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

Physical Therapy, Occupational Therapy, Speech Therapy, and Cognitive Rehabilitation Therapy
Outpatient treatment therapies, subject to visit limits:

 
  • Physical therapy, occupational therapy, and speech therapy:
     
    • Benefits are limited to 25 visits per person, per calendar year for physical, occupational, or speech therapy, or a combination of all three; regardless of the provider or facility billing for the services
       
  • Cognitive rehabilitation therapy, limited to 25 visits per calendar year, regardless of the provider billing the service

You Pay
Preferred: $25 copayment per visit (no deductible)

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

Notes:

 
  • You pay 30% of the Plan allowance for agents, drugs, and/or supplies administered or obtained in connection with your care. (See page 131 for more information about “agents.”)
     
  • See Section 5(c) for our payment levels for rehabilitative therapies billed for by the outpatient department of a hospital.
 
Benefit Description
Not covered:

 
  • Recreational or educational therapy, and any related diagnostic testing except as provided by a hospital as part of a covered inpatient stay
     
  • Maintenance or palliative rehabilitative therapy
     
  • Exercise programs
     
  • Hippotherapy/Equine therapy
     
  • Massage therapy

You Pay
All charges
 

List Item:

Calendar
deductible
physical
therapy
occupational
speach
cognitive
rehabilitation
rehab
recreational
educational
diagnostic
inpatient
maintenance
palliative
exercise
hippotherapy
equine
horse
massage