Compare Our Plans
See the differences between benefits and coverage for our three plan options side by side.
FEP Blue Focus
- Has a deductible
- Must see Preferred providers
- Out-of-pocket costs include deductible, copays and coinsurance
- Earn a reward for getting annual physical
Basic Option
- Has no deductible
- Must see Preferred providers
- Most out-of-pocket costs are copays
- Can get Medicare Part B premium reimbursement
- Earn up to $170 in rewards with the Wellness Incentive Program
Standard Option
- Has a deductible
- Can see any provider, even outside the network
- Out-of-pocket costs include deductible, copays and coinsurance
- Access to Mail Service Pharmacy Program
- Earn up to $170 in rewards with the Wellness Incentive Program
2024 Plan Rates
FEP Blue Focus
| Enrollment code | Bi-weekly | Monthly |
|---|---|---|
| Self (131) |
$55.30 | $119.83 |
| Self + 1 (133) |
$118.88 | $257.58 |
| Self & Family (132) |
$130.76 | $283.32 |
Basic Option
| Enrollment code | Bi-weekly | Monthly |
|---|---|---|
| Self (111) |
$95.74 | $207.44 |
| Self + 1 (113) |
$238.63 | $517.03 |
| Self & Family (112) |
$262.60 | $568.96 |
Standard Option
| Enrollment code | Bi-weekly | Monthly |
|---|---|---|
| Self (104) |
$150.79 | $326.71 |
| Self + 1 (106) |
$336.84 | $729.82 |
| Self & Family (105) |
$370.68 | $803.14 |
2024 Compare Benefits Chart
See costs for typical services when you use Preferred providers.
| FEP Blue Focus | Basic Option | Standard Option | |
|---|---|---|---|
| Preventive Care | You pay nothing | You pay nothing | You pay nothing |
| Physician Care |
$10 per visit for your first 10 primary and/or specialty care visits combined medical and mental health substance use1 |
$35 copay for primary care1 $45 copay for specialists1 $35 copay for mental health visits |
$30 copay for primary care $40 copay for specialists $30 copay for mental health visits |
| Virtual doctor visits by Teladoc® |
$0 for first 2 visits and all nutrition visits $10 all additional visits |
$0 for first 2 visits and all nutrition visits $15 all additional visits |
$0 for first 2 visits and all nutrition visits $10 all additional visits |
| Urgent Care Center | $25 copay |
$35 copay
|
$30 copay |
| Prescription Drugs |
Preferred Retail Pharmacy^: Tier 1 (Generics): $5 copay Tier 2 (Preferred brand): 40% of our allowance ($350 maximum)
Mail Service Pharmacy: Not a benefit
Specialty Pharmacy^: Tier 2 (Preferred specialty): 40% of our allowance ($350 maximum) |
Preferred Retail Pharmacy^: If you have Medicare Part B primary, your costs for prescription drugs may be lower. Tier 1 (Generics): $15 copay Tier 2 (Preferred brand): $60 copay Tier 3 (Non-preferred brand): 60% of our allowance ($90 minimum) Tier 4 (Preferred specialty): $85 copay Tier 5 (Non-preferred specialty): $110 copay
Mail Service Pharmacy: Available to members with Medicare Part B primary only. Visit the Medicarepage for more information. Tier 1 (Generics): $20 copay Tier 2 (Preferred brand): $100 copay Tier 3 (Non-preferred brand): $125 copay
Specialty Pharmacy^: Tier 4 (Preferred specialty): $85 copay Tier 5 (Non-preferred specialty): $110 copay |
Preferred Retail Pharmacy: If you have Medicare Part B primary, your costs for prescription drugs may be lower. Tier 1 (Generics): $7.50 copay^: Tier 2 (Preferred brand): 30% of our allowance Tier 3 (Non-preferred brand): 50% of our allowance Tier 4 (Preferred specialty): 30% of our allowance^: Tier 5 (Non-preferred specialty): 30% of our allowance^:
Mail Service Pharmacy: Tier 1 (Generics): $15 copay Tier 2 (Preferred brand): $90 copay Tier 3 (Non-preferred brand): $125 copay
Specialty Pharmacy^: Tier 4 (Preferred specialty): $65 copay Tier 5 (Non-preferred specialty): $85 copay |
| FEP Medicare Prescription Drug Program |
Preferred Retail Pharmacy^: Tier 1 (Generics): $5 copay Tier 2 (Preferred brand): 40% of our allowance ($350 maximum) Tier 3 (Non-preferred brand): 40% of our allowance ($350 maximum) Tier 4 (Specialty): 40% of our allowance ($350 maximum) |
Preferred Retail Pharmacy^: Tier 1 (Generics): $10 copay Tier 2 (Preferred brand): $45 copay Tier 3 (Non-preferred brand): 50% of our allowance ($60 minimum) Tier 4 (Specialty): $75 copay
Mail Service Pharmacy: Tier 1 (Generics): $15 copay Tier 2 (Preferred brand): $95 copay Tier 3 (Non-preferred brand): $125 copay Tier 4 (Specialty): $150 copay |
Preferred Retail Pharmacy^: Tier 1 (Generics): $5 copay Tier 2 (Preferred brand): 15% of our allowance Tier 3 (Non-preferred brand): 50% of our allowance Tier 4 (Specialty): $60 copay
Mail Service Pharmacy: Tier 1 (Generics): $5 copay Tier 2 (Preferred brand): $85 copay Tier 3 (Non-preferred brand): $125 copay Tier 4 (Specialty): $150 copay |
| Maternity Care |
$0 for doctor's visits $1,500 for facility care |
$250 inpatient $0 outpatient |
$0 copay |
| Hospital Care |
Inpatient (Precertification is required): 30% of our allowance*
Outpatient: 30% of our allowance* |
Inpatient (Precertification is required): $250 per day; up to $1,500 per admission Outpatient: $150 per day per facility1 |
Inpatient (Precertification is required): $350 per admission Outpatient: 15% of our allowance* |
| Surgery |
30% of our allowance* |
$150 per surgeon in an office1 $200 per surgeon in other settings1 |
15% of our allowance* |
| ER (accidental injury) | $0 within 72 hours | $250 per day per facility | $0 within 72 hours |
| ER (medical emergency) |
30% of our allowance* |
$250 per day per facility
|
15% of our allowance* |
| Lab work (such as blood tests) |
$0 for first 10 specific lab tests** |
15% of our allowance1 |
15% of our allowance* |
| Diagnostic services (such as sleep studies, CT scans) |
30% of our allowance* |
Up to $100 in an office1 Up to $200 in a hospital1 |
15% of our allowance* |
| Chiropractic Care | $25 for up to 10 visits a year 1 2 | $35 for up to 20 visits a year | $30 for up to 12 visits a year |
| Dental Care | Not a benefit |
$35 per evaluation; up to 2 evaluations per year |
The difference between the fee schedule amount and the Maximum Allowable Charge (MAC) |
| Rewards Program |
Earn a reward, such as a $150 MyBlue Wellness Card, at no out-of-pocket cost for getting an annual physical4 |
Earn $50 for completing the Blue Health Assessment3 Earn up to $120 for completing three eligible Daily Habits goals.3 |
Earn $50 for completing the Blue Health Assessment3 Earn up to $120 for completing three eligible Daily Habits goals.3 |
| Network Coverage | In-network care only, except in certain situations like emergency care | In-network care only, except in certain situations like emergency care | In-network and out-of-network care |
| Out-of-Pocket Maximum (PPO) |
Self Only: $9,000 Self + One and Self & Family: $18,000 |
Self Only: $6,500 Self + One and Self & Family: $13,000 |
Self Only: $6,000 Self + One and Self & Family: $12,000 |
| FEP Medicare Prescription Drug Program Out-of-Pocket Maximum | $3,250 per member | $3,250 per member | $2,000 per member |
| Annual Deductible |
Self Only: $500 Self + One and Self & Family: $1,000 |
No deductible |
Self Only: $350 Self + One and Self & Family: $700 |
Cost sharing may not apply or may be different if Medicare is your primary coverage (it pays first).
- * Deductible applies.
- ** Please see brochure for covered lab services.
- ^ What you’ll pay for a 30-day supply of covered drugs.
- 1 You pay 30% of our allowance for agents, drugs and/or supplies you receive during your care.
- 2 Up to 10 visits combined for chiropractic care and acupuncture.
- 3 You must be the contract holder or spouse, 18 or older, on a Standard or Basic Option plan to earn incentive rewards.
- 4 You must be the contract holder or spouse, 18 or older, on an FEP Blue Focus plan to earn this reward.
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 brochures (Standard Option and Basic Option: RI 71-005; FEP Blue Focus: RI 71-017). All benefits are subject to the definitions, limitations and exclusions set forth in the Federal brochures.