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Brochure sections
Cover Page and Inside Cover
Table of Contents
Introduction/Plain Language/Advisory
FEHB Facts
Section 1
Section 2
Section 3
Section 4
Section 5
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
Section 6
Section 7
Section 8
Section 9
Section 10
Index
Summary of Benefits – Standard Option
Summary of Benefits – Basic Option
2023 Rate Information
Entire brochure in page-number order
 
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Blue Cross and Blue Shield Service Benefit Plan Brochure - 2023

Standard and Basic Options

 

Section 4. Your Costs for Covered Services

Cost share/Cost-sharing
Copayment
Deductible
Coinsurance
If your provider routinely waives your cost
Waivers
Differences between our allowance and the bill
Important Notice About Surprise Billing — Know Your Rights
Your costs for other care
Your catastrophic protection out-of-pocket maximum for deductibles, coinsurance, and copayments
Carryover
If we overpay you
When Government facilities bill us
The Federal Flexible Spending Account Program – FSAFEDS
 

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