplies Provided by Physicians and Other Healthcare Professionals
Page 49

 

Benefit Description

Vision Services (Testing, Treatment, and Supplies) (cont.)
 
  • For the nonsurgical treatment for amblyopia and strabismus, for children from birth through age 21

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

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

 

Benefit Description
 
Not covered:
 
  • Eyeglasses, contact lenses, routine eye examinations, or vision testing for the prescribing or fitting of eyeglasses or contact lenses, except as described above
     
  • Deluxe eyeglass frames or lens features for eyeglasses or contact lenses such as special coating, polarization, UV treatment, etc.
     
  • Multifocal, accommodating, toric, or other premium intraocular lenses (IOLs) including Crystalens, ReStor, and ReZoom
     
  • Eye exercises, visual training, or orthoptics, except for nonsurgical treatment of amblyopia and strabismus as described above
     
  • LASIK, INTACS, radial keratotomy, and other refractive surgical services
     
  • Refractions, including those performed during an eye examination related to a specific medical condition, except as described above


You Pay
All charges

 

Benefit Description

Foot Care
Routine foot care when you are under active treatment for a metabolic or peripheral vascular disease, such as diabetes

Notes:
 
  • For corresponding office visits, see the beginning of Section 5(a).
     
  • See below, Orthopedic and Prosthetic Devices, for information on podiatric shoe inserts.
     
  • See Section 5(b) for our coverage for surgical procedures.


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

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

 

Benefit Description

Not covered:
 
  • Routine foot care, such as cutting, trimming, or removal of corns, calluses, or the free edge of toenails, and similar routine treatment of conditions of the foot, except as stated above


You Pay
All charges

 

Benefit Description

Orthopedic and Prosthetic Devices
Orthopedic braces and prosthetic appliances such as:
 
  • Artificial limbs and eyes
     
  • Functional foot orthotics when prescribed by a physician
     
  • Rigid devices attached to the foot or a brace, or placed in a shoe
     
  • Replacement, repair, and adjustment of covered devices
     
  • Following a mastectomy, breast prostheses and surgical bras, including necessary replacements
     
  • Surgically implanted penile prostheses limited to treatment of erectile dysfunction 
     
  • Surgical implants


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

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

 

Orthopedic and Prosthetic Devices - continued on next page