PSHB Standard and Basic Options
2026 Blue Cross and Blue Shield Service Benefit Plan - Standard and Basic Option
Index
Page 170
Index
Page 170
Medications and supplies - 105-109, 114-122
Member facilities - 14-15, 163-165
Mental health/substance use disorder - 19, 85-86, 95-99, 133
MRIs - 42-43, 80-84
Multiple procedures - 66-67
MyBlue Customer eService - 131
National Doctor & Hospital Finder - 131
Neurological testing - 42-43, 80-84
Never Events - 6-8, 163
Newborn care - 28, 41-42, 49-51
No Surprises Act (NSA) - 34
Non-member facilities - 14-15, 163-165
Non-participating providers - 14-15, 26, 163-165
Non-preferred providers - 31-34, 39
Non-PSHB benefits - 137
Nurse - 62-63, 87-89, 129
Nutritional counseling - 19, 41-42, 44-48, 78-80, 133
Observation care - 163
Obstetrical care - 49-51
Occupational therapy - 56-57, 87-89
Office visits - 41-42, 96-97
Oral surgery - 69
Organ/tissue transplants - 70, 73-75
Orthopedic devices - 59-60, 80-84
Osteopathic manipulative treatment - 63
Osteoporosis screening - 166
Ostomy and catheter supplies - 61-62
Out-of-pocket expenses - 31-36
Outpatient facility services - 84-85
Outpatient professional services - 41-42
Overpayments - 36
Overseas Assistance Center - 134
Overseas services, drugs, supplies and claims - 134-136
Oxygen - 61-62, 78-84
Pap tests - 44-48
Participating providers - 14-15
Patient Safety and Quality Monitoring (PSQM) Program - 102-103
Personal Health Record - 129
PET scans - 42-43, 80-84
Pharmacotherapy - 41-42, 55-56
Physical examination - 44-48, 80-84, 138-139
Physical therapy - 56-57, 87-89
Physician - 14-15, 19
Plan allowance - 31-34, 163-165
PPO - 14-15, 166
Pre-admission testing - 78-80
Precertification - 23, 26-27, 166
Preferred providers - 14-15, 19, 21-22
Pregnancy (see: Maternity care)
Pregnancy Care Incentive Program - 130-131
Prescription drugs
Prior approval - 23-27, 166
Professional providers - 19
Prostate cancer tests - 44-46
Prosthetic devices - 59-60, 78-84
Psychotherapy - 96-98
Pulmonary rehabilitation - 55-56, 80-84
Radiation therapy - 23-26, 55-56, 80-84
Reconsiderations - 28-29, 144-146
Renal dialysis - 55-56, 80-84
Replacement coverage - 13
Reproductive services - 23-26, 53-54
Retail Pharmacy Program - 100-101, 103-109, 135-136, 141-142
Rights and responsibilities - 14-15
Room and board - 78-80, 85-87, 97-98
Screening services - 166
Second surgical opinion - 41-42
Self-injectable drugs - 40, 65, 77, 80-84
Skilled nursing facility (SNF) care - 19-21, 86-87
Smoking cessation - 64, 117-122, 129
Social worker - 131-132
Specialty Drug Pharmacy Program - 100-101, 105-109, 135-136, 141-142
Specialty drugs - 101-103, 105-109, 111-112, 141-142, 167
Speech therapy - 56-57, 80-84, 87-89
Speech-Generating Devices - 60-61
Stem Cell Transplants - 70-75
Sterilization procedures - 51-53, 66-67
Subrogation - 149-150, 167
Substance use disorder - 19, 85-86, 95-99, 133
Surgery
Telehealth
Tobacco cessation - 64, 117-122, 129
Transplants - 23-26, 66-67, 70-75
Travel benefit - 74-75, 129
Treatment therapies - 55-56
TRICARE - 148-149
Ultrasounds - 42-43, 80-84
Urgent care center - 91-94
Urgent care claims - 27, 167-168
VA facilities - 36
Vision services - 57-58, 150
Waivers - 31
Weight control - 44-48
Wheelchairs - 60-61
Wigs - 59-60
X-rays - 42-43, 80-84
Member facilities - 14-15, 163-165
Mental health/substance use disorder - 19, 85-86, 95-99, 133
MRIs - 42-43, 80-84
Multiple procedures - 66-67
MyBlue Customer eService - 131
National Doctor & Hospital Finder - 131
Neurological testing - 42-43, 80-84
Never Events - 6-8, 163
Newborn care - 28, 41-42, 49-51
No Surprises Act (NSA) - 34
Non-member facilities - 14-15, 163-165
Non-participating providers - 14-15, 26, 163-165
Non-preferred providers - 31-34, 39
Non-PSHB benefits - 137
Nurse - 62-63, 87-89, 129
Nutritional counseling - 19, 41-42, 44-48, 78-80, 133
Observation care - 163
Obstetrical care - 49-51
Occupational therapy - 56-57, 87-89
Office visits - 41-42, 96-97
Oral surgery - 69
Organ/tissue transplants - 70, 73-75
Orthopedic devices - 59-60, 80-84
Osteopathic manipulative treatment - 63
Osteoporosis screening - 166
Ostomy and catheter supplies - 61-62
Out-of-pocket expenses - 31-36
Outpatient facility services - 84-85
Outpatient professional services - 41-42
Overpayments - 36
Overseas Assistance Center - 134
Overseas services, drugs, supplies and claims - 134-136
Oxygen - 61-62, 78-84
Pap tests - 44-48
Participating providers - 14-15
Patient Safety and Quality Monitoring (PSQM) Program - 102-103
Personal Health Record - 129
PET scans - 42-43, 80-84
Pharmacotherapy - 41-42, 55-56
Physical examination - 44-48, 80-84, 138-139
Physical therapy - 56-57, 87-89
Physician - 14-15, 19
Plan allowance - 31-34, 163-165
PPO - 14-15, 166
Pre-admission testing - 78-80
Precertification - 23, 26-27, 166
Preferred providers - 14-15, 19, 21-22
Pregnancy (see: Maternity care)
Pregnancy Care Incentive Program - 130-131
Prescription drugs
Brand-name drugs - 101-102, 105-109, 111-112
Drugs from other sources - 123-124
Generic drugs - 101-102, 111-113
Mail Service Prescription Drug Program - 100-102, 105-109, 114-117, 135-136, 141-142
Preferred retail pharmacies - 103-109, 117-122, 141-142
Retail Pharmacy Program - 100-101, 103-109, 135-136, 141-142
Self-injectable drugs - 40, 65, 77, 80-84
Specialty Drug Pharmacy Program - 100-101, 105-109, 135-136, 141-142
Specialty drugs - 101-103, 105-109, 111-112, 141-142, 167
Preventive carePrimary care provider - 19Drugs from other sources - 123-124
Generic drugs - 101-102, 111-113
Mail Service Prescription Drug Program - 100-102, 105-109, 114-117, 135-136, 141-142
Preferred retail pharmacies - 103-109, 117-122, 141-142
Retail Pharmacy Program - 100-101, 103-109, 135-136, 141-142
Self-injectable drugs - 40, 65, 77, 80-84
Specialty Drug Pharmacy Program - 100-101, 105-109, 135-136, 141-142
Specialty drugs - 101-103, 105-109, 111-112, 141-142, 167
Prior approval - 23-27, 166
Professional providers - 19
Prostate cancer tests - 44-46
Prosthetic devices - 59-60, 78-84
Psychotherapy - 96-98
Pulmonary rehabilitation - 55-56, 80-84
Radiation therapy - 23-26, 55-56, 80-84
Reconsiderations - 28-29, 144-146
Renal dialysis - 55-56, 80-84
Replacement coverage - 13
Reproductive services - 23-26, 53-54
Assisted reproductive technology (ART) - 159
Residential Treatment Center (RTC) - 19-21, 85-86, 97-98Retail Pharmacy Program - 100-101, 103-109, 135-136, 141-142
Rights and responsibilities - 14-15
Room and board - 78-80, 85-87, 97-98
Screening services - 166
Second surgical opinion - 41-42
Self-injectable drugs - 40, 65, 77, 80-84
Skilled nursing facility (SNF) care - 19-21, 86-87
Smoking cessation - 64, 117-122, 129
Social worker - 131-132
Specialty Drug Pharmacy Program - 100-101, 105-109, 135-136, 141-142
Specialty drugs - 101-103, 105-109, 111-112, 141-142, 167
Speech therapy - 56-57, 80-84, 87-89
Speech-Generating Devices - 60-61
Stem Cell Transplants - 70-75
Sterilization procedures - 51-53, 66-67
Subrogation - 149-150, 167
Substance use disorder - 19, 85-86, 95-99, 133
Surgery
Assistant surgeon - 21-22, 40, 65-67
Eye: cataract, amblyopia, strabismus - 57-58, 66-67
Multiple procedures - 66-67
Oral and maxillofacial - 69
Outpatient - 77, 163
Reconstructive - 68
Sterilization, reversal of voluntary - 51-53, 66-67
Surgical implants - 59-60, 80-84
Surgical treatment of severe obesity - 23-26, 66-67
Transplants - 23-26, 70-75
Syringes - 105-109, 114-117Eye: cataract, amblyopia, strabismus - 57-58, 66-67
Multiple procedures - 66-67
Oral and maxillofacial - 69
Outpatient - 77, 163
Reconstructive - 68
Sterilization, reversal of voluntary - 51-53, 66-67
Surgical implants - 59-60, 80-84
Surgical treatment of severe obesity - 23-26, 66-67
Transplants - 23-26, 70-75
Telehealth
Dermatology - 19, 41-42, 133, 167
Mental health/substance use disorder - 19, 133
Minor acute conditions - 19, 41-42, 133, 163
Nutritional counseling - 19, 44-48, 133
Temporary Continuation of Coverage (TCC) - 13Mental health/substance use disorder - 19, 133
Minor acute conditions - 19, 41-42, 133, 163
Nutritional counseling - 19, 44-48, 133
Tobacco cessation - 64, 117-122, 129
Transplants - 23-26, 66-67, 70-75
Travel benefit - 74-75, 129
Treatment therapies - 55-56
TRICARE - 148-149
Ultrasounds - 42-43, 80-84
Urgent care center - 91-94
Urgent care claims - 27, 167-168
VA facilities - 36
Vision services - 57-58, 150
Waivers - 31
Weight control - 44-48
Wheelchairs - 60-61
Wigs - 59-60
X-rays - 42-43, 80-84