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2023 Blue Cross and Blue Shield Service Benefit Plan - Standard and Basic Option
Section 2. Changes for 2023
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Section 2. Changes for 2023

Do not rely only on these change descriptions; this Section is not an official statement of benefits. For that, go to Section 5 (Benefits). Also, we edited and clarified language throughout the brochure; any language change not shown here is a clarification that does not change benefits.

Changes to our Standard Option only

Preferred insulins are now covered with a $35 copayment for up to a 30-day supply or a $65 copayment for a 31 to 90-day supply, when dispensed by a Preferred retail pharmacy. Previously, you paid 20% of the Plan allowance for each purchase of up to a 90-day supply. (See page 112.)

Changes to our Basic Option only

Your cost-share for outpatient surgical and treatment services performed and billed by a facility is now a $150 copayment per day per facility. Previously, you paid a $100 copayment per day per facility for these services. (See page 81.)
Your cost-share for laboratory tests (such as blood tests and urinalysis), pathology services, and EKGs is now a 15% coinsurance. Previously, you paid nothing for these services. (See page 40 and 85.)
Your copayment for an inpatient admission is now a $250 per day copayment for up to $1,500 per admission for unlimited days. Previously, you paid a $175 copayment per admission up to $875 for unlimited days. (See pages 47, 76, 79, 87 and 100.)
We now cover 12 acupuncture visits per calendar year. Previously, we covered 10 acupuncture visits per calendar year. (See page 60.)
Your copayment for outpatient observation services performed and billed by a hospital or freestanding ambulatory facility is now a $250 per day copayment up to $1,500. Previously, you paid a $175 per day copayment up to $875. (See page 82.)
Your cost-share for outpatient diagnostic testing and treatment services performed and billed by a facility is now a $200 copayment per day per facility. Previously, you paid a $150 copayment per day per facility for these services. (See page 83.)
Your cost-share for outpatient hospital emergency room services and supplies, including professional provider services, diagnostic studies, radiology services, laboratory tests, and pathology services, when billed by the hospital is now a $250 per day per facility copayment. Previously, your copayment for these services was $175. (See pages 95 and 96.)
Your copayment for Tier 1 (generic drugs) without Medicare Part B primary, is now $15 for each purchase of up to a 30-day supply ($40 for a 31 to 90-day supply). Previously, your copayment was $10 for each purchase of up to a 30-day supply ($30 for a 31 to 90-day supply). (See page 114.)
Your copayment for Tier 2 (preferred brand-name drugs) without Medicare Part B primary, is now $60 for each purchase of up to a 30-day supply ($180 for a 31 to 90-day supply). Previously, your copayment was $55 for each purchase of up to a 30-day supply ($165 for a 31 to 90-day supply). (See page 114.)
You are now responsible for up to a $90 minimum copayment for Tier 3 (non-preferred brand-name) drugs for up to a 30-day supply ($250 minimum for a 31 to 90-day supply) without Medicare Part B primary. Previously, you were responsible for a $75 minimum for up to a 30-day supply ($210 minimum for a 31 to 90-day supply). (See page 114.)

Changes to both our Standard and Basic Options

We now cover preventive low-dose CT screenings for lung cancer for members aged 50 to 80. Previously, preventive benefits did not start until age 55.
We now require prior approval for certain high-cost drugs obtained outside of a pharmacy setting. Previously, prior approval was not required. (See page 22.)
We now require prior approval for proton beam therapy. Previously, prior approval was not required. (See page 22.)
We now require prior approval for stereotactic radiosurgery and stereotactic body radiation therapy. Previously, prior approval was not required. (See page 22.)

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