Learn the answers to commonly asked questions about benefit options, enrolling, finding the right doctor, Medicare and other topics.
Who do I call if I have a question about a claim payment?
Do I need a referral to see a specialist?
How can I request an additional or replacement identification card?
Who do I call if I have a question about a claim payment?
If you have questions about a claim payment, please call the Blue Cross Blue Shield Plan listed on the Explanation of Benefits (EOB) that you received for your claim. If you do not have the EOB available, you may call the Customer Service phone number listed on the back of your identification card for further assistance. You can also find the contact information for your Local Plan in the Contact Us section of this Web site.
Do I need a referral to see a specialist?
No, if you use a Preferred provider, you do not need a referral. You can go directly to any of the Preferred primary care physicians or specialists listed in our Provider Directory.
How can I request an additional or replacement identification card?
To request an additional or replacement ID card visit Customer eService or call your local Blue Cross Blue Shield Plan. To locate the contact information for your Local Plan, please visit the Contact Us section of this Web site.
What is the difference between Standard Option and Basic Option?
Does the Service Benefit Plan offer dental benefits?
Do you offer a High Deductible Health Plan (HDHP)?
What is Temporary Continuation of Coverage (TCC) and what are the requirements to enroll under the TCC provisions of the Federal Employees Health Benefits (FEHB) law?
When is Open Season?
Where can I call to get benefit information about the Service Benefit Plan?
Does Standard Option or Basic Option provide coverage if I am overseas?
What is the difference between Standard Option and Basic Option?
While both Options offer comprehensive benefits for you and your family, they are structured differently to complement different healthcare needs. Under Basic Option, you use Preferred providers to provide all the medical care you and your family need, and there is no deductible. Standard Option provides benefits regardless of whether you use a Preferred or Non-participating provider; however, your out-of-pocket expenses will probably be lower if you choose a Preferred provider. For more information about the differences between the two Options, please visit the Compare Benefits section of this Web site or consult the Service Benefit Plan brochure.
Whether you decide to enroll in Standard Option or Basic Option, please be sure to use the appropriate enrollment code:
| Self | Self and Family | |
|---|---|---|
| Standard Option | 104 | 105 |
| Basic Option | 111 | 112 |
Does the Service Benefit Plan offer dental benefits?
Yes. Both Standard Option and Basic Option offer some level of dental benefits. Basic Option provides preventive dental care while Standard Option provides additional routine services. Additional information is available in the Basic Option Dental Benefits and Standard Option Dental Benefits sections of this Web site or consult the Service Benefit Plan brochure for more details.
Do you offer a High Deductible Health Plan (HDHP)?
The Blue Cross and Blue Shield Service Benefit Plan currently offers an HDHP in a select number of locations. Basic Consumer Option, a sub-option of Basic Option, is available to individuals residing in Minnesota, Ohio, Tennessee and select counties in Missouri and Kansas. To determine if you are eligible, please visit the Basic Consumer Option Web site.
What is Temporary Continuation of Coverage (TCC) and what are the requirements to enroll under the TCC provisions of the Federal Employees Health Benefits Program (FEHBP) law?
Temporary Continuation of Coverage (TCC) is available to:
- Employees who lose their FEHBP coverage because they leave their federal jobs; except in involuntary separations due to misconducts
- Children who lose their FEHBP family member status because they become age 22 or marry
- Former spouses who lose their FEHBP family member status because of divorce or annulment
TCC allows former employees to continue their healthcare coverage for up to 18 months and former family members (children and former spouses) to continue healthcare coverage for up to 36 months. TCC enrollees must pay the full premium for the plan they select (that is, both the employee and Government shares of the premium) plus a 2 percent administrative charge. For more specific information about TCC, please contact your employing office's health benefits officer.
When is Open Season?
The US Office of Personnel Management (OPM) holds Open Season each year from the Monday of the second full workweek in November through the Monday of the second full workweek in December. Open Season for the 2009 benefit year will be conducted from November 10 — December 8, 2008. Your Open Season election generally will take effect the following January. Please contact your employing office's health benefits officer for additional information.
Where can I call to get benefit information about the Service Benefit Plan?
During Open Season, you may call our Open Season Information Center at 1.800.411.BLUE. You may also contact your local Blue Cross Blue Shield Plan year-round for information about the Service Benefit Plan. To locate the contact information for your Local Plan, please visit the Contact Us section of this Web site. For current members, you can also find the phone number on the back of your identification card.
Does Standard Option or Basic Option provide coverage if I am overseas?
Yes, the Service Benefit Plan provides overseas coverage for you and your covered family members through our 24-hour Worldwide Assistance Center. Please keep in mind that many overseas providers require payment upfront and there will be differences regarding coverage and reimbursement between coverage under Standard Option and Basic Option. For more information, please visit the Standard Option and Basic Option Overseas Benefits sections of this Web site or consult the Service Benefit Plan brochure.
What is the formulary list?
What are the benefits of a formulary list?
What if I want to take a medicine that is not on the formulary list?
Are generic medications as safe and effective as brand-name medications?
Why are generic drugs less expensive than brand-name drugs?
How can I find out if there is a generic medication for the brand-name drug that I am taking?
How do I find a participating pharmacy?
I have Standard Option. Based on the benefits, is it more beneficial for me to go to my retail pharmacy or through the Mail Service Prescription Drug Program?
I have Standard Option. Can you transfer my prescription from the Mail Service Prescription Drug Program to my local pharmacy?
I have Basic Option. How do I know what copayment I'll pay for the medicine I'm currently taking?
I have Basic Option. Why are there different copayment levels for different drugs?
I have Basic Option. Can I get my medicine from an out-of-network pharmacy?
What is the formulary list?
The formulary list is a list of medicines that are considered the preferred treatment for a patient's condition and that can be used as a guide for a doctor when prescribing medicine. The formulary list was developed by an independent panel of doctors and pharmacists who worked with the Service Benefit Plan to ensure that the medicines listed were the most clinically appropriate and cost-effective medicines. While your prescription medicine program is not limited to the drugs on the formulary list, using formulary medicines may reduce your out-of-pocket expense.
What are the benefits of a formulary list?
The formulary list:
- Promotes use of prescriptions that could improve patient care and contain costs
- Empowers the member to be an educated healthcare consumer
- May encourage members to discuss their prescription medicine treatment with their physicians
- Aids the physician in making informed decisions based on appropriate clinical and prescribing guidelines
What if I want to take a medicine that is not on the formulary list?
Medicines that are not listed on the formulary are considered Non-Preferred medicines. You may still receive benefits if you choose a Non-Preferred medicine; however, your out-of-pocket expenses will be greater.
Are generic medications as safe and effective as brand-name medications?
There are some myths about generic medications. Some people believe that generic medications are not as safe as their brand-name counterparts. Others believe that they are more likely to cause side effects than brand-name medications. The fact is that the FDA mandates that all FDA-approved medications, brand name and generic, must be safe and effective. In order to get FDA approval, the generic medication must contain the same active ingredients as the brand-name product and must meet the same strict quality standards. The generic medication must also be the equivalent in strength and dosage to the original brand-name medication.
Why are generic drugs less expensive than brand-name drugs?
It's expensive to create a new brand name drug and market it to the public. Generic drug manufacturers do not have those expenses, since they don't pay for the research that led to the discovery of the new drug. Therefore, the medications they produce can cost significantly less for the exact same ingredients, strengths and doses. Those savings are usually passed on to you through lower out-of-pocket costs when generics are selected. Generic medications could lower your out-of-pocket costs by up to 60 percent over the cost of a brand-name medication.
How can I find out if there is a generic medication for the brand-name drug that I am taking?
There are two ways to find out if the brand-name drug you are taking is available in generic form. You can go to our website at www.fepblue.org, and click on Pharmacy and then follow the prompts to the Standard Option mail or retail pharmacy, or Basic Option retail pharmacy and you will be taken to the pharmacy benefit manager's login page (Medco for mail service, Caremark for retail) If you do not have a login ID and password, follow the prompts to create one. Once you have logged in, follow the prompts to enter drug information. You can also contact the mail service and retail prescription programs at the following toll- free numbers and a customer service representative will assist you.
- Mail Service 800.262.7890
- Retail 800.624.5060
How do I find a participating pharmacy?
You can visit the Pharmacy section of this Web site or contact the Retail Pharmacy Program 1.800.624.5060 for the most up-to-date listing in your area.
I have Standard Option. Based on the benefits, is it more beneficial for me to go to my retail pharmacy or through the Mail Service Prescription Drug program?
This is a decision that is entirely up to you. In order to make an informed decision, you will need to determine the Service Benefit Plan Preferred retail price and your 25% contribution to the cost of the medication. You can then compare the retail coinsurance cost to the flat copayment of $35.00 for brand name medicines and $10.00 for generic medicines if you use the Mail Service Prescription program.
To make sure you are getting the best value check the website at www.fepblue.org, select Pharmacy and compare the cost of obtaining your medication at mail or retail by using the "price quote" feature on the retail program website. After selecting Standard Option Retail, you will be taken to Caremark.com. If you do not have a login ID and password, follow the prompts to create one. Once you have logged in, click on 'Check Drug Cost' on the left hand side of the page. On the Check Drug Cost page, select the participant's name and enter the name of the drug. Click the 'Search' button. Select the appropriate strength and click 'Continue'. On the next page, enter the quantity your doctor has prescribed and select a retail pharmacy. Click 'Get Results'. The next page will provide estimated copayment amounts for the brand and generic forms of the drug, if available, for both retail and mail order.
You can also contact the mail service and retail prescription programs at the following toll- free numbers and ask a customer service representative to assist you.
- Mail Service 800.262.7890
- Retail 800.624.5060
I have Standard Option. Can you transfer my prescription from the Mail Service Prescription Drug Program to my local pharmacy?
Yes. A valid prescription can be transferred from the Mail Service Prescription Drug Program to your participating retail pharmacy. However, once the prescription is transferred, a new prescription will be needed before the Mail Service Prescription Drug Program can dispense the medicine again.
I have Basic Option. How do I know what copayment I'll pay for the medicine I'm currently taking?
Under Basic Option, there are three copayment levels. The copayment levels are:
- $10 for generics
- $30 for Preferred brand name medicines
- 50 percent for Non-Preferred brand name drugs, with a minimum copayment of $35
You can find information on which level your medicines are in and the associated cost by visiting the "price quote" feature on the Retail Program Web site where you will be directed to Caremark.com. If you do not have a login ID and password, follow the prompts to create one. Once you have logged in, click on 'Check Drug Cost' on the left hand side of the page. On the Check Drug Cost page, select the participant's name and enter the name of the drug. Click the 'Search' button. Select the appropriate strength and click 'Continue'. On the next page, enter the quantity your doctor has prescribed and select a retail pharmacy. Click 'Get Results'. The next page will provide estimated copayment amounts for the brand and generic forms of the drug, if available, for both retail and mail order.
You may also contact the Retail Prescription Program at 800.624.5060 and a customer service representative will assist you.
I have Basic Option. Why are there different copayment levels for different drugs?
The cost of medicines varies greatly, even though there may be different medicines available to treat the same condition. Generic medicines typically offer the most savings and have the lowest copayment. Brand name medicines generally are more expensive and there can be many different brand name medicines at various cost levels available to treat the same condition.
I have Basic Option. Can I get my medicine from an out-of-network pharmacy?
If you obtain your medicine from an out-of-network pharmacy, you will be responsible for 100 percent of the medicine's cost.
Why has the cost share for brand-name drugs increased in both the mail service and retail programs?
Are generic drugs as good as brand-name drugs?
Are generic medications as safe and effective as brand-name medications?
Why are generic drugs less expensive than brand-name drugs?
How can I find out if there is a generic medication for the brand-name drug that I am taking?
I take 3 different generic medications. How many mail service refills will I get for a zero copayment?
I can only take the brand medication for my condition. Is it more cost effective for me to use mail service or retail?
I have tried a generic medication to treat my condition and it didn't work for me. Can I get the brand-name medication for the generic copayment or coinsurance?
The prescription I take doesn't have a generic equivalent. Can I pay only the generic copayment/coinsurance?
I take medication every day for a chronic condition. Is it more cost effective for me to use mail service or retail?
I take a brand-name Proton Pump Inhibitor on a daily basis. Can I switch to generic omeprazole for the lower generic copayment?
How do I know if a generic medication will work for me?
What's the most I can save in out-of-pocket costs by filling my mail service prescriptions as generics?
What strength of generic omeprazole will now be covered under the prescription benefit?
What if I send in my copayment for a brand medication and the drug is switched to a generic?
Why can't I get the first 4 generic prescriptions at my local drug store for no coinsurance?
I want to continue getting my medication from my local drug store. How will this benefit change affect me?
What is the difference between generic and brand-name drugs?
Who makes generic drugs?
Many federal plans have a different co-pay structure for "specialty" medications. Is there a different set of co-payments that apply to these medications under the FEP program as well?
We did not experience any changes in cost share when CVS/Caremark was the vendor for both the retail and the mail service programs. In 2008 Medco became the administrator of the mail service program and a year later we are faced with increased member cost share. Are these two facts related?
How can I locate a pharmacy that will administer flu shots?
Why has the cost share for brand-name drugs increased in both the mail service and retail programs?
The Service Benefit Plan has not increased member cost share in the prescription drug program since 2002, while prescriptions costs have continued to increase at a rate of 8 - 10% yearly. The average wholesale price (AWP) of a brand-name drug increased 142% between 2001 and 2007. The changes in copayments and coinsurance for 2009 reflect the ability to balance benefit costs, member cost share and the overall increases in the cost of prescription drugs.
Are generic drugs as good as brand-name drugs?
Generic medications have the same active ingredients, the chemicals that make medications work, as their brand-name equivalents. Generic drugs have the same quality and strength as brand-name drugs and must meet the same strict United States Food and Drug Administration (FDA) standards as brand-name drugs.
Are generic medications as safe and effective as brand-name medications?
There are some myths about generic medications. Some people believe that generic medications are not as safe as their brand-name counterparts. Others believe that they are more likely to cause side effects than brand-name medications. The fact is that the FDA mandates that all FDA-approved medications, brand name and generic, must be safe and effective. In order to get FDA approval, the generic medication must contain the same active ingredients as the brand-name product and must meet the same strict quality standards. The generic medication must also be the equivalent in strength and dosage to the original brand-name medication.
Why are generic drugs less expensive than brand-name drugs?
It's expensive to create a new brand name drug and market it to the public. Generic drug manufacturers do not have those expenses, since they don't pay for the research that led to the discovery of the new drug. Therefore, the medications they produce can cost significantly less for the exact same ingredients, strengths and doses. Those savings are usually passed on to you through lower out-of-pocket costs when generics are selected. Generic medications could lower your out-of-pocket costs by up to 60 percent over the cost of a brand-name medication.
How can I find out if there is a generic medication for the brand-name drug that I am taking?
A: There are two ways to find out if the brand-name drug you are taking is available in generic form. You can go to our website at www.fepblue.org, and click on Pharmacy and then follow the prompts to the Standard Option mail or retail pharmacy, or Basic Option retail pharmacy and you will be taken to the pharmacy benefit manager's login page (Medco for mail service, Caremark for retail) If you do not have a login ID and password, follow the prompts to create one. Once you have logged in, follow the prompts to enter drug information. You can also contact the mail service and retail prescription programs at the following toll- free numbers and a customer service representative will be glad to assist you.
- Mail Service 800.262.7890
- Retail 800.624.5060
I take 3 different generic medications. How many mail service refills will I get for a zero copayment?
In 2009, through the mail service benefit you will receive up to four (4) generic prescriptions (either initial fills and/or refills) at no cost to you. All additional prescriptions for generic medications will be available for a copayment of up-to $10.
I can only take the brand medication for my condition. Is it more cost effective for me to use mail service or retail?
You can compare which of the programs will be the most cost effective for you by checking the website at www.fepblue.org and selecting Pharmacy. You will be able to compare the cost of obtaining your medication at mail or retail by using the "price quote" feature on the Caremark retail website. After selecting Standard Option Retail, you will be taken to the Caremark.com login page. If you do not have a login ID and password, follow the prompts to create one. Once you have logged in, click on 'Check Drug Cost' on the left hand side of the page. On the Check Drug Cost page, select the participant's name and enter the brand-name of the drug. Click the 'Search' button. Select the appropriate strength and click 'Continue'. On the next page, enter the quantity your doctor has prescribed and select a retail pharmacy. Click 'Get Results'. The next page will provide estimated copayment amounts for the drug at both retail and mail order.
I have tried a generic medication to treat my condition and it didn't work for me. Can I get the brand-name medication for the generic copayment or coinsurance?
We realize some people may not be able to take a specific generic medication. However in this program, the cost share, even for brand-name medications remains quite low and covers a significant portion of the cost. In 2009, at mail service a 90-day supply of brand-name medication is available for a $65 flat copayment for the first 30 fills. After 30 fills the copayment will be reduced to $50 for 90-day supplies of brand-name medications at mail service. When you use a retail pharmacy, coinsurance will be 30%.
The prescription I take doesn't have a generic equivalent. Can I pay only the generic copayment/coinsurance?
Unfortunately, not all brand name drugs have a generic equivalent. You are responsible for the brand name copayment when a brand drug is dispensed, even if there is no generic equivalent. You should talk to your doctor about generic drugs and how you could reduce your prescription costs. Doctors often have several medication options they can prescribe for your condition. If your brand name drug does not have an equivalent generic drug, there may be another generic available to treat your condition.
I take medication every day for a chronic condition. Is it more cost effective for me to use mail service or retail?
Generally, it is more cost effective to obtain long term maintenance medication through mail service. However, there may be instances when it is more cost effective to get your prescription through retail. To make sure you are getting the best value check the website at www.fepblue.org select Pharmacy and compare the cost of obtaining your medication at mail or retail by using the "price quote" feature on the retail website. After selecting Standard Option Retail, you will be taken to Caremark.com. If you do not have a login ID and password, follow the prompts to create one. Once you have logged in, click on 'Check Drug Cost' on the left hand side of the page. On the Check Drug Cost page, select the participant's name and enter the name of the drug. Click the 'Search' button. Select the appropriate strength and click 'Continue'. On the next page, enter the quantity your doctor has prescribed and select a retail pharmacy. Click 'Get Results'. The next page will provide estimated copayment amounts for the brand and generic forms of the drug, if available, for both retail and mail order.
You can also contact the mail service and retail prescription programs at the following toll- free numbers and ask a customer service representative to assist you.
- Mail Service 800.262.7890
- Retail 800.624.5060
I take a brand-name Proton Pump Inhibitor on a daily basis. Can I switch to generic omeprazole for the lower generic copayment?
Generic medications have the same active ingredients (the chemicals that make medications work) as their brand-name equivalents. Generic omeprazole can be used to treat the same conditions as the brand products listed above, but only your doctor can decide if it is an appropriate course of therapy for you. Talk to your doctor about the medications you are taking and if generic substitution is appropriate for you.
How do I know if a generic medication will work for me?
Generic medications have the same active ingredients, which are the chemicals that make medications work, as their brand-name equivalents. Talk to your doctor about the medications you are taking and if a therapeutically equivalent generic substitution is appropriate for you.
What's the most I can save in out-of-pocket costs by filling my mail service prescriptions as generics?
The amount you save will depend on the number of prescriptions you take. The mail service program has a plan design where the first four generic prescriptions you fill through the mail service program in 2009 will be filled for a $0 co-payment. After that a $10 co-payment is required for each generic prescription. If you only take one prescription and you fill it with a generic medication each time, your 4 fills will equate to one free year of generic prescriptions.
What strength of generic omeprazole will now be covered under the prescription benefit?
All strengths of prescription omeprazole will be covered by the prescription benefit.
What if I send in my copayment for a brand medication and the drug is switched to a generic?
If your prescription is dispensed as a generic medication, you will have a credit on your account that will be applied to future prescription orders, or you can ask Medco to send you a check in the amount of the credit. If you don't use the credit within 120 days, Medco will send you a check automatically.
Why can't I get the first 4 generic prescriptions at my local drug store for no coinsurance?
The pharmacy benefit plan is designed to provide the most value to our members who take prescription drugs on an intermittent and long-term basis. The mail service pharmacy offers the best value when you need to take maintenance medications on a long-term basis. We are able to provide a better out-of-pocket cost to our members when they use the mail service pharmacy. When you purchase prescription drugs at a retail pharmacy, you are usually purchasing drugs for a short-term illness.
I want to continue getting my medication from my local drug store. How will this benefit change affect me?
In 2009, your coinsurance has decreased from 25 percent to 20 percent for generics. The coinsurance amount has increased from 25 percent to 30 percent for brand-name medications. You can get the best value by filling your prescriptions at a Preferred pharmacy with a generic medication. Generic medications have the same active ingredients, the chemicals that make medications work, as their brand-name equivalents, and generic medications must meet identical strict quality standards of the United States Food and Drug Administration (FDA).
What is the difference between generic and brand-name drugs?
Generally, the generic name of a drug is its chemical name. The brand-name is the trade name under which the drug is advertised and sold. Both contain the same active ingredients in the same dosage form and, by law, generic and brand name drugs must meet the same standards for safety, purity, strength and effectiveness before earning approval from the U.S. Food and Drug Administration (FDA).
Who makes generic drugs?
Nearly 80% of all generic drugs are made by the same pharmaceutical firms that manufacture the brand-name equivalents, and the rest are made by companies that actually specialize in the production and manufacturing of generic drugs. In either case, the same commitment to quality goes into the manufacturing of generics as in brand name drugs. All generic manufacturing facilities are inspected and approved by the FDA just like they are for brand name drugs.
Many federal plans have a different co-pay structure for "specialty" medications. Is there a different set of co-payments that apply to these medications under the FEP program as well?
In the FEP Program specialty products take the same co-payments at retail and mail that apply to all other covered prescription medications.
We did not experience any changes in cost share when CVS/Caremark was the vendor for both the retail and the mail service programs. In 2008 Medco became the administrator of the mail service program and a year later we are faced with increased member cost share. Are these two facts related?
The change to the member cost share structure in the prescription drug program is not related to the change in pharmacy benefit manager for mail service. The Service Benefit Plan has not increased member cost share in the prescription drug program since 2002, while prescriptions costs have continued to increase and now account for about 30% of the Service Benefit Plan health care costs. The changes in co-payments and coinsurance for 2009 reflect the ability to balance benefit costs, member cost share and the overall increases in the growth of prescription drug costs. To accomplish this and keep our benefits affordable to our members, it was necessary to change the prescription drug benefits.
How can I locate a pharmacy that will administer flu shots?
In 2009, we are pleased to offer a select group of preferred network pharmacies that will administer the flu vaccine at no cost to you. Pharmacy chains participating in this program include CVS, Safeway, Rite Aid and many others. For a list of participating pharmacies, please contact the Retail Pharmacy Program at 800-624-5060 for assistance.