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Cover Page and Inside Cover
Table of Contents
Introduction/Plain Language/Advisory
PSHB Facts
Section 1
Section 2
Section 3
Section 4
Section 5
5(a). Medical Services and Supplies Provided by Physicians and Other Healthcare Professionals
5(b). Surgical and Anesthesia Services Provided by Physicians and Other Healthcare Professionals
5(c). Services Provided by a Hospital or Other Facility, and Ambulance Services
5(d). Emergency Services/Accidents
5(e). Mental Health and Substance Use Disorder Benefits
5(f). Prescription Drug Benefits
5(f)(a). FEP Medicare Prescription Drug Plan
5(g). Dental Benefits
5(h). Wellness and Other Special Features
5(i). Services, Drugs, and Supplies Provided Overseas
Non-PSHB Benefits Available to Plan Members
Section 6
Section 7
Section 8
Section 8(a)
Section 9
Section 10
Index
Summary of Benefits – FEP Blue Focus
2026 Rate Information
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Blue Cross Blue Shield Federal Employee Program logo

PSHB FEP Blue Focus

 
 

 

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

Page 137

 

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
 

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