FEP Blue Basic™
Stay in network for care. FEP Blue Basic gives you access to a network with over 2 million doctors and hospitals and over 55,000 retail pharmacies.
Benefits at a Glance
Get the details
Want to see detailed benefits for this plan? Download the 2025 Blue Cross and Blue Shield Service Benefit Plan Brochure – FEP Blue Standard and FEP Blue Basic below.
See Plan Brochure
2025 FEP Blue Basic Rates
| Enrollment Code | Bi-weekly | Monthly |
|---|---|---|
| Self Only (111) | $113.16 | $245.18 |
| Self + 1 (113) | $274.14 | $593.97 |
| Self & Family (112) | $303.61 | $657.82 |
Get up to $800 back with a Medicare Reimbursement Account
FEP Blue Basic members who have Medicare Part A and Part B can get up to $800 back with a Medicare Reimbursement Account.
Learn More
FEP Blue Basic™ Benefits
See costs for typical services when you use Preferred providers.
| FEP Blue Basic™ | |
|---|---|
| Virtual doctor visits by Teladoc Health® | $0 copay |
| Preventive Care | $0 copay for covered preventive screenings, immunizations and services |
| Physician and Mental Health Care |
$35 copay for primary care1 $50 copay for specialist1 $35 copay for mental health visits |
| Urgent Care Center | $50 copay |
| Chiropractic Care |
$35 copay per treatment; up to 20 visits a year1 |
| Prescription Drugs |
Retail Pharmacy^:
Generics: $20 copay |
| Maternity Care |
$0 copay for outpatient $350 copay for inpatient hospital delivery |
| Hospital Care |
$250 copay for outpatient care per day per facility1 $350 per day copay for inpatient care; up to $1,750 per admission (precertification is required) |
| Surgery |
$150 copay in an office setting1 $200 copay in a non-office setting1 |
| ER (accidental injury) |
$350 per day per facility |
| ER (medical emergency) |
$350 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 $250 copay in a hospital1 |
| Dental Care |
$30 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 |
| Annual Deductible | No deductible |
| Out-of-Pocket Maximum (PPO) |
Self Only: $7,500 Self + One and Self & Family: $15,000 |
| 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. New for 2025: the annual pharmacy out-of-pocket maximum is $2,000 per member and separate from the medical out-of-pocket maximum. Learn more here.
| FEP Blue Basic™ with MPDP | |
|---|---|
| Retail Pharmacy^ |
Generics: $10 copay Preferred brand name: $45 copay Non-preferred brand name: 50% of our allowance ($60 minimum) Specialty drugs: $75 copay |
| FEP Mail Service Pharmacy |
Generics: $15 copay Preferred brand name: $95 copay Non-preferred brand name: $125 copay Specialty drugs: $150 copay |
| FEP Blue Basic™ with MPDP | |
|---|---|
| Retail Pharmacy^ |
Generics: $10 copay Preferred brand name: $45 copay Non-preferred brand name: 50% of our allowance ($60 minimum) Specialty drugs: $75 copay |
| FEP Mail Service Pharmacy |
Generics: $15 copay Preferred brand name: $95 copay Non-preferred brand name: $125 copay 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).
- * FEP Blue Basic Traditional Pharmacy drug tiers: Tier 1 Generics, Tier 2 Preferred Brand Name, Tier 3 Non-preferred Brand Name, Tier 4 Preferred Specialty, Tier 5 Non-preferred Specialty.
- ^ 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.