PSHB Standard and Basic Options
2026 Blue Cross and Blue Shield Service Benefit Plan - Standard and Basic Option
Index
Index
Index
Do not rely only on this page; it is for your convenience and may not show all pages where the terms appear. This Index is not an official statement of benefits.
Abortion - 49-51, 138-139
Accidental injury - 91-94, 125-126, 159
Acupuncture - 63-64, 75-76, 80-84
Affordable Care Act (ACA) - 117-122
Allergy care - 54-55
Allogeneic transplants - 71-74
Alternative treatments - 63-64
Ambulance - 89-90
Ambulatory surgical center - 19-21, 80-84
Anesthesia - 75-76
Angiographies - 42-43, 80-84
Appeals - 29, 113-114
Applied behavior analysis (ABA) - 55-56, 80-84
Assistant surgeon - 21-22, 49-51, 66-67
Autism spectrum disorder - 55-56, 80-84
Autologous transplants - 70-74
Average wholesale price (AWP) - 163-165
Biopsies - 44-46, 66-67, 80-84
Birthing centers - 19-21
Blood and blood plasma - 61-62, 80-84
Blood or marrow stem cell transplants - 70-75
Blue Distinction Centers - 19-21, 74-75Blue Distinction Specialty Care - 19-21
Blue Health Assessment - 129-130, 162
Bone density tests - 42-43, 80-84
Brand-name drugs - 101-102, 105-109, 111-112
Breast pump and supplies - 49-51, 60-61
Breast reconstruction - 68Breastfeeding support and supplies - 49-51
Cancer tests - 44-46
Cardiac rehabilitation - 55-56, 80-84
Cardiovascular monitoring - 42-43, 80-84
Care Management Programs - 131-132
Case management - 131-132
Casts - 66-67, 78-84
Catastrophic protection - 35-36, 113-114
Cervical cancer screening - 44-48
CHAMPVA - 148-149
Changes for 2026 - 16-18
Chemotherapy - 55-56, 80-84
Children’s Equity Act - 11
Chiropractic manipulative treatment - 63
Cholesterol tests - 44-46
Circumcision - 49-51, 66-67
Claims and claims filing - 140
Clinic visits - 41-42, 96-97
Clinical trials - 73, 150-151, 160
Cognitive rehabilitation - 56-57, 80-84
Coinsurance - 31-34
Colorectal cancer testsConfidentiality - 14-15
Congenital anomalies - 66-67, 160
Consultations - 41-42, 96-97
Contact lenses - 57-58
Contraceptive devices and drugs - 51-53, 105-109, 114-122
Coordination of benefits - 148-158
Copayments - 30
Cosmetic surgery - 66-67, 160
Cost-sharing - 30
Costs for covered services - 30-36
Coverage information - 9
Covered facility providers - 19-21
Covered professional providers - 19
Cryopreservation - 53-54
CT scans - 42-43, 80-84
Custodial care - 78-80, 138-139, 160
Daily Habits - 129
Deductible - 30
Definitions - 159-168
Dental care - 69, 125-128
Diabetes Management Program - 129
Diabetic education - 64, 80-84
Diabetic supplies
Diagnostic tests - 42-43, 49-51, 95-99
Dialysis - 19-21, 55-56, 60-61, 80-84
Disease Management - 131-132
Disputed claims process - 144-147
Divorce - 12
DNA analysis of stool samples - 44-46
Donor expenses (transplants) - 53-54, 73-75
Drugs (see: Prescription drugs)
Durable medical equipment (DME) - 60-61Educational classes and programs - 64
EEGs - 42-43, 80-84
EKGs - 42-43, 80-84
Emergency - 21-22, 28, 91-94
Enrollment - 9-10
Exception situations - 21-23
Exclusions - 138-139
Experimental or investigational - 161
Extended care benefits - 86-87
Eyeglasses - 57-58
Facility providers - 14-15, 19-21
Family planning - 51-53
Fecal occult blood test - 44-46
FEDVIP - 125, 150
fepblue mobile application - 133
fepblue.org - 4
Flexible benefits option - 132-133
Foot care - 59
Formulary/Preferred drug list - 101-102, 111-112
Foundation for the Accreditation of Cellular Therapy (FACT) accredited facility - 19-21, 70
Fraud - 4
Freestanding ambulatory facilities - 19-21
Generic drugs - 101-102, 111-113
Generic Incentive Program - 103-105
Genetic screening/testing - 23-26, 42-43, 80-84
Health Insurance Marketplace - 13
Health tools - 129
Healthy Families - 129
Hearing aids and hearing services - 23-26, 57, 59-60
Home health services - 62-63
Home nursing care (maternity) - 62-63
Hospice care - 87-89
HospitalHuman papillomavirus (HPV) tests - 44-48
Hypertension Management Program - 130
Iatrogenic infertility - 53-54
Immunizations - 44-48, 117-122
Inpatient hospital benefits - 78-80
Inpatient professional services - 41-42, 96-97
Insulin - 105-109, 114-117
Insulin pumps - 60-61
Laboratory and pathology services - 42-43, 78-84, 91-94
Low-dose CT screening - 166
Mail Service Prescription Drug Program - 100-102, 105-109, 114-117, 135-136, 141-142
Mammograms - 44-46
Manipulative treatment - 63, 80-84
Maternity care - 49-51
Maxillofacial surgery - 69, 126
Medicaid - 149
Medical emergency - 21-22, 91-94
Medical foods - 61-62, 103-109, 113-117, 162
Medical supplies - 61-62
Medically necessary - 162-163
Medicare - 1, 148-158
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
Accidental injury - 91-94, 125-126, 159
Acupuncture - 63-64, 75-76, 80-84
Affordable Care Act (ACA) - 117-122
Allergy care - 54-55
Allogeneic transplants - 71-74
Alternative treatments - 63-64
Ambulance - 89-90
Ambulatory surgical center - 19-21, 80-84
Anesthesia - 75-76
Angiographies - 42-43, 80-84
Appeals - 29, 113-114
Applied behavior analysis (ABA) - 55-56, 80-84
Assistant surgeon - 21-22, 49-51, 66-67
Autism spectrum disorder - 55-56, 80-84
Autologous transplants - 70-74
Average wholesale price (AWP) - 163-165
Biopsies - 44-46, 66-67, 80-84
Birthing centers - 19-21
Blood and blood plasma - 61-62, 80-84
Blood or marrow stem cell transplants - 70-75
Blue Distinction Centers - 19-21, 74-75Blue Distinction Specialty Care - 19-21
Blue Health Assessment - 129-130, 162
Bone density tests - 42-43, 80-84
Brand-name drugs - 101-102, 105-109, 111-112
Breast pump and supplies - 49-51, 60-61
Breast reconstruction - 68Breastfeeding support and supplies - 49-51
Cancer tests - 44-46
Cardiac rehabilitation - 55-56, 80-84
Cardiovascular monitoring - 42-43, 80-84
Care Management Programs - 131-132
Case management - 131-132
Casts - 66-67, 78-84
Catastrophic protection - 35-36, 113-114
Cervical cancer screening - 44-48
CHAMPVA - 148-149
Changes for 2026 - 16-18
Chemotherapy - 55-56, 80-84
Children’s Equity Act - 11
Chiropractic manipulative treatment - 63
Cholesterol tests - 44-46
Circumcision - 49-51, 66-67
Claims and claims filing - 140
Clinic visits - 41-42, 96-97
Clinical trials - 73, 150-151, 160
Cognitive rehabilitation - 56-57, 80-84
Coinsurance - 31-34
Colorectal cancer testsConfidentiality - 14-15
Congenital anomalies - 66-67, 160
Consultations - 41-42, 96-97
Contact lenses - 57-58
Contraceptive devices and drugs - 51-53, 105-109, 114-122
Coordination of benefits - 148-158
Copayments - 30
Cosmetic surgery - 66-67, 160
Cost-sharing - 30
Costs for covered services - 30-36
Coverage information - 9
Covered facility providers - 19-21
Covered professional providers - 19
Cryopreservation - 53-54
CT scans - 42-43, 80-84
Custodial care - 78-80, 138-139, 160
Daily Habits - 129
Deductible - 30
Definitions - 159-168
Dental care - 69, 125-128
Diabetes Management Program - 129
Diabetic education - 64, 80-84
Diabetic supplies
Diabetic Meter Program - 105-109
Insulin pumps - 60-61
Insulin, test strips, and lancets - 105-109, 114-117
Needles and disposable syringes - 105-109, 114-117
Diagnostic and treatment services - 41-42, 80-84Insulin pumps - 60-61
Insulin, test strips, and lancets - 105-109, 114-117
Needles and disposable syringes - 105-109, 114-117
Diagnostic tests - 42-43, 49-51, 95-99
Dialysis - 19-21, 55-56, 60-61, 80-84
Disease Management - 131-132
Disputed claims process - 144-147
Divorce - 12
DNA analysis of stool samples - 44-46
Donor expenses (transplants) - 53-54, 73-75
Drugs (see: Prescription drugs)
Durable medical equipment (DME) - 60-61Educational classes and programs - 64
EEGs - 42-43, 80-84
EKGs - 42-43, 80-84
Emergency - 21-22, 28, 91-94
Enrollment - 9-10
Exception situations - 21-23
Exclusions - 138-139
Experimental or investigational - 161
Extended care benefits - 86-87
Eyeglasses - 57-58
Facility providers - 14-15, 19-21
Family planning - 51-53
Fecal occult blood test - 44-46
FEDVIP - 125, 150
fepblue mobile application - 133
fepblue.org - 4
Flexible benefits option - 132-133
Foot care - 59
Formulary/Preferred drug list - 101-102, 111-112
Foundation for the Accreditation of Cellular Therapy (FACT) accredited facility - 19-21, 70
Fraud - 4
Freestanding ambulatory facilities - 19-21
Generic drugs - 101-102, 111-113
Generic Incentive Program - 103-105
Genetic screening/testing - 23-26, 42-43, 80-84
Health Insurance Marketplace - 13
Health tools - 129
Healthy Families - 129
Hearing aids and hearing services - 23-26, 57, 59-60
Home health services - 62-63
Home nursing care (maternity) - 62-63
Hospice care - 87-89
HospitalHuman papillomavirus (HPV) tests - 44-48
Hypertension Management Program - 130
Iatrogenic infertility - 53-54
Immunizations - 44-48, 117-122
Inpatient hospital benefits - 78-80
Inpatient professional services - 41-42, 96-97
Insulin - 105-109, 114-117
Insulin pumps - 60-61
Laboratory and pathology services - 42-43, 78-84, 91-94
Low-dose CT screening - 166
Mail Service Prescription Drug Program - 100-102, 105-109, 114-117, 135-136, 141-142
Mammograms - 44-46
Manipulative treatment - 63, 80-84
Maternity care - 49-51
Maxillofacial surgery - 69, 126
Medicaid - 149
Medical emergency - 21-22, 91-94
Medical foods - 61-62, 103-109, 113-117, 162
Medical supplies - 61-62
Medically necessary - 162-163
Medicare - 1, 148-158
Reimbursement account
Medications and supplies - 105-109, 114-122Member 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