FEP Blue Standard™

Benefits at a Glance

In and out-of-network care
Up to $25,000 Annually for Covered Assisted Reproductive Technology (ART)^*
Access to 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.

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.

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View an interactive plan summary book

For a convenient summary of our three coverage options, view an interactive version of the 2025 Benefit Summary Book.

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2025 FEP Blue Standard Rates


Enrollment Code	Bi-weekly	Monthly
Self Only (104)	$174.81	$378.76
Self + 1 (106)	$384.14	$832.31
Self & Family (105)	$424.65	$920.07

These rates do not apply to all enrollees. If you are in a special enrollment category, contact the agency or Tribal employer that manages your health benefits enrollment.

See if your doctor is in our network

Use our National Doctor and Hospital Finder tool to see if your current doctor is in our Preferred provider network or to find a specialist, retail clinic or urgent care center near you.

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FEP Blue Standard™ Benefits

See costs for typical services when you use Preferred providers.

	In-Network (PPO benefit) - You pay:	Out-of-Network (Non-PPO benefit)* - You pay:
Virtual Doctor visits by Teladoc Health^®	$0 copay	N/A
Preventive Care	$0 copay for covered preventive screenings, immunizations and services	35% of our allowance^†
Physician and Mental Health Care	$30 copay for primary care $40 copay for specialists $30 copay for mental health visits	35% of our allowance^†
Urgent Care Center	Accidental Injury: $0 Medical Emergency: $30 copay	Accidental Injury: $0 Medical Emergency: 35% of our allowance
Chiropractic Care	$30 copay per treatment; up to 12 visits a year	35% of our allowance^† up to 12 visits a year
Prescription Drugs	Retail Pharmacy^{^}: Generics: $7.50 copay¹ Preferred brand: 30% of our allowance Non-preferred brand: 50% of our allowance Preferred specialty: 30% of our allowance^{^} Non-preferred specialty: 30% of our allowance^{^} Mail Service Pharmacy: Generics: $15 copay¹ Preferred brand: $90 copay Non-preferred brand: $125 copay Specialty Pharmacy^{^}²: Preferred specialty: $65 copay Non-preferred specialty: $85 copay	Retail Pharmacy: 45% of our allowance Mail Service Pharmacy: Not covered Specialty Pharmacy: Not covered
Maternity Care	$0 copay	Pre-/postnatal professional care: 35% of our allowance^† Inpatient hospital: $450 per admission copay for unlimited days, plus 35% of our allowance Outpatient facility care: 35% of our allowance^†
Hospital Care	15% of our allowance for outpatient care $350 per admission copay for inpatient care (precertification is required)	35% of our allowance^† $450 per admission copay plus 35% of our allowance for inpatient care (precertification is required)
Surgery	15% of our allowance^†	35% of our allowance^†^*
ER (accidental injury)	$0 within 72 hours	Nothing for covered services
ER (medical emergency)	15% of our allowance^†	15% of our allowance^†
Lab work (such as blood tests)	15% of our allowance^†	35% of our allowance^†
Diagnostic services (such as sleep studies, X-rays, CT scans)	15% of our allowance^†	35% of our allowance^†
Dental Care	See 2025 FEP Blue Standard and FEP Blue Basic brochure	35% of our allowance^†
Rewards Program	Earn $50 for completing the Blue Health Assessment ³ Earn up to $120 for completing three eligible Daily Habits goals³	Earn $50 for completing the Blue Health Assessment ³ Earn up to $120 for completing three eligible Daily Habits goals³
Annual Deductible	Self Only: $350 Self + One and Self & Family: $700	Self Only: $350 Self + One and Self & Family: $700
Annual Medical Out-of-Pocket Maximum (PPO)	Self Only: $6,000 Self + One and Self & Family: $12,000	Self Only: $8,000⁴ Self + One and Self & Family: $16,000⁴

	In-Network (PPO benefit) - You pay:	Out-of-Network (Non-PPO benefit)* - You pay:
Preventive Care	Nothing for covered preventive screenings, immunizations and services	35% of our allowance^†
Physician Care	$30 copay for primary care $40 copay for specialists $30 copay for mental health visits	35% of our allowance^†
Virtual Doctor Visits by Teladoc^®	$0 for first 2 visits and all nutrition visits $10 all additional visits	N/A
Urgent Care Center	Accidental Injury: $0 Medical Emergency: $30 copay	Accidental Injury: $0 Medical Emergency: 35% our our allowance^†
Prescription Drugs	Preferred Retail Pharmacy: Tier 1 (Generics): $7.50 copay^{^}¹ 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 copay¹ Tier 2 (Preferred brand): $90 copay Tier 3 (Non-preferred brand): $125 copay Specialty Pharmacy^{^}²: Tier 4 (Preferred specialty): $65 copay Tier 5 (Non-preferred specialty): $85 copay	Retail Pharmacy: 45% of our allowance Mail Service Pharmacy: Not covered Specialty Pharmacy: Not covered
Maternity Care	$0 copay	Pre-/postnatal professional care: 35% of our allowance^† Inpatient hospital: $450 per admission copay for unlimited days, plus 35% of our allowance Outpatient facility care: 35% of our allowance^†
Hospital Care	Inpatient (Precertification is required): $350 per admission Outpatient: 15% of our allowance^†	Inpatient (Precertification is required): $450 per admission copay, plus 35% of our allowance Outpatient: 35% of our allowance^†
Surgery	15% of our allowance^†	35% of our allowance^†^*
ER (accidental injury)	$0 within 72 hours	Nothing for covered services
ER (medical emergency)	15% of our allowance^†	15% of our allowance^†
Lab work (such as blood tests)	15% of our allowance^†	35% of our allowance^†
Diagnostic services (such as sleep studies, X-rays, CT scans)	15% of our allowance^†	35% of our allowance^†
Chiropractic Care	$30 copay per treatment; up to 12 visits a year	35% of our allowance^† up to 12 visits a year
Dental Care	The difference between the fee schedule amount and the Maximum Allowable Charge (MAC)	35% of our allowance^†
Rewards Program	Earn $50 for completing the Blue Health Assessment.³ Earn up to $120 for completing three eligible Daily Habits goals.³	Earn $50 for completing the Blue Health Assessment.³ Earn up to $120 for completing three eligible Daily Habits goals.³
Network Coverage	In-network and out-of-network care	In-network and out-of-network care
Out-of-Pocket Maximum	Self Only: $6,000 Self + One and Self & Family: $12,000	Self Only: $8,000⁴ Self + One and Self & Family: $16,000⁴
Annual Deductible	Self Only: $350 Self + One and Self & Family: $700	Self Only: $350 Self + One and Self & Family: $700

FEP Blue Standard™ 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 Standard™ with MPDP
Retail Pharmacy^{^}	Generics: $5 copay Preferred brand name: $35 copay Non-preferred brand name: 50% of our allowance Specialty drugs: $60 copay
FEP Mail Service Pharmacy	Generics: $5 copay Preferred brand name: $85 copay Non-preferred brand name: $125 copay Specialty drugs: $150 copay

	FEP Blue Standard™ with MPDP
In-network 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 name): 15% of our allowance for up to a 90-day supply Tier 3 (Non-preferred brand name): 50% of our allowance for up to a 90-day supply Tier 4 (Specialty drugs): $60 for up to a 30-day supply; $170 for a 31 to 90-day supply
FEP Mail Service Pharmacy	Tier 1 (Generics): $5 copay Tier 2 (Preferred brand name): $85 copay Tier 3 (Non-preferred brand name): $125 copay Tier 4 (Specialty drugs): $150 copay
Annual Pharmacy Out-of-Pocket Maximum⁵	$2,000 per member

Coinsurance (a type of cost sharing) is the percentage of our allowance you pay. We contract with providers to pay them a set rate, or an allowance. Cost sharing may not apply or may be different if Medicare is your primary coverage (it pays first).

^*FEP Blue Standard 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.
^*If you use a Non-preferred provider under FEP Blue Standard, you generally pay any difference between our allowance and the billed amount, in addition to any share of our allowance shown in the table above. Certain out-of-pocket costs do not apply if Medicare is your primary coverage for medical services (it pays first).
^† Subject to the calendar year deductible: $350 per person or $700 in total for Self + One or Self & Family contracts.
^{^} What you’ll pay for a 30-day supply of covered drugs.
¹ If you have Medicare Part B primary, your costs for prescription drugs may be lower.
² On limited occasions, such as for certain drugs that require prior approval, you will need to file a claim for services received from Preferred providers.
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.
⁴ Eligible expenses for the services of Preferred (In-Network) providers also count toward these limits.
⁵ You still have an overall medical out-of-pocket maximum. Your MPDP pharmacy out-of-pocket maximum is separate.

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.

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. If you’re a member and logged in to MyBlue®, you can access a personalized drug cost tool that shows you the cost of prescription drugs for your specific plan.

Check Drug Costs See Personalized Costs

Get prescriptions delivered right to your door

All FEP Blue Standard members get access to our Mail Service Pharmacy Program. It’s a convenient way to get any prescription drugs you take regularly sent to your home. You can use your MyBlue® account to access the Mail Service Pharmacy and place mail order prescriptions.

Learn More

FEP Blue Standard™

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Benefits at a Glance

Get the details

View an interactive plan summary book

2025 FEP Blue Standard Rates

See if your doctor is in our network

FEP Blue Standard™ Benefits

FEP Blue Standard™ with FEP Medicare Prescription Drug Program

Try our Prescription Drug Cost Tool

Get prescriptions delivered right to your door

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