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Blue HowTo: FEP 101

Health insurance isn’t always easy to understand. As part of our Blue HowTo series, we’re helping explain how your benefits and coverage work and what it means to you as a member of the Blue Cross and Blue Shield Service Benefit Plan.

What’s the Federal Employee Program?
Since 1960, the Blue Cross and Blue Shield Service Benefit Plan, also known as the Federal Employee Program (FEP), has provided health insurance to federal employees, retirees and their families, offering coverage across the U.S. and overseas. The Service Benefit Plan now offers three plan options you can choose from based on your healthcare needs: Standard Option, Basic Option and FEP Blue Focus.

Choosing a Provider
Providers are the licensed or board-certifed doctors and caregivers who provide you with medical services like your annual physical, treat you when you’re sick or injured and more. Use the Find a Preferred Provider tool or the fepblue app to find a doctor, specialist or urgent care center near you.

In-Network vs. Out-of-Network
A provider can either be in-network or out-of-network. As a Preferred Provider Organization (PPO), we have a network of doctors, hospitals, pharmacies and facilities that have contracted with us to provide medical services at a discounted rate. You’ll pay less if you see someone in our network, or what we call a Preferred provider.

When you go to a provider who doesn’t have a contract with us, they’re out-of-network. Standard Option gives you the flexiblity to see a provider out-of-network, but you’ll typically pay more for medical care, making it worth the effort to find an in-network doctor or hospital. With both Basic Option and FEP Blue Focus, you must go to a provider in our network to receive benefits.

Seeing a Provider
When you go to a provider or pharmacy, remember to bring your member ID card as proof of insurance. With the fepblue app, you can view and share your card with only a few taps.

With the Service Benefit Plan, preventive care services are free when you see a Preferred provider. These are routine checkups and screenings like annual physicals, well-child visits, and cancer screenings. You also never need a referral to see a specialist.

Some medical services, such as in-patient hospital stays and certain prescription drugs, need to be approved before we’ll cover them. This is known as prior approval, or precertification. Your provider can submit approval requests on your behalf.

Paying for Services
How you pay for medical services depends on which Service Benefit Plan coverage type you have. Standard Option and FEP Blue Focus have a mixture of copays and coinsurance, while Basic Option has set copays for most services.

Explanation of Benefits
Each time you go to a provider and we process a claim, you’ll receive an Explanation of Benefits (EOB). An EOB is not a bill, but instead an outline of what services were performed and how your benefits were applied to cover those services, including the amount billed, the amount we paid and any balance you may be responsible for paying. You can view your personal EOBs through your MyBlue® account and on the fepblue app.

As a trusted partner for nearly 60 years, you can count on us to help you stay informed and healthy every step of the way.

Published on: January 24, 2019