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Virtual doctor visits by Teladoc Health®
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$0 copay
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N/A
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Preventive Care
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$0 copay for covered preventive screenings, immunizations and services
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35% coinsurance
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Physician and Mental Health Care
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$30 copay for primary care
$40 copay for specialists
$30 copay for mental health visits
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35% coinsurance
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Urgent Care Center
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Accidental Injury: $0
Medical Emergency: $30 copay
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Accidental Injury: $0
Medical Emergency: 35% coinsurance
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Chiropractic Care
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$30 copay per treatment; up to 12 visits a year
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35% coinsurance; up to 12 visits a year
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Prescription Drugs
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Retail Pharmacy:
Generics: $7.50 copay
Preferred brand: 30% coinsurance
Non-preferred brand: 50% coinsurance
Preferred specialty: 30% coinsurance
Non-preferred specialty: 30% coinsurance
Mail Service Pharmacy:
Generics: $15 copay
Preferred brand: $140 copay
Non-preferred brand: $175 copay
Specialty Pharmacy:
Preferred specialty: $100 copay
Non-preferred specialty: $135 copay
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Retail Pharmacy:
45% coinsurance
Mail Service Pharmacy:
Not covered
Specialty Pharmacy:
Not covered
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Maternity Care
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$0 copay
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Pre-/postnatal professional care: 35% coinsurance
Inpatient hospital: $450 per admission copay for unlimited days, plus 35% coinsurance
Outpatient facility care: 35% coinsurance
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Hospital Care
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15% coinsurance for outpatient care
$350 per admission copay for inpatient care (precertificiation is required)
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35% coinsurance for outpatient care
$450 per admission copay plus 35% coinsurance for inpatient care (precertificiation is required)
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Surgery
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15% coinsurance
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35% coinsurance
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ER (accidental injury)
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$0 within 72 hours
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Nothing for covered services
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ER (medical emergency)
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15% coinsurance
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15% coinsurance
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Lab work (such as blood tests)
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15% coinsurance
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35% coinsurance
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Diagnostic services (such as sleep studies, X-rays, CT scans)
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15% coinsurance
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35% coinsurance
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Dental Care
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See 2026 FEP Blue Standard and FEP Blue Basic PSHB brochure
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35% coinsurance
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Rewards Program
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Earn $50 for completing the Blue Health Assessment
Earn up to $120 for completing three eligible Daily Habits goals
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Earn $50 for completing the Blue Health Assessment
Earn up to $120 for completing three eligible Daily Habits goals
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Annual Deductible
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Self Only: $350
Self + One and Self & Family: $700
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Self Only: $350
Self + One and Self & Family: $700
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Annual Medical Out-of-Pocket Maximum (PPO)
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Self Only: $6,000
Self + One and Self & Family: $12,000
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Self Only: $8,000
Self + One and Self & Family: $16,000
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