PSHB Standard and Basic Options
2026 Blue Cross and Blue Shield Service Benefit Plan - Standard and Basic Option
Section 5. Benefits
Page 37
Section 5. Benefits
Page 37
Section 5. Benefits
See Section 2 for how our benefits changed this year. The Summary of Benefits is the benefits summary of each option. Make sure that you review the benefits that are available under the option in which you are enrolled.
Section 5. Standard and Basic Option Overview - 39
Section 5(a). Medical Services and Supplies Provided by Physicians and Other Healthcare Professionals - 40
Section 5. Standard and Basic Option Overview - 39
Section 5(a). Medical Services and Supplies Provided by Physicians and Other Healthcare Professionals - 40
Diagnostic and Treatment Services - 41
Lab, X-ray and Other Diagnostic Tests - 42
Preventive Care, Adult - 44
Preventive Care, Child - 47
Maternity Care - 49
Family Planning - 51
Reproductive Services - 53
Allergy Care - 54
Treatment Therapies - 55
Physical Therapy, Occupational Therapy, Speech Therapy, and Cognitive Rehabilitation Therapy - 56
Hearing Services (Testing, Treatment, and Supplies) - 57
Vision Services (Testing, Treatment, and Supplies) - 57
Foot Care - 59
Orthopedic and Prosthetic Devices - 59
Durable Medical Equipment (DME) - 60
Medical Supplies - 61
Home Health Services - 62
Manipulative Treatment - 63
Alternative Treatments - 63
Educational Classes and Programs - 64
Section 5(b). Surgical and Anesthesia Services Provided by Physicians and Other Healthcare Professionals - 65Lab, X-ray and Other Diagnostic Tests - 42
Preventive Care, Adult - 44
Preventive Care, Child - 47
Maternity Care - 49
Family Planning - 51
Reproductive Services - 53
Allergy Care - 54
Treatment Therapies - 55
Physical Therapy, Occupational Therapy, Speech Therapy, and Cognitive Rehabilitation Therapy - 56
Hearing Services (Testing, Treatment, and Supplies) - 57
Vision Services (Testing, Treatment, and Supplies) - 57
Foot Care - 59
Orthopedic and Prosthetic Devices - 59
Durable Medical Equipment (DME) - 60
Medical Supplies - 61
Home Health Services - 62
Manipulative Treatment - 63
Alternative Treatments - 63
Educational Classes and Programs - 64
Surgical Procedures - 66
Reconstructive Surgery - 68
Oral and Maxillofacial Surgery - 69
Organ/Tissue Transplants - 70
Anesthesia - 75
Section 5(c). Services Provided by a Hospital or Other Facility, and Ambulance Services - 77Reconstructive Surgery - 68
Oral and Maxillofacial Surgery - 69
Organ/Tissue Transplants - 70
Anesthesia - 75
Inpatient Hospital - 78
Outpatient Hospital or Ambulatory Surgical Center - 80
Blue Distinction® Specialty Care - 84
Residential Treatment Center - 85
Extended Care Benefits/Skilled Nursing Care Facility Benefits - 86
Hospice Care - 87
Ambulance - 89
Section 5(d). Emergency Services/Accidents - 91Section 5(e). Mental Health and Substance Use Disorder Benefits - 95
Outpatient Hospital or Ambulatory Surgical Center - 80
Blue Distinction® Specialty Care - 84
Residential Treatment Center - 85
Extended Care Benefits/Skilled Nursing Care Facility Benefits - 86
Hospice Care - 87
Ambulance - 89