FEP Blue Focus®
Get quality health care coverage that’s easy on your wallet, plus access to a network with over 2 million doctors and hospitals and over 55,000 retail pharmacies.
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 copayTier 2 (Preferred brand): 40% of our allowance ($350 maximum)2 Mail Service Pharmacy: 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 |
| 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.