2026 Blue Cross and Blue Shield Service Benefit Plan - Standard and Basic Option
Section 2. Changes for 2026
Page 16
Section 2. Changes for 2026
Page 16
Section 2. Changes for 2026
Do not rely only on these change descriptions; this Section is not an official statement of benefits. For that, go to Section 5 (Benefits). Also, we edited and clarified language throughout the brochure; any language change not shown here is a clarification that does not change benefits.
Changes to our Standard Option only
Changes to our Basic Option only
- There is no longer a reduced Preferred retail pharmacy Tier 1 (generic drug) benefit for members enrolled in our regular pharmacy drug program who have Medicare Part B as primary. You will pay the same cost-share as those who are enrolled in our regular pharmacy drug program that do not have Medicare Part B primary when purchased from a Preferred retail pharmacy. (See page 105.)
- There is no longer a reduced Tier 1 (generic drug) copayment for the Mail Service Prescription Drug Program for members enrolled in our regular prescription drug program who have Medicare Part B primary. You will pay the same cost-share as those enrolled in our regular prescription drug program who do not have Medicare Part B primary, when purchased through the Mail Service Prescription Drug Program. (See page 107.)
- For members enrolled in our regular pharmacy drug program, you are now responsible for a $140 copay for a Tier 2 (preferred brand-name drug) purchased through the Mail Service Prescription Drug Program. (See page 107.)
- For members enrolled in our regular pharmacy drug program, you are now responsible for $175 copay for Tier 3 (non-preferred brand-name drug) obtained through the Mail Order Service Prescription Drug Program. (See page 107.)
- For members enrolled in our regular pharmacy drug program, your Tier 4 (preferred specialty drug) copayment will be $100 for each purchase up to a 30-day supply ($300 copay for 31 to 90-day supply), when purchased through the Specialty Drug Pharmacy Program. (See page 108.)
- For members enrolled in our regular pharmacy drug program, your Tier 5 (non-preferred specialty drug) copayment will be $135 for each purchase up to a 30-day supply ($405 copay for 31 to 90-day supply), when purchased through the Specialty Drug Pharmacy Program. (See page 108.)
- For members enrolled in our regular prescription drug program, certain asthma controller medications under our Tier 2 (preferred brand-name drug) are now only a $35 copayment for each purchase of up to a 30-day supply ($105 copayment for a 31 to 90-day supply) when purchased at a Preferred retail pharmacy. (See page 108.)
Changes to our Basic Option only
- Your cost-share for oral and transdermal contraceptives is now 35% of the Plan allowance when obtained from a Preferred provider. (See page 52.)
- Your cost share for reproductive services is now 35% of the Plan allowance when obtained from a Preferred provider. (See page 53.)
- Your cost-share for certain vision services (testing, treatment and supplies) is now 35% of the Plan allowance when obtained from a Preferred provider. (See page 57.)
- Your cost-share for orthopedic and prosthetic devices is now 35% of the Plan allowance when obtained from a Preferred provider. (See page 59.)
- Your cost-share for durable medical equipment (DME) is now 35% of the Plan allowance when obtained from a Preferred provider. (See page 60.)
- Your cost-share for medical supplies is now 35% of the Plan allowance when obtained from a Preferred provider. (See page 61.)
- Your copayment for an inpatient admission is now a $425 per day copayment. (See pages 78, 85 and 97.)
- The copayment associated with the charges incurred during delivery will be waived if you give birth in a Blue Distinction Center for Maternity. (See page 78.)
- Your copayment for outpatient observation services performed and billed by a hospital or freestanding ambulatory facility is now a $425 per day copayment. (See page 81.)