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FEP Blue Focus

Get quality healthcare coverage that’s easy on your wallet. FEP Blue Focus was designed with your needs and budget in mind.

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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.

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