Coverage information - 9
• No pre-existing condition limitation - 9
• Minimum essential coverage (MEC) - 9
• Minimum value standard - 9
• Where you can get information about enrolling in the PSHB Program - 9
• Enrollment types available for you and your family - 9
• Family Member Coverage - 10
• Children’s Equity Act - 11
• Medicare Prescription Drug Plan (PDP) Employer Group Waiver Plan (EGWP) - 11
• When benefits and premiums start - 11
• When you retire - 12
When you lose benefits - 12
• When PSHB coverage ends - 12
• Upon divorce - 12
• Medicare PDP EGWP - 12
• Temporary Continuation of Coverage (TCC) - 12
• Finding replacement coverage - 13
• Health Insurance Marketplace - 13

General features of FEP Blue Focus - 14
We have a Preferred Provider Organization (PPO) - 14
How we pay professional and facility providers - 14
Your rights and responsibilities - 15
Your medical and claims records are confidential - 15

Identification cards - 17
Where you get covered care - 17
Balance Billing Protection - 17
• Covered professional providers - 17
• Covered facility providers - 17
What you must do to get covered care - 19
• Transitional care - 19
• If you are hospitalized when your enrollment begins - 19
You need prior Plan approval for certain services - 20
• Inpatient hospital admission, inpatient residential treatment center admission - 20
• Other services - 20
• Special prior authorization situations related to coordination of benefits (COB) - 24
• Prior notification – Maternity care - 25
How to request precertification for an admission or get prior authorization for Other services - 25
• Non-urgent care claims - 25
• Urgent care claims - 26
• Concurrent care claims - 26