Section 1. How This Plan Works

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Cover Page and Inside Cover

Table of Contents

Introduction/Plain Language/Advisory

5(a). Medical Services and Supplies Provided by Physicians and Other Healthcare Professionals

5(b). Surgical and Anesthesia Services Provided by Physicians and Other Healthcare Professionals

5(c). Services Provided by a Hospital or Other Facility, and Ambulance Services

5(d). Emergency Services/Accidents

5(e). Mental Health and Substance Use Disorder Benefits

5(f). Prescription Drug Benefits

5(g). Dental Benefits

5(h). Wellness and Other Special Features

5(i). Services, Drugs, and Supplies Provided Overseas

Non-FEHB Benefits Available to Plan Members

Summary of Benefits – Standard Option

Summary of Benefits – Basic Option

2023 Rate Information

Entire brochure in page-number order

Blue Cross and Blue Shield Service Benefit Plan Brochure - 2023

Standard and Basic Options

Section 1. How This Plan Works

Section 1. How This Plan Works

General features of our Standard and Basic Options//We have a Preferred Provider Organization (PPO)

How we pay professional and facility providers

Your rights and responsibilities

Your medical and claims records are confidential

© 2022 Blue Cross Blue Shield Association. All rights reserved.

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