Document Number:
PSB26-051
Revision #:
v1.0
Date Published:
1/1/2026
 

 

2026 Blue Cross and Blue Shield Service Benefit Plan - Standard and Basic Option
Section 5(a). Medical Services and Supplies Provided by Physicians and Other Healthcare Professionals
Page 51

 

Benefit Description

Maternity Care (cont.)
 
  • Breast pump, limited to one per calendar year for members who are pregnant and/or nursing
     
  • Blood pressure monitor, limited to one every two years

Note: Benefits for the breast pump, milk storage bags, and blood pressure monitors are only available when you order them through our fulfillment vendor by visiting www.fepblue.org/maternity or calling
1-800-411-2583. Milk storage bags will be included with your breast pump.


Standard Option - You Pay
Nothing (no deductible)

Basic Option - You Pay
Nothing

 

Benefit Description

Not covered:
 
  • Procedures, services, drugs, and supplies related to abortions except when the life of the mother would be endangered if the fetus were carried to term or when the pregnancy is the result of an act of rape or incest
     
  • Childbirth preparation, Lamaze, and other birthing/parenting classes
     
  • Doula, birth companion, and similar supporter
     
  • Breast pumps and milk storage bags except as previously noted
     
  • Breastfeeding supplies other than those contained in the breast pump kit previously described including clothing (e.g., nursing bras), baby bottles, or items for personal comfort or convenience (e.g., nursing pads)
     
  • Tocolytic therapy and related services except as previously described 
     
  • Maternity care for individuals not enrolled in the Service Benefit Plan
     

Standard Option - You Pay
All charges

Basic Option - You Pay
All charges

 

Benefit Description

Family Planning
A range of voluntary family planning services, without cost-sharing, that includes at least one form of contraception in each of the categories in the HRSA-supported guidelines. This list includes:
 
  • Contraceptive counseling
     
  • Diaphragms and contraceptive rings
     
  • Injectable contraceptives
     
  • Intrauterine devices (IUDs)
     
  • Implantable contraceptives
     
  • Salpingectomy
     
  • Tubal ligation or tubal occlusion/tubal blocking procedures only
     
  • Vasectomy