FEP Blue Basic™
Stay in network for care. FEP Blue Basic gives you access to our Preferred provider network that includes over 1.7 million doctors and hospitals in the U.S.
FEP Blue Basic™ Benefits
See costs for typical services when you use Preferred providers.
| FEP Blue Basic™ | |
|---|---|
| Preventive Care | Nothing for covered preventive screenings, immunizations and services |
| Physician Care |
$35 copay for primary care1 $45 copay for specialists1$35 copay for mental health visits |
| Virtual doctor visits by Teladoc® |
$0 for first 2 visits and all nutrition visits $15 all additional visits |
| Urgent Care Center | $35 copay |
| Prescription Drugs |
Preferred Retail Pharmacy^:
Tier 1 (Generics): $20 copay |
| Maternity Care |
$250 copay inpatient $0 outpatient |
| Hospital Care |
Inpatient (Precertification is required): $250 per day copay; up to $1,500 per admission Outpatient: $150 copay per day per facility1 |
| Surgery |
$150 per surgeon in an office1 $200 per surgeon in other settings1 |
| ER (accidental injury) |
$250 per day per facility |
| ER (medical emergency) |
$250 per day per facility |
| Lab work (such as blood tests) |
15% our allowance1 |
|
Diagnostic services (such as sleep studies, CT scans) |
Up to $100 copay in an office1 Up to $200 copay in a hospital1 |
| Chiropractic Care |
$35 for up to 20 visits a year1 |
| Dental Care |
$35 copay per evaluation; up to 2 per year |
| Rewards Program |
Earn $50 for completing the Blue Health Assessment3 Earn up to $120 for completing three eligible Daily Habits goals3 |
| Network Coverage | In-network care only, except in certain situations like emergency care |
| Out-of-Pocket Maximum (PPO) |
Self Only: $6,500 Self + One and Self & Family: $13,000 |
| Annual Deductible | No deductible |
FEP Blue Basic™ with FEP Medicare Prescription Drug Program
Eligible members with Medicare get lower out-of-pocket costs for higher cost drugs and additional approved prescription drugs in some tiers than the traditional pharmacy benefit. Learn more here.
| FEP Blue Basic™ with MPDP | |
|---|---|
| Preferred Retail Pharmacy |
Tier 1 (Generics): $10 for up to a 30-day supply; $30 for a 31 to 90-day supply Tier 2 (Preferred brand name): $45 for up to a 30-day supply; $135 for a 31 to 90-day supply Tier 3 (Non-preferred brand name): 50% of our allowance ($60 min) for up to a 30-day supply; $175 min for a 31 to 90-day supply Tier 4 (Specialty drugs): $75 for up to a 30-day supply; $195 for a 31 to 90-day supply |
| Mail Service Pharmacy |
Tier 1 (Generics): $15 copay Tier 2 (Preferred brand name): $95 copay Tier 3 (Non-preferred brand name): $125 copay Tier 4 (Specialty drugs): $150 copay |
| FEP Specialty Pharmacy | Your specialty drug benefits are in Tier 4 (see above) for a 30-day supply |
| Annual Prescription Drug Out-of-Pocket Maximum | $3,250 per member |
Under FEP Blue Basic, benefits are not available for services performed by Non-preferred providers, except in certain situations such as emergency care.
Cost sharing may not apply or may be different if Medicare is your primary coverage (it pays first).
- ^ What you’ll pay for a 30-day supply of covered drugs.
- 1 Under FEP Blue Basic you pay 30% of our allowance for agents, drugs and/or supplies you receive during your care.
- 2 If you have Medicare Part B primary, your costs for prescription drugs may be lower.
- 3 You must be the contract holder or spouse, 18 or older, on a FEP Blue Standard™ or FEP Blue Basic Plan to earn incentive rewards.
The FEP Medicare Prescription Drug Program is a prescription drug plan with a Medicare contract. Enrollment in MPDP depends on contract renewal.
The formulary and/or pharmacy network may change at any time. You will receive notice when necessary.
This is a summary of the features of the Blue Cross and Blue Shield Service Benefit Plan. Before making a final decision, please read the Plan’s federal brochure (RI 71-005). All benefits are subject to the definitions, limitations, and exclusions set forth in the federal brochure.
Get up to $800 back with a Medicare Reimbursement Account
Each member of a FEP Blue Basic plan who has Medicare Part A and Part B can get reimbursed up to $800 per year for paying their Medicare Part B premiums.
Learn More