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 58

 

Benefit Description

Reconstructive Surgery (cont.)

Not covered:
 
  • Sex-Trait Modification: If you are mid-treatment under this Plan, within a surgical or chemical regimen for Sex-Trait Modification for diagnosed gender dysphoria, for services for which you received coverage under the 2025 Plan brochure, you may seek an exception to continue care for that treatment. If you have questions about the exception process, contact us using the customer service phone number listed on the back of your ID card.  If you disagree with our decision, please see Section 8 of this brochure for the disputed claims process. Individuals under age 19 are not eligible for exceptions related to services for ongoing surgical or hormonal treatment for diagnosed gender dysphoria.


You Pay
All charges

 

Benefit Description

Oral and Maxillofacial Surgery
 
Oral surgical procedures when prior approved are limited to:
 
  • Excision of tumors and cysts of the jaws, cheeks, lips, tongue, roof and floor of mouth when pathological examination is necessary
     
  • Surgery needed to correct accidental injuries to jaws, cheeks, lips, tongue, roof and floor of mouth
     
  • Excision of exostoses of jaws and hard palate
     
  • Incision and drainage of abscesses and cellulitis
     
  • Incision and surgical treatment of accessory sinuses, salivary glands, or ducts
     
  • Reduction of dislocations and excision of temporomandibular joints
     
  • Removal of impacted teeth

Notes:
 
  • See Section 3 for information regarding prior approval.
     
  • Prior approval is required for oral/maxillofacial surgery, except when related to an accidental injury and provided within 72 hours of the accident. For more information regarding the prior approval see Section 3.
     
  • Call us at the customer service phone number on the back of your ID card to verify that your provider is Preferred for the type of care (e.g., oral surgery) you are scheduled to receive.


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

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

 

Benefit Description

Not covered:
 
  • Oral implants and transplants except for those required to treat accidental injuries as specifically described above and in Section 5(g)
     
  • Surgical procedures that involve the teeth or their supporting structures (such as the periodontal membrane, gingiva, and alveolar bone), except for those required to treat accidental injuries as specifically described above and in Section 5(g)
     
  • Surgical procedures involving dental implants or preparation of the mouth for the fitting or the continued use of dentures, except for those required to treat accidental injuries as specifically described above and in Section 5(g)
     
  • Orthodontic care before, during, or after surgery, except for orthodontia associated with surgery to correct accidental injuries as specifically described above and in Section 5(g)


You Pay
All charges