2026 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
Page 45

 

Benefit Description

Reproductive Services (cont.)
 
  • Procurement of sperm or eggs including medical, surgical, and pharmacy claims associated with retrieval;
     
  • Cryopreservation of sperm and mature oocytes; and
     
  • Cryopreservation storage costs for one year.

Note: See other sections in this brochure for benefits associated with any other services performed to diagnose and treat the cause of infertility.


You Pay
Preferred: 30% of the Plan allowance (deductible applies)

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

 

Benefit Description

Not covered: The services listed below are not covered as treatments for infertility or as alternatives to conventional conception:
 
  • Assisted reproductive technology (ART), including but not limited to:
     
    • In vitro fertilization (IVF)
       
    • Embryo transfer and gamete intrafallopian transfer (GIFT) and zygote intrafallopian transfer (ZIFT)
       
  • Intracytoplasmic sperm injection (ICSI)
     
  • Services, procedures, and/or supplies that are related to ART and assisted insemination procedures except as described above
     
  • Cryopreservation or storage of sperm (sperm banking), eggs, or embryos except as described above
     
  • Preimplantation diagnosis, testing, and/or screening, including the testing or screening of eggs, sperm, or embryos
     
  • Drugs used in conjunction with ART and assisted insemination procedures except as described above and in Section 5(f), or 5(f)(a) if applicable, Prescription Drug Benefits
     
  • Services, supplies, or drugs provided to individuals not enrolled in this Plan including surrogates


You Pay
All charges

 

Benefit Description

Allergy Care
 
  • Allergy testing
     
  • Allergy treatment
     
  • Allergy injections
     
  • Sublingual allergy desensitization drugs as licensed by the U.S. FDA
     
  • Preparation of each multi-dose vial of antigen
     
  • Agents, drugs, and/or supplies administered or obtained in connection with your care

Note: See earlier in this section for applicable office visit copayment.


You Pay
Preferred: 30% of the Plan allowance (deductible applies)

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

Note: When care is provided by a Non-preferred laboratory and/or radiologist, as stated in Section 3 for an exception, you pay:
 
  • Participating laboratories or radiologists: 30% of the Plan allowance (deductible applies)
     
  • Non-participating laboratories or radiologists: 30% of the Plan allowance, plus any difference between our allowance and the billed amount (deductible applies)

 

Benefit Description
Not covered: Provocative food testing

You Pay
All charges