Blue Cross and Blue Shield Service Benefit Plan Brochure - 2026

FEHB FEP Blue Focus

 

Document list

 
Document Name Document Number
Cover Page FFBF26.00.1.1
Inside cover FFBF26.00.1.2
Table of Contents FFBF26.00.1.3
Introduction FFBF26.00.2.1
Plain Language FFBF26.00.2.2
Stop Healthcare Fraud FFBF26.00.2.3
Discrimination is Against the Law FFBF26.00.2.4
Preventing Medical Mistakes FFBF26.00.2.5
No pre-existing condition limitation FFBF26.00.3.1.1
Minimum essential coverage (MEC) FFBF26.00.3.1.2
Minimum value standard FFBF26.00.3.1.3
Where you can get information about enrolling in the FEHB Program FFBF26.00.3.1.4
Enrollment types available for you and your family FFBF26.00.3.1.5
Family member coverage FFBF26.00.3.1.6
Children's Equity Act FFBF26.00.3.1.7
When benefits and premiums start FFBF26.00.3.1.8
When you retire FFBF26.00.3.1.9
When FEHB coverage ends FFBF26.00.3.2.1
Upon divorce FFBF26.00.3.2.2
Temporary Continuation of Coverage (TCC) FFBF26.00.3.2.3
Finding replacement coverage FFBF26.00.3.2.4
Health Insurance Marketplace FFBF26.00.3.2.5
Section 1. How This Plan Works FFBF26.01.0
General features of FEP Blue Focus/We have a Preferred Provider Organization (PPO) FFBF26.01.1
How we pay professional and facility providers FFBF26.01.2
Your rights and responsibilities FFBF26.01.3
Your medical and claims records are confidential FFBF26.01.4
Section 2. Changes for 2026 FFBF26.02
Identification cards FFBF26.03.1
Where you get covered care FFBF26.03.2.0
Balance Billing Protection FFBF26.03.2.01
Covered professional providers FFBF26.03.2.1
Covered facility providers FFBF26.03.2.2
What you must do to get covered care FFBF26.03.3.0
Transitional care FFBF26.03.3.1
If you are hospitalized when your enrollment begins FFBF26.03.3.2
You need prior Plan approval for certain services FFBF26.03.4.00
Inpatient hospital admission, inpatient residential treatment center admission FFBF26.03.4.01
Other services FFBF26.03.4.02
Special prior authorization situations related to coordination of benefits (COB) FFBF26.03.4.03
Prior notification - Maternity care FFBF26.03.4.04
How to request precertification for an admission or get approval for Other services FFBF26.03.4.05
Non-urgent care claims FFBF26.03.4.06
Urgent care claims FFBF26.03.4.07
Concurrent care claims FFBF26.03.4.08
Emergency inpatient admission FFBF26.03.4.09
Maternity care FFBF26.03.4.10
If your facility stay needs to be extended FFBF26.03.4.11
If your treatment needs to be extended FFBF26.03.4.12
If you disagree with our pre-service claim decision FFBF26.03.5.0
To reconsider a non-urgent care claim FFBF26.03.5.1
To reconsider an urgent care claim FFBF26.03.5.2
To file an appeal with OPM FFBF26.03.5.3
Cost-share/Cost-sharing FFBF26.04.01
Copayment FFBF26.04.02
Deductible FFBF26.04.03
Coinsurance FFBF26.04.04
If your provider routinely waives your cost FFBF26.04.05
Waivers FFBF26.04.06
Differences between our allowance and the bill FFBF26.04.07
Important Notice About Surprise Billing – Know Your Rights FFBF26.04.08
Your costs for other care FFBF26.04.09
Your catastrophic protection out-of-pocket maximum for deductibles, coinsurance, and copayments FFBF26.04.10
Carryover FFBF26.04.11
If we overpay you FFBF26.04.12
When Government facilities bill us FFBF26.04.13
The Federal Flexible Spending Account Program – FSAFEDS FFBF26.04.14
Section 5. Benefits [Table of Contents] FFBF26.05.01
Section 5. FEP Blue Focus Overview FFBF26.05.02
Section 5(a). Overview FFBF26.05a.0
Diagnostic and Treatment Services FFBF26.05a.01
Lab, X-ray and Other Diagnostic Tests FFBF26.05a.02
Preventive Care, Adult FFBF26.05a.03
Preventive Care, Child FFBF26.05a.04
Maternity Care FFBF26.05a.05
Family Planning FFBF26.05a.06
Reproductive Services FFBF26.05a.07
Allergy Care FFBF26.05a.08
Treatment Therapies FFBF26.05a.09
Physical Therapy, Occupational Therapy, Speech Therapy, and Cognitive Rehabilitation Therapy FFBF26.05a.10
Hearing Services FFBF26.05a.11
Vision Services (Testing, Treatment, and Supplies) FFBF26.05a.12
Foot Care FFBF26.05a.13
Orthopedic and Prosthetic Devices FFBF26.05a.14
Durable Medical Equipment (DME) FFBF26.05a.15
Medical Supplies FFBF26.05a.16
Home Health Services FFBF26.05a.17
Alternative/Manipulative Treatment FFBF26.05a.18
Educational Classes and Programs FFBF26.05a.19
Section 5(b). Overview FFBF26.05b.0
Surgical Procedures FFBF26.05b.1
Reconstructive Surgery FFBF26.05b.2
Oral and Maxillofacial Surgery FFBF26.05b.3
Organ/Tissue Transplants FFBF26.05b.4
Anesthesia FFBF26.05b.5
Section 5(c). Overview FFBF26.05c.0
Inpatient Hospital FFBF26.05c.1
Maternity - Facility FFBF26.05c.2
Outpatient Hospital or Ambulatory Surgical Center FFBF26.05c.3
Residential Treatment Center FFBF26.05c.4
Extended Care Benefits/Skilled Nursing Care Facility Benefits FFBF26.05c.5
Hospice Care FFBF26.05c.6
Ambulance FFBF26.05c.7
Section 5(d). Overview FFBF26.05d.0
Accidental Injury FFBF26.05d.1
Medical Emergency FFBF26.05d.2
Ambulance FFBF26.05d.3
Section 5(e). Overview FFBF26.05e.0
Professional Services FFBF26.05e.1
Inpatient Hospital or Other Covered Facility FFBF26.05e.2
Residential Treatment Center FFBF26.05e.3
Outpatient Hospital or Other Covered Facility FFBF26.05e.4
Section 5(f). Overview FFBF26.05f.0
There are important features you should be aware of FFBF26.05f.01
Who can write your prescriptions FFBF26.05f.02
Where you can obtain them FFBF26.05f.03
What is covered FFBF26.05f.04
Generic equivalents FFBF26.05f.05
Disclosure of information FFBF26.05f.06
These are the dispensing limitations FFBF26.05f.07
Patient Safety and Quality Monitoring (PSQM) FFBF26.05f.08
Prior Approval FFBF26.05f.09
Medical Foods FFBF26.05f.10
Here is how to obtain your prescription drugs and supplies FFBF26.05f.11
Preferred retail pharmacies FFBF26.05f.12
Over-the-counter (OTC) contraceptive drugs and devices FFBF26.05f.27
Immunizations when provided by a Preferred retail pharmacy that participates in our vaccine network FFBF26.05f.28
Diabetic Meter Program FFBF26.05f.29
Medications to promote better health as recommended under the ACA FFBF26.05f.30
Generic medications to reduce breast cancer risk for women FFBF26.05f.31
Bowel preparation medications and antiretroviral therapy medications for HIV FFBF26.05f.32
Opioid rescue agents FFBF26.05f.33
Smoking and Tobacco Cessation Medications FFBF26.05f.34
Not Covered FFBF26.05f.35
Drugs From Other Sources FFBF26.05f.36
Section 5(g). Overview FFBF26.05g.0
Accidental Injury Benefit FFBF26.05g.1
Inpatient and Outpatient Facility Care FFBF26.05g.2
Health Tools FFBF26.05h.01
Services for the Deaf and Hearing Impaired FFBF26.05h.02
Web Accessibility for the Visually Impaired FFBF26.05h.03
Travel Benefit/Services Overseas FFBF26.05h.04
Healthy Families FFBF26.05h.05
Blue Health Assessment FFBF26.05h.06
Hypertension Management Program FFBF26.05h.07
MyBlue Customer eService FFBF26.05h.08
National Doctor & Hospital Finder FFBF26.05h.09
Care Management Programs FFBF26.05h.10
Flexible Benefits Option FFBF26.05h.11
Telehealth Services FFBF26.05h.12
Routine Annual Physical Incentive Program FFBF26.05h.13
The fepblue Mobile Application FFBF26.05h.14
Weight Loss Management Program FFBF26.05h.15
Section 5(i). Services, Drugs, and Supplies Provided Overseas FFBF26.05i.0
Non-FEHB Benefits Available to Plan Members FFBF26.05N.0
Section 6. General Exclusions - Services, Drugs, and Supplies We Do Not Cover FFBF26.06
Section 7. Filing a Claim for Covered Services FFBF26.07
Section 8. The Disputed Claims Process FFBF26.08
When you have other health coverage FFBF26.09.1.0
TRICARE and CHAMPVA FFBF26.09.1.1
Workers' Compensation FFBF26.09.1.2
Medicaid FFBF26.09.1.3
When other Government agencies are responsible for your care FFBF26.09.2
When others are responsible for injuries FFBF26.09.3
When you have Federal Employees Dental and Vision Insurance Plan (FEDVIP) FFBF26.09.4
Clinical trials FFBF26.09.5
When you have Medicare FFBF26.09.6.1
The Original Medicare Plan (Part A or Part B) FFBF26.09.6.2
Tell us about your Medicare coverage FFBF26.09.6.3
Private contract with your physician FFBF26.09.6.4
Medicare Advantage (Part C) FFBF26.09.6.5
Medicare prescription drug coverage (Part D) FFBF26.09.6.6
Medicare prescription drug coverage (Part B) FFBF26.09.6.7
Primary payor chart FFBF26.09.6.8
When you are age 65 or over and do not have Medicare FFBF26.09.7
Physicians Who Opt-Out of Medicare FFBF26.09.8
When you have the Original Medicare Plan (Part A, Part B, or both) FFBF26.09.9
Cost-share when Medicare is your primary payor FFBF26.09.95
Section 10. Definitions of Terms We Use in This Brochure FFBF26.10
Index FFBF26.11
Summary of Benefits for the Blue Cross and Blue Shield Service Benefit Plan FEP Blue Focus - 2026 FFBF26.12
2026 Rate Information for the Blue Cross and Blue Shield Service Benefit Plan FFBF26.13
Quick Links FFBF26.QL
Cover page FFBF26-000-1
Inside cover FFBF26-000-2
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