What’s New for 2026

• We only require prior approval if 1) you don’t show signs/symptoms of a condition, or 2) you request testing to see if you could pass a genetic condition to your child.
• You do not need to request prior approval for outpatient hospice care.

• We will make updates to your preventive care benefits throughout the year based on the latest preventive care guidelines.

• The annual pharmacy out-of-pocket maximum will be $2,100 per member for all plans.

This is not a full list of changes. For the full list and details, including the sex trait modification change, see the Blue Cross and Blue Shield Service Benefit Plan brochures at fepblue.org/brochure.

• The Medicare Prescription Drug Program will not be available for FEP Blue Focus members.
• The deductible will be $750 for Self Only and $1,500 for Self Plus One and Self & Family.
• The catastrophic out-of-pocket maximum will be $10,000 for Self Only and $20,000 for Self + One and Self & Family.
• The copay for maternity facility care will be $2,500.

• We will waive the delivery copay if you give birth at a Blue Distinction Center® for Maternity Care.
• You will pay 35% coinsurance for Preferred brand name, Preferred specialty and Non-preferred specialty prescription drugs.
• The inpatient admission copay will be $425 per day up to $2,975 per admission.
• The emergency room visit copay will be $425.
• The ground ambulance copay will be $250.
• Air or sea ambulance copay will be $750.
• The facility diagnostic testing copay will be $75.
• You will pay 35% coinsurance for oral and transdermal contraceptives, reproductive services, vision services, orthopedic and prosthetic devices, durable medical equipment, medical supplies, accidental dental and facility-billed agents, drugs and/or supplies.
• The outpatient observation services copay will be $425 per day up to $2,975.

• You will pay 15% coinsurance for Preferred brand name and 20% coinsurance for Non-preferred brand name prescription drugs obtained via the Mail Service Pharmacy.
• You will have a $100 copay for a 30-day supply of Preferred specialty drugs and $150 copay for a 30-day supply of Non-preferred specialty drugs.

• The deductible will be $750 for Self Only and $1,500 for Self Plus One and Self & Family.
• The catastrophic out-of-pocket maximum will be $10,000 for Self Only and $20,000 for Self + One and Self & Family.
• The copay for maternity facility care will be $3,500.

• We will waive the delivery copay if you give birth at a Blue Distinction Center® (BDC) for Maternity Care.
• You will pay 35% coinsurance for Preferred brand name, Preferred specialty and Non-preferred specialty prescription drugs.
• You will pay 35% coinsurance for oral and transdermal contraceptives, reproductive services, vision services, orthopedic and prosthetic devices, durable medical equipment, medical supplies, accidental dental and facility-billed agents, drugs and/or supplies.
• The inpatient admission copay will be $425 per day up to $2,975 per admission.
• The outpatient observation services copay will be $425 per day up to $2,975.
• The emergency room visit copay will be $425.

• You will have a $140 copay for Preferred brand name and $175 copay for Non-preferred brand name prescription drugs obtained via the Mail Service Pharmacy.
• You will have a $100 copay for a 30-day supply of Preferred specialty drugs and $135 copay for a 30-day supply of Non-preferred specialty drugs.