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FBF20.00.1.1
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Cover page
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v1.0
|
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FBF20.00.1.2
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Inside cover
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v1.0
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FBF20.00.1.3
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Table of Contents
|
v1.0
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FBF20.00.2.1
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Introduction
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v1.0
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FBF20.00.2.2
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Plain Language
|
v1.0
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FBF20.00.2.3
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Stop Health Care Fraud
|
v1.0
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FBF20.00.2.4
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Discrimination is Against the Law
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v1.0
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FBF20.00.2.5
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Preventing Medical Mistakes
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v1.0
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FBF20.00.3.1.1
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No pre-existing condition limitation
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v1.0
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FBF20.00.3.1.2
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Minimum essential coverage (MEC)
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v1.0
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FBF20.00.3.1.3
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Minimum value standard
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v1.0
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FBF20.00.3.1.4
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Where you can get information about enrolling in the FEHB Program
|
v1.0
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FBF20.00.3.1.5
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Types of coverage available for you and your family
|
v1.0
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FBF20.00.3.1.6
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Family member coverage
|
v1.0
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FBF20.00.3.1.7
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Children's Equity Act
|
v1.0
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FBF20.00.3.1.8
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When benefits and premiums start
|
v1.0
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FBF20.00.3.1.9
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When you retire
|
v1.0
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FBF20.00.3.2.1
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When FEHB coverage ends
|
v1.0
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FBF20.00.3.2.2
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Upon divorce
|
v1.0
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FBF20.00.3.2.3
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Temporary Continuation of Coverage (TCC)
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v1.0
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FBF20.00.3.2.4
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Finding replacement coverage
|
v1.0
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FBF20.00.3.2.5
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Health Insurance Marketplace
|
v1.0
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FBF20.01.0
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Overview
|
v1.0
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FBF20.01.1
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General features of FEP Blue Focus
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v1.0
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FBF20.01.2
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How we pay professional and facility providers
|
v1.0
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FBF20.01.3
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Your rights and responsibilities
|
v1.0
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FBF20.01.4
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Your medical and claims records are confidential
|
v1.0
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FBF20.02
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Section 2. Changes for 2020
|
v1.0
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FBF20.03.1
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Identification cards
|
v1.0
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FBF20.03.2.0
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Where you get covered care
|
v1.0
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FBF20.03.2.1
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Covered professional providers
|
v1.0
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FBF20.03.2.2
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Covered facility providers
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v1.0
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FBF20.03.3.0
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What you must do to get covered care
|
v1.0
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FBF20.03.3.1
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Transitional care
|
v1.0
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FBF20.03.3.2
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If you are hospitalized when your enrollment begins
|
v1.0
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FBF20.03.4.00
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You need prior Plan approval for certain services
|
v1.0
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FBF20.03.4.01
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Inpatient hospital admission, inpatient residential treatment center admission
|
v1.0
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FBF20.03.4.02
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Other services
|
v1.0
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FBF20.03.4.03
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Special prior authorization situations related to coordination of benefits (COB)
|
v1.0
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FBF20.03.4.04
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Prior notification - Maternity care
|
v1.0
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FBF20.03.4.05
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How to request precertification for an admission or get approval for Other services
|
v1.0
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FBF20.03.4.06
|
Non-urgent care claims
|
v1.0
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FBF20.03.4.07
|
Urgent care claims
|
v1.1
|
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FBF20.03.4.08
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Concurrent care claims
|
v1.0
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FBF20.03.4.09
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Emergency inpatient admission
|
v1.0
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FBF20.03.4.10
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Maternity care
|
v1.0
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FBF20.03.4.11
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If your facility stay needs to be extended
|
v1.0
|
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FBF20.03.4.12
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If your treatment needs to be extended
|
v1.0
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FBF20.03.5.0
|
If you disagree with our pre-service claim decision
|
v1.0
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FBF20.03.5.1
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To reconsider a non-urgent care claim
|
v1.0
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FBF20.03.5.2
|
To reconsider an urgent care claim
|
v1.0
|
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FBF20.03.5.3
|
To file an appeal with OPM
|
v1.0
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|
FBF20.03.5.4
|
The Federal Flexible Spending Account Program – FSAFEDS
|
v1.0
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FBF20.04.01
|
Cost-share/Cost-sharing
|
v1.1
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FBF20.04.02
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Copayment
|
v1.0
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FBF20.04.03
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Deductible
|
v1.0
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FBF20.04.04
|
Coinsurance
|
v1.0
|
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|
FBF20.04.05
|
If your provider routinely waives your cost
|
v1.0
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|
FBF20.04.06
|
Waivers
|
v1.0
|
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|
FBF20.04.07
|
Differences between our allowance and the bill
|
v1.0
|
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|
FBF20.04.08
|
Important notice about Non-participating providers!
|
v1.0
|
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|
FBF20.04.09
|
Your costs for other care
|
v1.0
|
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|
FBF20.04.10
|
Your catastrophic protection out-of-pocket maximum for deductibles, coinsurance, and copayments
|
v1.0
|
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|
FBF20.04.11
|
Carryover
|
v1.0
|
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|
FBF20.04.12
|
If we overpay you
|
v1.0
|
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|
FBF20.04.13
|
When Government facilities bill us
|
v1.0
|
|
|
FBF20.05.0.1
|
Section 5. Benefits - Table of Contents
|
v1.0
|
|
|
FBF20.05.0.2
|
FEP Blue Focus Overview
|
v1.0
|
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|
FBF20.05a.0
|
Section 5(a) Overview
|
v1.0
|
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|
FBF20.05a.01
|
Diagnostic and Treatment Services
|
v1.0
|
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|
FBF20.05a.02
|
Lab, X-ray and Other Diagnostic Tests
|
v1.0
|
|
|
FBF20.05a.03
|
Preventive Care, Adult
|
v1.0
|
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|
FBF20.05a.04
|
Preventive Care, Child
|
v1.0
|
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|
FBF20.05a.05
|
Maternity Care
|
v1.0
|
|
|
FBF20.05a.06
|
Family Planning
|
v1.0
|
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|
FBF20.05a.07
|
Reproductive Services
|
v1.0
|
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|
FBF20.05a.08
|
Allergy Care
|
v1.0
|
|
|
FBF20.05a.09
|
Treatment Therapies
|
v1.0
|
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|
FBF20.05a.10
|
Physical Therapy, Occupational Therapy, Speech Therapy, and Cognitive Rehabilitation Therapy
|
v1.0
|
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|
FBF20.05a.11
|
Hearing Services
|
v1.0
|
|
|
FBF20.05a.12
|
Vision Services (Testing, Treatment, and Supplies)
|
v1.0
|
|
|
FBF20.05a.13
|
Foot Care
|
v1.0
|
|
|
FBF20.05a.14
|
Orthopedic and Prosthetic Devices
|
v1.0
|
|
|
FBF20.05a.15
|
Durable Medical Equipment (DME)
|
v1.0
|
|
|
FBF20.05a.16
|
Medical Supplies
|
v1.0
|
|
|
FBF20.05a.17
|
Home Health Services
|
v1.0
|
|
|
FBF20.05a.18
|
Alternative/Manipulative Treatment
|
v1.0
|
|
|
FBF20.05a.19
|
Educational Classes and Programs
|
v1.0
|
|
|
FBF20.05b.0
|
Section 5(b) Overview
|
v1.0
|
|
|
FBF20.05b.1
|
Surgical Procedures
|
v1.0
|
|
|
FBF20.05b.2
|
Reconstructive Surgery
|
v1.0
|
|
|
FBF20.05b.3
|
Oral and Maxillofacial Surgery
|
v1.0
|
|
|
FBF20.05b.4
|
Organ/Tissue Transplants
|
v1.0
|
|
|
FBF20.05b.5
|
Anesthesia
|
v1.0
|
|
|
FBF20.05c.0
|
Section 5(c) Overview
|
v1.0
|
|
|
FBF20.05c.1
|
Inpatient Hospital
|
v1.0
|
|
|
FBF20.05c.2
|
Maternity - Facility
|
v1.0
|
|
|
FBF20.05c.3
|
Outpatient Hospital or Ambulatory Surgical Center
|
v1.0
|
|
|
FBF20.05c.4
|
Residential Treatment Center
|
v1.0
|
|
|
FBF20.05c.5
|
Extended Care Benefits/Skilled Nursing Care Facility Benefits
|
v1.0
|
|
|
FBF20.05c.6
|
Hospice Care
|
v1.0
|
|
|
FBF20.05c.7
|
Ambulance
|
v1.0
|
|
|
FBF20.05d.0
|
Section 5(d) Overview
|
v1.0
|
|
|
FBF20.05d.1
|
Accidental Injury
|
v1.0
|
|
|
FBF20.05d.2
|
Medical Emergency
|
v1.0
|
|
|
FBF20.05d.3
|
Ambulance
|
v1.0
|
|
|
FBF20.05e.0
|
Section 5(e) Overview
|
v1.0
|
|
|
FBF20.05e.1
|
Professional Services
|
v1.0
|
|
|
FBF20.05e.2
|
Inpatient Hospital or Other Covered Facility
|
v1.0
|
|
|
FBF20.05e.3
|
Residential Treatment Center
|
v1.0
|
|
|
FBF20.05e.4
|
Outpatient Hospital or Other Covered Facility
|
v1.0
|
|
|
FBF20.05f.0
|
Section 5(f) Overview
|
v1.0
|
|
|
FBF20.05f.1
|
Covered Medications and Supplies
|
v1.0
|
|
|
FBF20.05g.0
|
Section 5(g) Overview
|
v1.0
|
|
|
FBF20.05g.1
|
Accidental Injury Benefit
|
v1.0
|
|
|
FBF20.05g.2
|
Inpatient and Outpatient Facility Care
|
v1.0
|
|
|
FBF20.05h.01
|
Health Tools
|
v1.0
|
|
|
FBF20.05h.02
|
Services for the Deaf and Hearing Impaired
|
v1.0
|
|
|
FBF20.05h.03
|
Web Accessibility for the Visually Impaired
|
v1.0
|
|
|
FBF20.05h.04
|
Travel Benefit/Services Overseas
|
v1.0
|
|
|
FBF20.05h.05
|
Healthy Families
|
v1.0
|
|
|
FBF20.05h.06
|
Blue Health Assessment
|
v1.0
|
|
|
FBF20.05h.07
|
Hypertension Management Program
|
v1.2
|
05/19/2020 |
|
FBF20.05h.08
|
MyBlue Customer eService
|
v1.0
|
|
|
FBF20.05h.09
|
National Doctor & Hospital Finder
|
v1.0
|
|
|
FBF20.05h.10
|
Care Management Programs
|
v1.0
|
|
|
FBF20.05h.11
|
Flexible Benefits Option
|
v1.0
|
|
|
FBF20.05h.12
|
Telehealth Services
|
v1.0
|
|
|
FBF20.05h.13
|
Routine Annual Physical Incentive Program
|
v1.0
|
|
|
FBF20.05h.14
|
The fepblue Mobile Application
|
v1.0
|
|
|
FBF20.05i.0
|
Section 5(i). Services, Drugs, and Supplies Provided Overseas
|
v1.0
|
|
|
FBF20.05N.0
|
Non-FEHB Benefits Available to Plan Members
|
v1.0
|
|
|
FBF20.06
|
Section 6. General Exclusions - Services, Drugs, and Supplies We Do Not Cover
|
v1.0
|
|
|
FBF20.07
|
Section 7. Filing a Claim for Covered Services
|
v1.0
|
|
|
FBF20.08
|
Section 8. The Disputed Claims Process
|
v1.0
|
|
|
FBF20.09.1.0
|
When you have other health coverage
|
v1.0
|
|
|
FBF20.09.1.1
|
TRICARE and CHAMPVA
|
v1.0
|
|
|
FBF20.09.1.2
|
Workers' Compensation
|
v1.0
|
|
|
FBF20.09.1.3
|
Medicaid
|
v1.0
|
|
|
FBF20.09.2
|
When other Government agencies are responsible for your care
|
v1.0
|
|
|
FBF20.09.3
|
When others are responsible for injuries
|
v1.0
|
|
|
FBF20.09.4
|
When you have Federal Employees Dental and Vision Insurance Plan (FEDVIP)
|
v1.0
|
|
|
FBF20.09.5
|
Clinical trials
|
v1.0
|
|
|
FBF20.09.6.1
|
What is Medicare?
|
v1.0
|
|
|
FBF20.09.6.2
|
Should I enroll in Medicare?
|
v1.0
|
|
|
FBF20.09.6.3
|
The Original Medicare Plan (Part A or Part B)
|
v1.0
|
|
|
FBF20.09.6.4
|
Tell us about your Medicare coverage
|
v1.0
|
|
|
FBF20.09.6.5
|
Private contract with your physician
|
v1.0
|
|
|
FBF20.09.6.6
|
Medicare Advantage (Part C)
|
v1.0
|
|
|
FBF20.09.6.7
|
Medicare prescription drug coverage (Part D)
|
v1.0
|
|
|
FBF20.09.6.8
|
Medicare prescription drug coverage (Part B)
|
v1.1
|
|
|
FBF20.09.6.8.5
|
Primary payor chart
|
v1.0
|
02/05/2020 |
|
FBF20.09.7
|
When you are age 65 or over and do not have Medicare
|
v1.0
|
|
|
FBF20.09.8
|
Physicians Who Opt-Out of Medicare
|
v1.0
|
|
|
FBF20.09.9
|
When you have the Original Medicare Plan (Part A, Part B, or both)
|
v1.0
|
|
|
FBF20.09.95
|
Cost-share when Medicare is your primary payor
|
v1.0
|
|
|
FBF20.10
|
Section 10. Definitions of Terms We Use in This Brochure
|
v1.0
|
|
|
FBF20.11
|
Index
|
v1.0
|
|
|
FBF20.12
|
Summary of Benefits for the Blue Cross and Blue Shield Service Benefit Plan FEP Blue Focus - 2020
|
v1.0
|
|
|
FBF20.13
|
2020 Rate Information for the Blue Cross and Blue Shield Service Benefit Plan
|
v1.0
|
|
|
FBF20-000-1
|
Cover page
|
v1.0
|
|
|
FBF20-000-2
|
Inside cover
|
v1.0
|
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|
FBF20-001
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1
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v1.0
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FBF20-002
|
2
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v1.0
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FBF20-003
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3
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v1.0
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FBF20-004
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4
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FBF20-005
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5
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v1.0
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FBF20-006
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6
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v1.0
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FBF20-007
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7
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FBF20-008
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8
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v1.0
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FBF20-009
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9
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v1.0
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FBF20-010
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10
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v1.0
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FBF20-011
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11
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v1.0
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FBF20-012
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12
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v1.0
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FBF20-013
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13
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v1.0
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FBF20-014
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14
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v1.0
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FBF20-015
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15
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FBF20-016
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16
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FBF20-017
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17
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FBF20-018
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18
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FBF20-019
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19
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FBF20-020
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20
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FBF20-021
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21
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FBF20-022
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22
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FBF20-023
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23
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v1.0
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FBF20-024
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24
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FBF20-025
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25
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v1.1
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FBF20-026
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26
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FBF20-027
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27
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FBF20-028
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28
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FBF20-029
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29
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FBF20-030
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30
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FBF20-031
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31
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FBF20-032
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32
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FBF20-033
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33
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FBF20-034
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34
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FBF20-035
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FBF20-036
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36
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FBF20-037
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FBF20-038
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FBF20-039
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FBF20-040
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40
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FBF20-041
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FBF20-042
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42
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FBF20-043
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FBF20-044
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44
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FBF20-045
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FBF20-046
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FBF20-047
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FBF20-048
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FBF20-049
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FBF20-050
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FBF20-051
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FBF20-052
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FBF20-053
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FBF20-054
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FBF20-055
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55
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FBF20-056
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56
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FBF20-057
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57
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v1.0
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|
FBF20-058
|
58
|
v1.0
|
|
|
FBF20-059
|
59
|
v1.0
|
|
|
FBF20-060
|
60
|
v1.0
|
|
|
FBF20-061
|
61
|
v1.0
|
|
|
FBF20-062
|
62
|
v1.0
|
|
|
FBF20-063
|
63
|
v1.0
|
|
|
FBF20-064
|
64
|
v1.0
|
|
|
FBF20-065
|
65
|
v1.0
|
|
|
FBF20-066
|
66
|
v1.0
|
|
|
FBF20-067
|
67
|
v1.0
|
|
|
FBF20-068
|
68
|
v1.0
|
|
|
FBF20-069
|
69
|
v1.0
|
|
|
FBF20-070
|
70
|
v1.0
|
|
|
FBF20-071
|
71
|
v1.0
|
|
|
FBF20-072
|
72
|
v1.0
|
|
|
FBF20-073
|
73
|
v1.0
|
|
|
FBF20-074
|
74
|
v1.0
|
|
|
FBF20-075
|
75
|
v1.0
|
|
|
FBF20-076
|
76
|
v1.0
|
|
|
FBF20-077
|
77
|
v1.0
|
|
|
FBF20-078
|
78
|
v1.0
|
|
|
FBF20-079
|
79
|
v1.0
|
|
|
FBF20-080
|
80
|
v1.0
|
|
|
FBF20-081
|
81
|
v1.0
|
|
|
FBF20-082
|
82
|
v1.0
|
|
|
FBF20-083
|
83
|
v1.0
|
|
|
FBF20-084
|
84
|
v1.0
|
|
|
FBF20-085
|
85
|
v1.0
|
|
|
FBF20-086
|
86
|
v1.0
|
|
|
FBF20-087
|
87
|
v1.0
|
|
|
FBF20-088
|
88
|
v1.0
|
|
|
FBF20-089
|
89
|
v1.0
|
|
|
FBF20-090
|
90
|
v1.0
|
|
|
FBF20-091
|
91
|
v1.0
|
|
|
FBF20-092
|
92
|
v1.0
|
|
|
FBF20-093
|
93
|
v1.0
|
|
|
FBF20-094
|
94
|
v1.0
|
|
|
FBF20-095
|
95
|
v1.0
|
|
|
FBF20-096
|
96
|
v1.0
|
|
|
FBF20-097
|
97
|
v1.0
|
|
|
FBF20-098
|
98
|
v1.0
|
|
|
FBF20-099
|
99
|
v1.0
|
|
|
FBF20-100
|
100
|
v1.0
|
|
|
FBF20-101
|
101
|
v1.0
|
|
|
FBF20-102
|
102
|
v1.0
|
|
|
FBF20-103
|
103
|
v1.0
|
|
|
FBF20-104
|
104
|
v1.0
|
|
|
FBF20-105
|
105
|
v1.2
|
05/19/2020 |
|
FBF20-106
|
106
|
v1.0
|
|
|
FBF20-107
|
107
|
v1.0
|
|
|
FBF20-108
|
108
|
v1.0
|
|
|
FBF20-109
|
109
|
v1.0
|
|
|
FBF20-110
|
110
|
v1.0
|
|
|
FBF20-111
|
111
|
v1.0
|
|
|
FBF20-112
|
112
|
v1.0
|
|
|
FBF20-113
|
113
|
v1.0
|
|
|
FBF20-114
|
114
|
v1.0
|
|
|
FBF20-115
|
115
|
v1.0
|
|
|
FBF20-116
|
116
|
v1.0
|
|
|
FBF20-117
|
117
|
v1.0
|
|
|
FBF20-118
|
118
|
v1.0
|
|
|
FBF20-119
|
119
|
v1.0
|
|
|
FBF20-120
|
120
|
v1.0
|
|
|
FBF20-121
|
121
|
v1.0
|
|
|
FBF20-122
|
122
|
v1.0
|
|
|
FBF20-123
|
123
|
v1.0
|
|
|
FBF20-124
|
124
|
v1.0
|
|
|
FBF20-125
|
125
|
v1.0
|
|
|
FBF20-126
|
126
|
v1.0
|
|
|
FBF20-127
|
127
|
v1.0
|
|
|
FBF20-128
|
128
|
v1.0
|
|
|
FBF20-129
|
129
|
v1.0
|
|
|
FBF20-130
|
130
|
v1.0
|
|
|
FBF20-131
|
131
|
v1.0
|
|
|
FBF20-132
|
132
|
v1.0
|
|
|
FBF20-133
|
133
|
v1.0
|
|
|
FBF20-134
|
134
|
v1.0
|
|
|
FBF20-135
|
135
|
v1.0
|
|
|
FBF20-136
|
136
|
v1.0
|
|
|
FBF20-137
|
137
|
v1.0
|
|
|
FBF20-138
|
138
|
v1.0
|
|
|
FBF20-139
|
139
|
v1.0
|
|
|
FBF20-140
|
140
|
v1.0
|
|
|
FBF20-141
|
141
|
v1.0
|
|
|
FBF20-142
|
142
|
v1.0
|
|
|
FBF20-143
|
143
|
v1.0
|
|
|
FBF20-144
|
144
|
v1.0
|
|
|
FBF20-145
|
145
|
v1.0
|
|
|
FBF20-146
|
146
|
v1.0
|
|
