2023 Blue Cross and Blue Shield Service Benefit Plan - Standard and Basic Option
Table of Contents
Page 1
Table of Contents
Page 1
Table of Contents
Introduction - 4
Plain Language - 4
Stop Healthcare Fraud! - 4
Discrimination is Against the Law - 5
Preventing Medical Mistakes - 6
FEHB Facts - 9
Plain Language - 4
Stop Healthcare Fraud! - 4
Discrimination is Against the Law - 5
Preventing Medical Mistakes - 6
FEHB Facts - 9
Coverage information - 9
• No pre-existing condition limitation - 9
• Minimum essential coverage (MEC) - 9
• Minimum value standard - 9
• Where you can get information about enrolling in the FEHB Program - 9
• Types of coverage available for you and your family - 9
• Family member coverage - 10
• Children’s Equity Act - 10
• When benefits and premiums start - 11
• When you retire - 11
When you lose benefits - 11
• When FEHB coverage ends - 11
• Upon divorce - 12
• Temporary Continuation of Coverage (TCC) - 12
• Finding replacement coverage - 12
• Health Insurance Marketplace - 12
Section 1. How This Plan Works - 13• No pre-existing condition limitation - 9
• Minimum essential coverage (MEC) - 9
• Minimum value standard - 9
• Where you can get information about enrolling in the FEHB Program - 9
• Types of coverage available for you and your family - 9
• Family member coverage - 10
• Children’s Equity Act - 10
• When benefits and premiums start - 11
• When you retire - 11
When you lose benefits - 11
• When FEHB coverage ends - 11
• Upon divorce - 12
• Temporary Continuation of Coverage (TCC) - 12
• Finding replacement coverage - 12
• Health Insurance Marketplace - 12
General features of our Standard and Basic Options - 13
We have a Preferred Provider Organization (PPO) - 13
How we pay professional and facility providers - 13
Your rights and responsibilities - 14
Your medical and claims records are confidential - 14
Section 2. Changes for 2023 - 15We have a Preferred Provider Organization (PPO) - 13
How we pay professional and facility providers - 13
Your rights and responsibilities - 14
Your medical and claims records are confidential - 14
Changes to our Standard Option only - 15
Changes to our Basic Option only - 15
Changes to both our Standard and Basic Options - 16
Section 3. How You Get Care - 17Changes to our Basic Option only - 15
Changes to both our Standard and Basic Options - 16
Identification cards - 17
Where you get covered care - 17
Balance Billing Protection - 17
• Covered professional providers - 17
• Covered facility providers - 18
What you must do to get covered care - 20
• Transitional care - 20
• If you are hospitalized when your enrollment begins - 20
You need prior Plan approval for certain services - 21
• Inpatient hospital admission, inpatient residential treatment center admission, or skilled nursing facility admission - 21
• Other services - 22
• Surgery by Non-participating providers under Standard Option - 24
How to request precertification for an admission or get prior approval for Other services - 24
• Non-urgent care claims - 25
• Urgent care claims - 25
Where you get covered care - 17
Balance Billing Protection - 17
• Covered professional providers - 17
• Covered facility providers - 18
What you must do to get covered care - 20
• Transitional care - 20
• If you are hospitalized when your enrollment begins - 20
You need prior Plan approval for certain services - 21
• Inpatient hospital admission, inpatient residential treatment center admission, or skilled nursing facility admission - 21
• Other services - 22
• Surgery by Non-participating providers under Standard Option - 24
How to request precertification for an admission or get prior approval for Other services - 24
• Non-urgent care claims - 25
• Urgent care claims - 25
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