2020 Blue Cross and Blue Shield Service Benefit Plan - FEP Blue Focus
Section 5(a). Medical Services and Supplies Provided by Physicians and Other Healthcare Professionals


Note: The calendar year deductible applies to almost all benefits in this Section. We say "(No deductible)" when it does not apply.
 
Benefit Description

Family Planning
A range of voluntary family planning services for women, limited to:

 
  • Contraceptive counseling
  • Diaphragms and contraceptive rings
  • Injectable contraceptives
  • Intrauterine devices (IUDs)
  • Implantable contraceptives
  • Tubal ligation or tubal occlusion/tubal blocking procedures only

Family planning services for men, limited to:

 
  • Vasectomy

Notes:

 
  • We also provide benefits for professional services associated with tubal ligation/occlusion/blocking procedures, vasectomy, and with the fitting, insertion, or removal of the contraceptives as shown on the previous page.
     
  • When billed by a facility, such as the outpatient department of a hospital, we provide benefits as shown here, according to the contracting status of the facility.

You Pay
Preferred: Nothing (no deductible)

Non-preferred (Participating/Non-participating): You pay all charges
 
Benefit Description
 
  • Oral and transdermal contraceptives

Note: We waive your cost-share for generic oral and transdermal contraceptives when you purchase them at a Preferred retail pharmacy; see Section 5(f) page 97.

You Pay
Preferred: 30% of the Plan allowance

Non-preferred (Participating/Non-participating): You pay all charges
 
Benefit Description

Not covered:

 
  • Reversal of voluntary surgical sterilization
     
  • Contraceptive devices not described above
     
  • Over-the-counter (OTC) contraceptives, except as described in Section 5(f)

You Pay
All charges
 

List Item:

family
planning
contraceptive
diaphragms
rings
injectable
contraceptives
intrauterine
devices
implantable
tubal
ligation
occlusion
vasectomy
transdermal
oral
medicare
sterilization
over-the-counter