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FEP Blue Focus® Benefits
See costs for typical services when you use Preferred providers.
| FEP Blue Focus® | |
|---|---|
| Preventive Care | Nothing for covered preventive screenings, immunizations and services |
| Physician Care | $10per visit for your first 10 primary and/or specialty care visits combined medical and mental health substance use5 |
| Virtual doctor visits by Teladoc® | $0 for first 2 visits and all nutrition visits $10all additional visits |
| Urgent Care Center | $25 copay |
| Prescription Drugs | Preferred Retail Pharmacy^: Tier 1 (Generics): $5 copayTier 2 (Preferred brand): 40% of our allowance ($350 maximum)2 Mail Service Pharmacy: Specialty Pharmacy^: Tier 2 (Preferred specialty): 40% of our allowance ($350 maximum)2 |
| Maternity Care | $0 for doctor's visits $1,500copay for facility care |
| Hospital Care | Inpatient (Precertification is required): 30% of our allowance1 Outpatient: 30% of our allowance1 |
| Surgery | 30% of our allowance1 |
| ER (accidental injury) | $0 within 72 hours |
| ER (medical emergency) | 30% of our allowance1 |
| Lab work (such as blood tests) | $0 for first 10 specific lab tests34 |
| Diagnostic services (such as sleep studies, X-rays, CT scans) | 30% of our allowance1 |
| Chiropractic Care | $25for up to 10 visits a year5 |
| Dental Care | Not covered |
| Rewards Program | Earn a reward, such as a $150 MyBlue Wellness Card, at no out-of-pocket cost for getting an annual physical6 |
| Network Coverage | In-network care only, except in certain situations like emergency care |
| Out-of-Pocket Maximum (PPO) | Self Only: $9,000 Self + One and Self & Family: $18,000 |
| Annual Deductible | Self Only: $500 Self + One and Self & Family: $1,000 |
FEP Blue Focus® with FEP Medicare Prescription Drug Program
Eligible members with Medicare get lower out-of-pocket costs for higher cost drugs and additional approved prescription drugs in some tiers than the traditional pharmacy benefit. Learn more here.
| FEP Blue Focus® with MPDP | |
|---|---|
| In-network (Preferred) Retail Pharmacy | Tier 1 (Generics): $5 for up to a 30-day supply; $15 for a 31 to 90-day supply |
| FEP Mail Service Pharmacy | Not a benefit |
| FEP Specialty Pharmacy | Your specialty drug benefits are in Tier 4 (see above) for a 30-day supply |
| Annual Pharmacy Out-of-Pocket Maximum7 | $3,250per member |
Under FEP Blue Focus, benefits are not available for services performed by Non-preferred providers, except in certain situations such as emergency care. Cost sharing may not apply or may be different if Medicare is your primary coverage (it pays first). The FEP Medicare Prescription Drug Program is a prescription drug plan with a Medicare contract. Enrollment in MPDP depends on contract renewal. The formulary and/or pharmacy network may change at any time. You will receive notice when necessary. This is a summary of the features of the Blue Cross and Blue Shield Service Benefit Plan. Before making a final decision, please read the Plan’s federal brochure (RI 71-017). All benefits are subject to the definitions, limitations, and exclusions set forth in the federal brochure.
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