2026 Blue Cross and Blue Shield Service Benefit Plan - FEP Blue Focus
Section 2. Changes for 2026

 

Section 2. Changes for 2026

 

Do not rely only on these change descriptions; this Section is not an official statement of benefits. For that, go to Section 5 (Benefits). Also, we edited and clarified language throughout the brochure; any language change not shown here is a clarification that does not change benefits.

 

Changes to our FEP Blue Focus
 
  • Prior approval for genetic testing will be required when the test is being performed to assess the risk of passing a genetic condition to a child, or when the member has no active disease or signs or symptoms of the disease that is being screened. Prior approval is not required when a member has an active disease, signs and symptoms of a genetic condition that could be passed to a child, or when the test is needed to determine a course of treatment for a disease. (See page 21.)
     
  • For Self Only contracts, the calendar year deductible is now $750. For Self Plus One and Self and Family Contracts, the deductible is now $1,500. (See pages 28, 35, 53, 62, 74, 78, 99, 122, 127 and 139.)
     
  • For Self only contracts, your Preferred Provider catastrophic out-of-pocket maximum is now $10,000. For Self Plus One and Self and Family Contracts, your Preferred Provider catastrophic out-of-pocket maximum is now $20,000. (See pages 30, 127 and 141.)
     
  • Surgical and pharmacy services related to sex-trait modifications are no longer covered under this program. (See page 110.)
     
  • Your copay for maternity services billed by a Preferred facility is $3,500 per pregnancy. (See page 64.)
     
  • Prior approval for outpatient hospice services will no longer be required. (See pages 70-72.)
     
  • For members enrolled in our regular pharmacy drug program, Tier 2 Preferred Brand-Name Drugs purchased at a Preferred retail pharmacy you are responsible for 40% of the Plan allowance (up to a maximum of $550) for a 30-day supply and 40% of the Plan allowance (up to a maximum of $1,650) for 31 to 90-day supply. (See page 86.)
     
  • For members enrolled in our regular pharmacy drug program, Tier 2 Preferred Specialty Drugs purchased at Preferred retail pharmacies and through the Specialty Drug Pharmacy Program for generic and brand-name drugs you are now responsible for 40% of the Plan allowance (up to the maximum of $550) for a 30-day supply and 40% of the Plan allowance (up to a maximum of $1,650) for 31 to 90-day supply. (See page 87.)
     
  • For those enrolled in our Medicare Prescription Drug Program, the prescription out-of-pocket maximum is now $2,100. (See pages 30 and 92.)