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FEP Blue Focus®

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FEP Blue Focus® Benefits

 

See costs for typical services when you use Preferred providers.

FEP Blue Focus®
Preventive Care Nothing for covered preventive screenings, immunizations and services
Physician Care

$10 per visit for your first 10 primary and/or specialty care visits combined medical and mental health substance use5

Virtual doctor visits by Teladoc®

$0 for first 2 visits and all nutrition visits

$10 all additional visits

Urgent Care Center $25 copay
Prescription Drugs

Preferred Retail Pharmacy^:

Tier 1 (Generics): $5 copay
Tier 2 (Preferred brand): 40% of our allowance ($350 maximum)2

Mail Service Pharmacy:
Not covered

Specialty Pharmacy^:

Tier 2 (Preferred specialty): 40% of our allowance ($350 maximum)2

Maternity Care

$0 for doctor's visits

$1,500 copay for facility care

Hospital Care

Inpatient (Precertification is required): 30% of our allowance1

Outpatient: 30% of our allowance1

Surgery 30% of our allowance1
ER (accidental injury) $0 within 72 hours
ER (medical emergency) 30% of our allowance1
Lab work (such as blood tests) $0 for first 10 specific lab tests3 4
Diagnostic services (such as sleep studies, X-rays, CT scans) 30% of our allowance1
Chiropractic Care

$25 for up to 10 visits a year5

Dental Care Not covered
Rewards Program Earn a reward, such as a $150 MyBlue Wellness Card, at no out-of-pocket cost for getting an annual physical6
Network Coverage In-network care only, except in certain situations like emergency care
Out-of-Pocket Maximum (PPO)

Self Only: $9,000

Self + One and Self & Family: $18,000

Annual Deductible

Self Only: $500

Self + One and Self & Family: $1,000

FEP Blue Focus® 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 Focus® with MPDP
In-network (Preferred) Retail Pharmacy

Tier 1 (Generics): $5 for up to a 30-day supply; $15 for a 31 to 90-day supply
Tier 2 (Preferred brand): 40% of our allowance ($350 max) for up to a 30-day supply; 40% of our allowance ($1,050 max) for a 31 to 90-day supply
Tier 3 (Non-preferred brand): 40% of our allowance ($350 maxfor up to a 30-day supply; 40% of our allowance ($1,050 max) for a 31 to 90-day supply
Tier 4 (Specialty drugs): 40% of our allowance ($350 max) for up to a 30-day supply; 40% of our allowance ($1,050 max) for a 31 to 90-day supply

FEP Mail Service Pharmacy Not a benefit
FEP Specialty Pharmacy Your specialty drug benefits are in Tier 4 (see above) for a 30-day supply
Annual Pharmacy Out-of-Pocket Maximum7 $3,250 per member

Under FEP Blue Focus, 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 Deductible applies. $500 for Self Only and $1,000 for Self + One and Self & Family.
  • 2 Specialty drugs are limited to a 30-day supply.
  • 3 Professional charges for facility-based intensive outpatient treatment and professional charges for outpatient diagnostic tests to include psychological testing are not part of the 10 for $10 benefit.
  • 4 Please see brochure for covered lab services.
  • 5 You pay 30% of our allowance for agents, drugs and/or supplies you receive during your care.
  • 6 You must be the contract holder or spouse, 18 or older, on a FEP Blue Focus plan to earn incentive rewards.
  • 7 You still have an overall medical out-of-pocket maximum. Your MPDP pharmacy out-of-pocket maximum is part of it, not added to it.
  •  

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 71-017). All benefits are subject to the definitions, limitations, and exclusions set forth in the federal brochure.

Try our Prescription Drug Cost Tool

Our Prescription Drug Cost Tool lets you check drug costs 24/7. See if your drug is covered under your selected plan and compare costs of covered drugs for all three plans.

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