2026 Blue Cross and Blue Shield Service Benefit Plan - Standard and Basic Option
Section 5. Benefits

 

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
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 - 65
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 - 77
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 - 91
Accidental Injury - 92
Medical Emergency - 93
Ambulance - 94
Section 5(e). Mental Health and Substance Use Disorder Benefits - 95
Professional Services - 96
Inpatient Hospital or Other Covered Facility - 97
Residential Treatment Center - 97
Outpatient Hospital or Other Covered Facility - 98
Not Covered (Inpatient or Outpatient) - 98
Section 5(f). Prescription Drug Benefits - 100
Covered Medications and Supplies - 105
Section 5(f)(a). FEP Medicare Prescription Drug Plan - 110
Covered Medications and Supplies - 114
Section 5(g). Dental Benefits - 125
Accidental Injury Benefit - 125
Dental Benefits - 126
Section 5(h). Wellness and Other Special Features - 129
Health Tools - 129
Services for the Deaf and Hearing Impaired - 129
Web Accessibility for the Visually Impaired - 129
Travel Benefit/Services Overseas - 129
Healthy Families - 129
Diabetes Management Program - 129
Blue Health Assessment - 129
Hypertension Management Program - 130
Pregnancy Care Incentive Program - 130
Annual Incentive Limitation - 131
Reimbursement Account for Basic Option Members Enrolled in Medicare Part A and Part B - 131
MyBlue® Customer eService - 131
National Doctor & Hospital Finder - 131
Care Management Programs - 131
Flexible Benefits Option - 132
Telehealth Services - 133
The fepblue Mobile Application - 133
Weight Loss Management Program - 133
Section 5(i). Services, Drugs, and Supplies Provided Overseas - 134
Non-PSHB Benefits Available to Plan Members - 137