2023 Blue Cross and Blue Shield Service Benefit Plan - Standard and Basic Option
Index
Index
Index
Do not rely only on this page; it is for your convenience and may not show all pages where the terms appear. This Index is not an official statement of benefits.
Abortion - 47-49 , 134-135
Accidental injury - 79-81, 92-97, 121-122, 152
Acupuncture - 60-61, 77
Affordable Care Act (ACA) - 9, 12, 45-47
Allergy care - 51
Allogeneic transplants - 70-76
Alternative treatments - 60-61
Ambulance - 20, 92-93, 97
Ambulatory surgical center - 18-19, 81-85
Anesthesia - 77, 79-81
Angiographies - 40-42, 81-85
Appeals - 25-27, 139-141
Applied behavior analysis (ABA) - 22-24, 52-53, 81-85
Assistant surgeon - 20
Autism spectrum disorder - 52-53, 81-85
Autologous transplants - 69-75
Average wholesale price (AWP) - 108-119, 163
Biopsies - 42-45, 63-65, 81-85
Birthing centers - 18-19
Blood and blood plasma - 58-59, 81-85
Blood or marrow stem cell transplants - 69-76
Blue Distinction Centers - 18-19, 70, 75-76, 86-87 Blue Distinction Specialty Care - 18-19
Blue Health Assessment - 125-126
Bone density tests - 40-42, 81-85
Brand-name drugs - 104-107
Breast pump and supplies - 47-49
Breast reconstruction - 66-68 Breastfeeding support and supplies - 47-49, 58-59
Cancer tests - 42-45
Cardiac rehabilitation - 52-53, 81-85
Cardiovascular monitoring - 40-42, 81-85
Care Management Programs - 128
Case management - 70-75, 87-92, 100-101, 128
Casts - 63-65, 79-85
Catastrophic protection - 32-33, 163, 165
Cervical cancer screening - 42-47
CHAMPVA - 142-145
Changes for 2023 - 15-16
Chemotherapy - 52-53, 70-75, 81-85
Children’s Equity Act - 10-11
Chiropractic manipulative treatment - 52-53, 60-61
Cholesterol tests - 42-45, 108-119
Circumcision - 47-49, 63-65
Claims and claims filing - 13-14, 25-27, 127-128, 131-132, 136-141, 152, 157-159
Clinic visits - 39-40, 81-85, 99-100
Clinical trials - 22-24, 70-75, 134-135, 144-145, 152-154
Cognitive rehabilitation - 53-54, 81-85, 88-89
Coinsurance - 13-14, 20, 29, 32-33, 152
Colorectal cancer tests - 42-45 Confidentiality - 13-14, 154
Congenital anomalies - 22-24, 63-65, 78-79, 152
Consultations - 39-40, 99-100
Contact lenses - 54-55, 133
Contraceptive devices and drugs - 49, 108-119
Coordination of benefits - 108-119, 142
Copayments - 13-14, 28, 32-33, 142, 145-147, 149
Cosmetic surgery - 63-68, 153
Cost-sharing - 28, 32-33, 153
Costs for covered services - 28-34
Coverage information - 9
Covered facility providers - 18-19
Covered professional providers - 17
CT scans - 40-42, 81-85, 152
Custodial care - 18-19
Deductible - 28, 37
Definitions - 152-159
Dental care - 68-69, 121-124, 163
Diabetes Management Incentive Program - 126, 163, 165
Diabetes Management Program - 125
Diabetic education - 61, 81-85
Diabetic supplies
Diagnostic tests - 40-42, 47-50, 100-102
Dialysis - 52-53, 57-58, 81-85, 88-89
Disease Management - 128
Disputed claims process - 139-141
Divorce - 9-10, 12
DNA analysis of stool samples - 42-45
Donor expenses (transplants) - 70-76
Drugs (see: Prescription drugs)
Durable medical equipment (DME) - 57-58, 153 Educational classes and programs - 61
EEGs - 40-42, 81-85
EKGs - 40-42, 81-85
Emergency - 20, 26, 92-97, 121-122
Enrollment - 9, 11-12
Exception situations - 20-21
Exclusions - 134-135
Experimental or investigational - 153-154
Extended care benefits - 88-89
Eyeglasses - 54-55
Facility providers - 18-19
Family planning - 49
Fecal occult blood test - 42-45
FEDVIP - 121, 145
fepblue mobile application - 129
fepblue.org - 4
Flexible benefits option - 128-129
Foot care - 56
Formulary/Preferred drug list - 103-120
Foundation for the Accreditation of Cellular Therapy (FACT) accredited facility - 70
Fraud - 4
Freestanding ambulatory facilities - 18-19
Gender affirming care - 21-24, 56-57, 63-65
Generic drugs - 104-107
Generic Incentive Program - 107-108
Genetic screening/testing - 40-42
Health Insurance Marketplace - 12
Health tools - 125
Healthy Families - 125
Hearing aids and hearing services - 54, 56-57
Home health services - 59-60
Home nursing care (maternity) - 47-49
Hospice care - 89-92
HospitalHuman papillomavirus (HPV) tests - 42-47
Hypertension Management Program - 126-127
Immunizations - 42-47, 81-85, 108-119
Inpatient hospital benefits - 79-81, 86-87
Inpatient professional services - 21, 26, 39-40, 79-81
Insulin - 108-119
Insulin pumps - 57-58, 108-119
Intensity-modulated radiation therapy (IMRT) - 22-24, 52-53
Laboratory and pathology services - 20
Low-dose CT screening - 158
Mail Service Prescription Drug Program - 104-119, 131-132, 137-138, 163, 165
Mammograms - 42-45
Manipulative treatment - 60, 81-85
Maternity care - 26, 47-49
Maxillofacial surgery - 68-69
Medicaid - 143
Medical emergency - 20, 94, 96-97
Medical foods - 58-59, 108-119,155
Medical supplies - 58-59, 79-85, 89-92
Medically necessary - 21, 26, 134-135, 144-145, 155
Medicare - 1, 21, 69-70, 88-89, 127, 142-151
Member facilities - 13-14, 18-19, 155-157
Mental health/substance use disorder - -47-49, 87-88, 98-102, 154
MRIs - 40-42, 81-85, 152
Multiple procedures - 63-65
MyBlue Customer eService - 127-128
National Doctor & Hospital Finder - 128
Neurological testing - 40-42, 81-85
Never Events - 6-8, 155
Newborn care - 26, 39-40, 45-49
No Surprises Act (NSA) - 32
Non-member facilities - 13-14, 155-157
Non-participating providers - 13-14, 24, 32
Non-preferred providers - 29-33
Nurse - 18-19, 59-60, 89-92, 125, 128
Nutritional counseling - 42-47, 126, 129
Observation care - 155
Obstetrical care - 47-49
Occupational therapy - 53-54, 89-92
Office visits - 37, 39-40, 99-100, 158, 163
Online Health Coach (OHC) - 125
Oral surgery - 68-69
Organ/tissue transplants - 22-24, 69-76
Orthopedic devices - 56-57, 81-85
Osteopathic manipulative treatment - 60
Osteoporosis screening - 158
Ostomy and catheter supplies - 58-59
Out-of-pocket expenses - 32-33, 37, 157-158
Outpatient facility services - 81-85
Outpatient professional services - 39-40
Overpayments - 34
Overseas Assistance Center - 130
Overseas services, drugs, supplies and claims - 130-132
Oxygen - 57-59
Pap tests - 42-47
Participating providers - 39-61, 63-75, 77, 94-97, 99-100, 124
Patient Safety and Quality Monitoring (PSQM) Program - 104-107
Personal Health Record - 125
PET scans - 42, 81-85, 152
Pharmacotherapy - 39-40, 52-53
Physical examination - 81-85,134-135
Physical therapy - 39-40, 53-54, 89-92
Physician - 17, 21, 146, 149-150, 154,162-165
Plan allowance - 155-157
PPO - 13-14, 158
Pre-admission testing - 79-81
Precertification - 21, 24-26, 154, 157-158
Preferred providers - 1314, 20, 29-32
Pregnancy (see: Maternity care)
Pregnancy Care Incentive Program - 127
Prescription drugs - 108-119
Prior approval - 21-25, 52-53, 62-70, 78-79, 89-92, 103-119, 137-138,152, 154, 158
Professional providers - 17
Prostate cancer tests - 42-45
Prosthetic devices - 56-57, 63-68, 78-85
Psychotherapy - 99-102
Pulmonary rehabilitation - 52-53, 81-85
Radiation therapy - 52-53, 81-85
Reconsiderations - 27, 139-141
Renal dialysis - 18-19, 52-53, 81-85
Replacement coverage - 12
Reproductive services - 50, 152Residential Treatment Center (RTC) - 18-19, 21, 24-25, 87-88, 100-101, 128, 153
Retail Pharmacy Program - 37, 103-119, 131-132, 136-138, 158, 163, 165
Rights and responsibilities - 13-14
Room and board - 21, 26, 39-40, 79-81, 87-89, 100-101
Screening services - 158
Second surgical opinion - 39-40
Self-injectable drugs - 108-119, 158-159
Skilled nursing facility (SNF) care - 18-19, 153
Smoking cessation - 61, 108-119, 125
Social worker - 128
Specialty Drug Pharmacy Program - 103-104, 108-119, 131-132, 137-138
Specialty drugs - 108-119, 158-159
Speech therapy - 53-54, 81-85, 89-92
Speech-Generating Devices - 57-58
Stem Cell Transplants - 69-75
Sterilization procedures - 49, 63-65
Subrogation - 143-144, 159
Substance use disorder - 98-102, 163-164
Surgery - 24, 54-55, 62-77, 86-87, 153
Telehealth - 159
Tobacco cessation - 61, 108-119, 125
Transplants - 18-19, 21-24, 52-53, 69-76
Travel benefit - 75-76, 125
Treatment therapies - 52-53
TRICARE - 142-143
Ultrasounds - 40-42, 81-85
Urgent care center - 95-97
Urgent care claims - 25-26, 159
VA facilities - 150
Vision services - 54-55, 144
Waivers - 29
Weight control - 125, 134-135
Wheelchairs - 57-58, 88-89, 92-93
Wigs - 56-57
X-rays - 40-42, 144-145
Accidental injury - 79-81, 92-97, 121-122, 152
Acupuncture - 60-61, 77
Affordable Care Act (ACA) - 9, 12, 45-47
Allergy care - 51
Allogeneic transplants - 70-76
Alternative treatments - 60-61
Ambulance - 20, 92-93, 97
Ambulatory surgical center - 18-19, 81-85
Anesthesia - 77, 79-81
Angiographies - 40-42, 81-85
Appeals - 25-27, 139-141
Applied behavior analysis (ABA) - 22-24, 52-53, 81-85
Assistant surgeon - 20
Autism spectrum disorder - 52-53, 81-85
Autologous transplants - 69-75
Average wholesale price (AWP) - 108-119, 163
Biopsies - 42-45, 63-65, 81-85
Birthing centers - 18-19
Blood and blood plasma - 58-59, 81-85
Blood or marrow stem cell transplants - 69-76
Blue Distinction Centers - 18-19, 70, 75-76, 86-87 Blue Distinction Specialty Care - 18-19
Blue Health Assessment - 125-126
Bone density tests - 40-42, 81-85
Brand-name drugs - 104-107
Breast pump and supplies - 47-49
Breast reconstruction - 66-68 Breastfeeding support and supplies - 47-49, 58-59
Cancer tests - 42-45
Cardiac rehabilitation - 52-53, 81-85
Cardiovascular monitoring - 40-42, 81-85
Care Management Programs - 128
Case management - 70-75, 87-92, 100-101, 128
Casts - 63-65, 79-85
Catastrophic protection - 32-33, 163, 165
Cervical cancer screening - 42-47
CHAMPVA - 142-145
Changes for 2023 - 15-16
Chemotherapy - 52-53, 70-75, 81-85
Children’s Equity Act - 10-11
Chiropractic manipulative treatment - 52-53, 60-61
Cholesterol tests - 42-45, 108-119
Circumcision - 47-49, 63-65
Claims and claims filing - 13-14, 25-27, 127-128, 131-132, 136-141, 152, 157-159
Clinic visits - 39-40, 81-85, 99-100
Clinical trials - 22-24, 70-75, 134-135, 144-145, 152-154
Cognitive rehabilitation - 53-54, 81-85, 88-89
Coinsurance - 13-14, 20, 29, 32-33, 152
Colorectal cancer tests - 42-45 Confidentiality - 13-14, 154
Congenital anomalies - 22-24, 63-65, 78-79, 152
Consultations - 39-40, 99-100
Contact lenses - 54-55, 133
Contraceptive devices and drugs - 49, 108-119
Coordination of benefits - 108-119, 142
Copayments - 13-14, 28, 32-33, 142, 145-147, 149
Cosmetic surgery - 63-68, 153
Cost-sharing - 28, 32-33, 153
Costs for covered services - 28-34
Coverage information - 9
Covered facility providers - 18-19
Covered professional providers - 17
CT scans - 40-42, 81-85, 152
Custodial care - 18-19
Deductible - 28, 37
Definitions - 152-159
Dental care - 68-69, 121-124, 163
Diabetes Management Incentive Program - 126, 163, 165
Diabetes Management Program - 125
Diabetic education - 61, 81-85
Diabetic supplies
Diabetic Meter Program - 108-119
Insulin pumps - 57-58
Insulin, test strips, and lancets - 108-119
Needles and disposable syringes - 108-119
Diagnostic and treatment services - 42-47, 81-85 Insulin pumps - 57-58
Insulin, test strips, and lancets - 108-119
Needles and disposable syringes - 108-119
Diagnostic tests - 40-42, 47-50, 100-102
Dialysis - 52-53, 57-58, 81-85, 88-89
Disease Management - 128
Disputed claims process - 139-141
Divorce - 9-10, 12
DNA analysis of stool samples - 42-45
Donor expenses (transplants) - 70-76
Drugs (see: Prescription drugs)
Durable medical equipment (DME) - 57-58, 153 Educational classes and programs - 61
EEGs - 40-42, 81-85
EKGs - 40-42, 81-85
Emergency - 20, 26, 92-97, 121-122
Enrollment - 9, 11-12
Exception situations - 20-21
Exclusions - 134-135
Experimental or investigational - 153-154
Extended care benefits - 88-89
Eyeglasses - 54-55
Facility providers - 18-19
Family planning - 49
Fecal occult blood test - 42-45
FEDVIP - 121, 145
fepblue mobile application - 129
fepblue.org - 4
Flexible benefits option - 128-129
Foot care - 56
Formulary/Preferred drug list - 103-120
Foundation for the Accreditation of Cellular Therapy (FACT) accredited facility - 70
Fraud - 4
Freestanding ambulatory facilities - 18-19
Gender affirming care - 21-24, 56-57, 63-65
Generic drugs - 104-107
Generic Incentive Program - 107-108
Genetic screening/testing - 40-42
Health Insurance Marketplace - 12
Health tools - 125
Healthy Families - 125
Hearing aids and hearing services - 54, 56-57
Home health services - 59-60
Home nursing care (maternity) - 47-49
Hospice care - 89-92
HospitalHuman papillomavirus (HPV) tests - 42-47
Hypertension Management Program - 126-127
Immunizations - 42-47, 81-85, 108-119
Inpatient hospital benefits - 79-81, 86-87
Inpatient professional services - 21, 26, 39-40, 79-81
Insulin - 108-119
Insulin pumps - 57-58, 108-119
Intensity-modulated radiation therapy (IMRT) - 22-24, 52-53
Laboratory and pathology services - 20
Low-dose CT screening - 158
Mail Service Prescription Drug Program - 104-119, 131-132, 137-138, 163, 165
Mammograms - 42-45
Manipulative treatment - 60, 81-85
Maternity care - 26, 47-49
Maxillofacial surgery - 68-69
Medicaid - 143
Medical emergency - 20, 94, 96-97
Medical foods - 58-59, 108-119,155
Medical supplies - 58-59, 79-85, 89-92
Medically necessary - 21, 26, 134-135, 144-145, 155
Medicare - 1, 21, 69-70, 88-89, 127, 142-151
Reimbursement account - 127
Medications and supplies - 108-119Member facilities - 13-14, 18-19, 155-157
Mental health/substance use disorder - -47-49, 87-88, 98-102, 154
MRIs - 40-42, 81-85, 152
Multiple procedures - 63-65
MyBlue Customer eService - 127-128
National Doctor & Hospital Finder - 128
Neurological testing - 40-42, 81-85
Never Events - 6-8, 155
Newborn care - 26, 39-40, 45-49
No Surprises Act (NSA) - 32
Non-member facilities - 13-14, 155-157
Non-participating providers - 13-14, 24, 32
Non-preferred providers - 29-33
Nurse - 18-19, 59-60, 89-92, 125, 128
Nutritional counseling - 42-47, 126, 129
Observation care - 155
Obstetrical care - 47-49
Occupational therapy - 53-54, 89-92
Office visits - 37, 39-40, 99-100, 158, 163
Online Health Coach (OHC) - 125
Oral surgery - 68-69
Organ/tissue transplants - 22-24, 69-76
Orthopedic devices - 56-57, 81-85
Osteopathic manipulative treatment - 60
Osteoporosis screening - 158
Ostomy and catheter supplies - 58-59
Out-of-pocket expenses - 32-33, 37, 157-158
Outpatient facility services - 81-85
Outpatient professional services - 39-40
Overpayments - 34
Overseas Assistance Center - 130
Overseas services, drugs, supplies and claims - 130-132
Oxygen - 57-59
Pap tests - 42-47
Participating providers - 39-61, 63-75, 77, 94-97, 99-100, 124
Patient Safety and Quality Monitoring (PSQM) Program - 104-107
Personal Health Record - 125
PET scans - 42, 81-85, 152
Pharmacotherapy - 39-40, 52-53
Physical examination - 81-85,134-135
Physical therapy - 39-40, 53-54, 89-92
Physician - 17, 21, 146, 149-150, 154,162-165
Plan allowance - 155-157
PPO - 13-14, 158
Pre-admission testing - 79-81
Precertification - 21, 24-26, 154, 157-158
Preferred providers - 1314, 20, 29-32
Pregnancy (see: Maternity care)
Pregnancy Care Incentive Program - 127
Prescription drugs - 108-119
Brand-name drugs - 104-119
Drugs from other sources - 119-120
Generic drugs - 108-119
Mail Service Prescription Drug Program - 108-119,131-132, 137-138
Preferred retail pharmacies - 108-119, 137-138
Retail Pharmacy Program - 104-119, 131-132, 137-138
Self-injectable drugs - 103-104
Specialty Drug Pharmacy Program - 108-119, 131-132
Specialty drugs - 104-119, 158-159
Preventive carePrimary care provider - 17, 37, 39-40, 45-47, 50-56, 61, 89-92 Drugs from other sources - 119-120
Generic drugs - 108-119
Mail Service Prescription Drug Program - 108-119,131-132, 137-138
Preferred retail pharmacies - 108-119, 137-138
Retail Pharmacy Program - 104-119, 131-132, 137-138
Self-injectable drugs - 103-104
Specialty Drug Pharmacy Program - 108-119, 131-132
Specialty drugs - 104-119, 158-159
Prior approval - 21-25, 52-53, 62-70, 78-79, 89-92, 103-119, 137-138,152, 154, 158
Professional providers - 17
Prostate cancer tests - 42-45
Prosthetic devices - 56-57, 63-68, 78-85
Psychotherapy - 99-102
Pulmonary rehabilitation - 52-53, 81-85
Radiation therapy - 52-53, 81-85
Reconsiderations - 27, 139-141
Renal dialysis - 18-19, 52-53, 81-85
Replacement coverage - 12
Reproductive services - 50, 152Residential Treatment Center (RTC) - 18-19, 21, 24-25, 87-88, 100-101, 128, 153
Retail Pharmacy Program - 37, 103-119, 131-132, 136-138, 158, 163, 165
Rights and responsibilities - 13-14
Room and board - 21, 26, 39-40, 79-81, 87-89, 100-101
Screening services - 158
Second surgical opinion - 39-40
Self-injectable drugs - 108-119, 158-159
Skilled nursing facility (SNF) care - 18-19, 153
Smoking cessation - 61, 108-119, 125
Social worker - 128
Specialty Drug Pharmacy Program - 103-104, 108-119, 131-132, 137-138
Specialty drugs - 108-119, 158-159
Speech therapy - 53-54, 81-85, 89-92
Speech-Generating Devices - 57-58
Stem Cell Transplants - 69-75
Sterilization procedures - 49, 63-65
Subrogation - 143-144, 159
Substance use disorder - 98-102, 163-164
Surgery - 24, 54-55, 62-77, 86-87, 153
Assistant surgeon - 20, 63-65
Eye: cataract, amblyopia, strabismus - 54-55, 63-65
Gender affirming - 21-24, 63-65
Multiple procedures - 63-65
Oral and maxillofacial - 68-69
Outpatient - 22-24, 52-53, 63-65, 81-85, 101-102, 154-155
Reconstructive - 66-68
Sterilization, reversal of voluntary - 49, 63-65
Surgical implants - 56-57,81-85
Surgical treatment of morbid obesity - 22-24, 63-65
Transplants - 69-75
Syringes - 108-119Eye: cataract, amblyopia, strabismus - 54-55, 63-65
Gender affirming - 21-24, 63-65
Multiple procedures - 63-65
Oral and maxillofacial - 68-69
Outpatient - 22-24, 52-53, 63-65, 81-85, 101-102, 154-155
Reconstructive - 66-68
Sterilization, reversal of voluntary - 49, 63-65
Surgical implants - 56-57,81-85
Surgical treatment of morbid obesity - 22-24, 63-65
Transplants - 69-75
Telehealth - 159
Dermatology - 129, 159
Mental health/substance use disorder - 38
Minor acute conditions - 129, 155, 159
Nutritional counseling - 129, 159
Temporary Continuation of Coverage (TCC) - 11-12Mental health/substance use disorder - 38
Minor acute conditions - 129, 155, 159
Nutritional counseling - 129, 159
Tobacco cessation - 61, 108-119, 125
Transplants - 18-19, 21-24, 52-53, 69-76
Travel benefit - 75-76, 125
Treatment therapies - 52-53
TRICARE - 142-143
Ultrasounds - 40-42, 81-85
Urgent care center - 95-97
Urgent care claims - 25-26, 159
VA facilities - 150
Vision services - 54-55, 144
Waivers - 29
Weight control - 125, 134-135
Wheelchairs - 57-58, 88-89, 92-93
Wigs - 56-57
X-rays - 40-42, 144-145