2026 Blue Cross and Blue Shield Service Benefit Plan - FEP Blue Focus
Index

 

Index

 

Do not rely only on this page; it is for your convenience and may not show all pages where the terms appear. This Index is not an official statement of benefits.

Abortion - 42-43, 64-66, 109-110
Accidental injury - 74-77, 99, 128
Acupuncture - 52, 61
Affordable Care Act (ACA) - 13, 94-98
Allergy care - 45
Allogeneic transplants - 58-60
Alternative treatments - 52
Ambulance - 73
Ambulatory surgical center - 17-18, 66-69
Anesthesia - 42-43, 61
Angiographies - 37, 66-69
Appeals - 27, 114-116
Applied behavior analysis (ABA) - 46
Assistant surgeon - 54-55
Autism spectrum disorder - 46, 66-69
Autologous transplants - 57-60
Biopsies - 38-40, 54-55, 66-69
Birthing centers - 17-18
Blood and blood plasma - 51, 66-69
Blood or marrow stem cell - 57-60
Blue Distinction Centers - 17-18
for Transplants - 20-23, 56-58, 60
Blue Distinction Specialty Care - 17-18
Blue Health Assessment - 101
Bone density tests - 37, 66-69
Brand-name drugs - 83-84, 86-87, 89-90, 92-93
Breast pump and supplies - 42-43, 64-66
Breast reconstruction - 55
Breast prostheses and surgical bras - 49
Breastfeeding support and supplies - 42-43, 64-66
Cancer tests - 38-40
Cardiac rehabilitation - 20-23, 46, 66-69
Cardiovascular monitoring - 37, 66-69
Care Management Programs - 102-103
Case management - 102-103
Casts - 63-64, 66-69
Catastrophic protection - 30-31, 91-92
Cervical cancer screening - 38-42
CHAMPVA - 118-119
Changes for 2026 - 16
Chemotherapy - 46, 66-69
Children’s Equity Act - 11
Chiropractic manipulative treatment - 52, 66-69
Cholesterol tests - 37-40
Circumcision - 42-43, 54-55, 64-66
Claims and claims filing
Overseas - 106
Post-service - 111-112, 114-116, 134
Pre-service - 27, 114-116, 134
Clinic visits - 36-37, 66-69, 78-79
Clinical trials - 58-60, 120-121, 129
Cognitive rehabilitation - 47, 66-70
Coinsurance - 28-29
Colonoscopy - 38-40, 54-55, 66-69
Colorectal cancer tests
Colonoscopy - 38-40, 54-55, 66-69
Fecal occult blood test - 38-40
Sigmoidoscopy - 38-40
Confidentiality - 14-15
Congenital anomalies - 54-55, 129
Consultations - 36-37, 78-79
Contact lenses - 48
Contraceptives - 43-44, 66-69, 86-87, 92-98
Coordination of benefits - 118-127
Copayments - 28
CORE benefits - 129
Cosmetic surgery - 54-55, 129
Cost-share/cost-sharing - 28
Costs for covered services - 28-31
Coverage information - 9
Covered facility providers - 17-18
Covered professional providers - 17
Cryopreservation - 44-45
CT scans - 37, 66-69
Custodial or long-term care - 63-64, 80-81, 109-110, 129
Daily Habits - 101
Deductible - 28
Definitions - 128-136
Dental care - 99-100
Diabetic education - 52, 66-69
Diabetic supplies
Diabetic Meter Program - 94-98
Insulin pumps - 50-51
Insulin, test strips, and lancets - 86-87, 92-98
Needles and disposable syringes - 86-87, 92-93
Diagnostic and treatment services - 36-37
Diagnostic tests - 37, 42-43, 48, 78-81
Dialysis - 46, 50-51, 66-69
Disease Management - 102-103
Disputed claims - 27, 114-117
Divorce - 12
DNA analysis of stool samples - 38-40
Donor expenses - 60
Drugs (see: Prescription drugs)
Durable medical equipment - 50-51, 129-130
Prosthetic devices - 49, 63-64, 66-69
Educational classes and programs - 52
EEGs - 37, 66-69
EKGs - 37, 66-69
Emergency - 26, 73-77
Enrollment - 9-10
Exception situations - 19-20
Exclusions - 109-110
Experimental or investigational - 130
Extended care benefits - 70
Eyeglasses - 48
Facility providers - 17-18
Family planning - 43-44
Fecal occult blood test - 38-40
FEDVIP - 99, 120
fepblue mobile application - 104
fepblue.org - 4
Flexible benefits option - 103
Foot care - 49
Formulary/Preferred drug list - 82-84, 88-90
Fraud - 4
Generic drugs - 83-87, 89-93
Generic equivalents - 84-85
Genetic screening/testing - 20-23, 37, 66-69
Health Insurance Marketplace - 13
Health tools - 101
Healthy Families - 101
Hearing aids and hearing services - 49
Home health services - 51-52
Home nursing care (maternity) - 51-52
Hospice care - 70-72
Hospital
inpatient - 20, 63-64, 80
outpatient - 66-69, 75-77, 80-81
Human papillomavirus (HPV) tests - 38-42
Hypertension Management Program - 101-102
Iatrogenic infertility - 44-45
Identification cards - 17
Immunizations - 38-42, 94-98
Inpatient hospital benefits - 63-64
Inpatient professional services - 36-37, 78-79
Insulin - 86-87, 92-93
Insulin pumps - 50-51
Laboratory and pathology services - 37
Low-dose CT screening - 135
Mammograms - 38-40
Manipulative treatment - 52, 66-69
Maternity care - 25-27, 42-43
Maxillofacial surgery - 56
Medicaid - 119
Medical emergency - 74, 76-77
Medical foods - 51, 85-86, 91-92, 131
Medical supplies - 51, 63-72
Medically necessary - 131-132
Medicare - 1, 118-127
Medications and supplies - 86-87, 92-98
Medications to promote better health - 94-98
Member facilities - 109-110
Mental health/substance use disorder - 17, 69-70, 78 , 79 , 80 , 81, 103
MRIs - 37, 66-69
Multiple procedures - 53-55
MyBlue Customer eService - 102
National Doctor & Hospital Finder - 102
Neurological testing - 37, 66-69
Never Events - 6-8, 132
Newborn care - 10, 26-27, 36-37, 42-43, 64-66
No Surprises Act (NSA) - 29-30
NON-CORE benefits - 132
Non-member facilities - 133-134
Non-participating providers - 29, 133-134
Non-preferred providers - 14-15, 17, 29
Non-PSHB benefits - 108
Nurse - 51-52, 70-72, 101
Nutritional counseling - 17, 36-42, 63-64, 103
Observation care - 132
Obstetrical care - 42-43, 64-66
Occupational therapy - 47, 66-72
Office visits - 36-37, 78-79
Oral surgery - 56
Organ/tissue transplants - 20-23, 56-58, 60
Orthopedic devices - 49, 66-69
Osteoporosis screening - 135
Ostomy and catheter supplies - 51
Out-of-pocket expenses - 30-31
Outpatient facility services - 44-45, 66-69, 100
Outpatient professional services - 36-37, 78-79
Overpayments - 31
Overseas Assistance Center - 73, 105
Overseas services, drugs, supplies and claims - 105-107
Oxygen - 50-51, 63-72
Pap tests - 38-42
Participating providers - 29, 133-134
Patient Safety and Quality Monitoring (PSQM) program - 84-85
Personal Health Record - 101
PET scans - 37, 66-69
Pharmacotherapy - 36-37, 46
Physical examinations - 66-69, 109-110
Physical therapy - 47, 66-72
Physician - 14-15
Plan allowance - 29, 133-134
PPO - 14-15, 134
Pre-admission testing - 63-64
Precertification - 20, 25, 134
Preferred providers - 14-15
Pregnancy (see: Maternity care)
Prescription drugs
Brand-name drugs - 83-84, 86-87, 89-90, 92-93
Drugs from other sources - 98
Generic drugs - 83-87, 89-93
Preferred retail pharmacies - 14-15, 83-84, 86-87, 112
Retail Pharmacy Program - 82-84, 106-107, 111
Self-injectable drugs - 35, 53, 62, 66-69
Specialty Drug Pharmacy Program - 82-84, 86-87, 106-107, 112
Specialty drugs - 83-84, 86-87, 89-90, 92-93, 135
Preventive care
Adult - 38-40
Child - 40-42
Primary care provider (PCP) - 136
Prior approval - 20-23
Professional providers - 14-15, 17
Prostate cancer - 38-40
Prosthetic devices - 49, 63-64, 66-69
Psychotherapy - 78-81
Pulmonary rehabilitation - 46, 66-69
Radiation therapy - 46, 66-69
Reconsiderations - 27, 114-116
Replacement coverage - 13
Reproductive services - 44-45
Assisted reproductive technology (ART) - 128
Residential treatment center (RTC) - 17-18, 26, 69-70, 80
Rights and responsibilities - 14-15
Room and board - 63-66, 69-70, 80
Routine Annual Physical Incentive Program - 104
Screening services - 135
Second surgical opinion - 36-37
Self-injectable drugs - 35, 53, 62, 66-69
Skilled nursing facility (SNF) care - 70
Smoking cessation - 52, 94-98
Social worker - 102-103
Specialty Drug Pharmacy Program - 82-84, 86-87, 106-107, 112
Specialty drugs - 83-84, 86-87, 89-90, 92-93
Speech therapy - 47, 66-72
Speech-generating devices - 50-51
Stem cell transplants - 57-60
Sterilization procedures - 43-44
Subrogation - 119-120, 135
Substance use disorder - 17, 78-81, 103
Surgery
Assistant surgeon - 19, 35, 53-55
Eye: cataract, amblyopia, strabismus - 48, 54-55
Multiple procedures - 53-55
Oral and maxillofacial - 56
Outpatient - 53-61, 66-69
Reconstructive - 55
Sterilization, reversal of voluntary - 43-44, 54-55
Surgical implants - 49, 66-69
Surgical treatment of severe obesity - 20-23
Transplants - 20-23, 56-60
Syringes - 86-87, 92-93
Telehealth
Dermatology - 17, 36-37, 103
Mental health/substance use disorder - 17, 103
Minor acute conditions - 17, 36-37, 103
Nutritional counseling - 17, 103
Temporary Continuation of Coverage (TCC) - 12-13
Tobacco cessation - 52, 94-98
Transplants - 20-23, 56-60
Travel benefit - 60, 101
Treatment therapies - 46-47
TRICARE - 118-119
Ultrasounds - 37, 66-69
Urgent care center - 75-77
Urgent care claims - 26, 136
VA facility - 31, 126
Vaccines - 38-42
Verbal statements - 4, 27
Vision services - 48, 120
Waivers - 29
Weight control - 38-42, 101
Wheelchairs - 50-51
Wigs - 49
WRAP benefits - 136
X-rays - 19, 37, 66-69