Blue cross blue shield basic federal employee program

Blue Cross and Blue Shield of New Mexico, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the

Blue Cross and Blue Shield Association

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2021 Blue Cross and Blue Shield Service Benefit Plan - Standard and Basic Option
Summary of Benefits for the Blue Cross and Blue Shield Service Benefit Plan Basic Option – 2021

Do not rely on this chart alone. This is a summary. All benefits are subject to the definitions, limitations, and exclusions in this brochure. Before making a decision, please read this FEHB brochure.

If you want to enroll or change your enrollment in this Plan, be sure to put the correct enrollment code from the cover on your enrollment form.

Basic Option does not provide benefits when you use Non-preferred providers. For a list of the exceptions to this requirement, see page 20. There is no deductible for Basic Option.

You can also obtain a copy of our Summary of Benefits and Coverage as required by the Affordable Care Act at www.fepblue.org/brochure.

Medical services provided by physicians:

Diagnostic and treatment services provided in the office (pages 39-46)

You pay:PPO: Nothing for preventive care; $30 per office visit for primary care physicians and other healthcare professionals; $40 per office visit for specialistsNon-PPO: You pay all charges

Telehealth services (pages 39, 99)

You pay:PPO: Nothing for the first 2 visits per calendar year

after the 2nd visit: $15 copayment per visit

Non-PPO: You pay all charges

Services provided by a hospital:

Inpatient (pages 79-81)

You pay:PPO: $175 per day up to $875 per admission

Non-PPO: You pay all charges

Outpatient (pages 81-85)

You pay:PPO: $100 per day per facility

Non-PPO: You pay all charges

Emergency benefits:

Accidental injury (pages 95-96)

You pay:PPO: $35 copayment for urgent care; $175 copayment for emergency room careNon-PPO: $175 copayment for emergency room care; you pay all charges for care in settings other than the emergency room

Ambulance transport services: $100 per day for ground ambulance; $150 per day for air or sea ambulance

Medical emergency (pages 96-97)

You pay:

Same as for accidental injury

Mental health and substance use disorder treatment (pages 98-102)

You pay:PPO: Regular cost-sharing, such as $30 office visit copayment; $175 per day up to $875 per inpatient admissionNon-PPO: You pay all charges

Prescription drugs (pages 108-120)

Retail Pharmacy Program:

You pay:PPO: $10 generic/$55 Preferred brand-name per prescription ($50 if you have primary Medicare Part B)/60% coinsurance ($75 minimum) for non-preferred brand-name drugs (50% ($60 minimum) if you have primary Medicare Part B)Non-PPO: You pay all charges

Specialty Drug Pharmacy Program:

You pay:
11/10/20 correction (red text):
$70 $85 preferred specialty drug for a purchase of up to a 30-day supply;$95 $110 non-preferred specialty drug for a purchase of up to a 30-day supply

Mail Service Prescription Drug Program (for primary Medicare Part B members only):

You pay:

$20 generic/$100 Preferred brand-name/$125 non-preferred brand-name per prescription; up to a 90-day supply

Dental care (page 124)

You pay:PPO: $30 copayment per evaluation (exam, cleaning, and X-rays); most services limited to 2 per year; sealants for children up to age 16; $30 copayment for dental services required due to accidental injury; regular benefits for covered oral and maxillofacial surgeryNon-PPO: You pay all charges

Wellness and other special features (pages 125-129)

Health Tools; Blue Health Assessment; MyBlue® Customer eService; Diabetes Management Incentive Program; National Doctor and Hospital Finder; Healthy Families; travel benefit/services overseas; Care Management Programs; and Flexible benefits option

Protection against catastrophic costs (your catastrophic protection out-of-pocket maximum) (pages 32-33)

You pay:

Self Only: Nothing after $5,500 (PPO) per contract per year
Self Plus One: Nothing after $11,000 (PPO) per contract per year
Self and Family: Nothing after $11,000 (PPO) per contract per year; nothing after $5,500 (PPO) per individual per year

Note: Some costs do not count toward this protection.

Note: When one covered family member (Self Plus One and Self and Family contracts) reaches the Self Only maximum during the calendar year, that member’s claims will no longer be subject to associated member cost-share amounts for the remainder of the year. All remaining family members will be required to meet the balance of the catastrophic protection out-of-pocket maximum.

What is the most popular federal health insurance?

Albany, NY – February 3, 2021 – CDPHP is proud to announce that it is ranked No. 1 in the nation for federal employee health benefits (FEHB) for the second year in a row.

What does FEP mean in insurance?

Since 1960, the Blue Cross and Blue Shield Service Benefit Plan, also known as the Federal Employee Program (FEP), has provided health insurance to federal employees, retirees and their families, offering coverage across the U.S. and overseas.