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.
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:
Family planning services for men, limited to:
Notes:
You Pay
Preferred: Nothing (no deductible)
Non-preferred (Participating/Non-participating): You pay all charges
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
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
- 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:
You Pay
All charges
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
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List Item: |
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family |
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planning |
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contraceptive |
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diaphragms |
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rings |
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injectable |
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contraceptives |
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intrauterine |
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devices |
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implantable |
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tubal |
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ligation |
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occlusion |
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vasectomy |
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transdermal |
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oral |
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medicare |
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sterilization |
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over-the-counter |