2020 Blue Cross and Blue Shield Service Benefit Plan - FEP Blue Focus
Section 2. Changes for 2020
Section 2. Changes for 2020
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 FEP Blue Focus
- There is no member cost-share for the first 10 laboratory tests performed in each of the following laboratory test categories: Basic metabolic panels; Cholesterol screenings; Complete blood counts; Fasting lipoprotein profiles; General health panels; Urinalysis; and 10 Venipunctures. This benefit is applicable to laboratory services not associated with preventive, maternity, or accidental injury care. Previously, after meeting your calendar year deductible, you were responsible for 30% of the Plan allowance for these laboratory tests. (See page 40.)
- We now provide a preventive telehealth benefit for nutritional counseling with no member cost-share. Previously, there was no telehealth benefit. (See pages 16, 43, 47, 107 and 138.)
- We now provide benefits to cover up to 4 visits per year in full to treat depression associated with pregnancy (i.e., depression during pregnancy, postpartum depression, or both) when you use a Preferred provider. Previously, screening for perinatal depression was covered under the mental health benefit with a member cost-share. (See pages 48, 75, and 88.)
- We now provide autologous blood or marrow stem cell transplant benefits for scleroderma without a clinical trial. Previously, a clinical trial was required. (See page 67.)
- We now provide preventive care benefits with no member cost-share for screening pregnant members for syphilis. Previously, the screening would have been included in the $1,500 copayment per pregnancy. (See page 75.)
- We now provide preventive care benefits with no member cost-share for reducing alcohol abuse for pregnant members when billed by an outpatient facility. Previously, these services were applied to the $1,500 copayment per pregnancy. (See page 75.)
- We now define an episode of care for traditional home hospice as one home hospice treatment plan per calendar year. Previously, there was no description for an episode of care. (See page 82.)
- You now pay all charges for traditional home hospice care received from a Non-preferred provider (Member/Non-member facility). Previously, there was no member cost-share. (See page 82.)
- You may receive continuous home hospice care without 21 days of traditional home hospice care between each episode. Previously, each episode of continuous home hospice care had to be separated by at least 21 days of traditional home hospice care. (See page 82.)
- You do not need to be enrolled in a home hospice program to be eligible for the first continuous home hospice care. You must be enrolled in a home hospice program to receive benefits for subsequent continuous home hospice care. Previously, you had to be enrolled in a home hospice program to be eligible for continuous home hospice care. (See page 82.)
- You may receive inpatient hospice care without 21 days of traditional home hospice care between each episode. Previously, each episode of an inpatient hospice stay had to be separated by at least 21 days of traditional home hospice care. (See page 82.)
- We now provide only pharmacy benefits for prescription vitamin D. Previously, vitamin D supplements were available under the preventive care adult benefits with no member cost-share.
- We now limit the timely filing for overseas pharmacy claims to one year from the prescription fill date. Previously, you had to submit your overseas pharmacy claims by December 31 of the year after the year you received the service. (See pages 110 and 116.)
- We have added to the preventive care adult definition that screening for intimate partner violence for women of reproductive age is covered under this benefit. (See page 137.)
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changes |
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2020 |
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rely |
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descriptions |
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official |
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statement |
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edited |
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clarified |
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cost-share |
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laboratory |
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lab |
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tests |
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metabolic |
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cholesterol |
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blood |
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counts |
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fasting |
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lipoprotein |
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profiles |
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general |
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health |
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panels |
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urinalysis |
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venipunctures |
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preventative |
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maternity |
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accidental |
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allowance |
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telehealth |
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counseling |
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member |
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depression |
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treatment |
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treat |
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pregnancy |
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postpartum |
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perinatal |
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mental |
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autologous |
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marrow |
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stem |
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cell |
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transplant |
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scleroderma |
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clinical |
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trials |
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syphilis |
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copayment |
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alcohol |
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abuse |
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outpatient |
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traditional |
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home |
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hospice |
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non-preffered |
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non-member |
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inpatient |
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pharmacy |
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prescription |
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vitamin |
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overseas |
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claims |
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screening |
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intimate |
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partner |
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violence |
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woman |
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reproductive |