PSHB Standard and Basic Options
2026 Blue Cross and Blue Shield Service Benefit Plan - Standard and Basic Option
Section 5. Benefits
Page 36
Section 5. Benefits
Page 36
Not Covered (Inpatient or Outpatient) - 98
Section 5(f). Prescription Drug Benefits - 100Covered Medications and Supplies - 105
Section 5(f)(a). FEP Medicare Prescription Drug Plan - 110Covered Medications and Supplies - 114
Section 5(g). Dental Benefits - 125Section 5(h). Wellness and Other Special Features - 129Health 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 - 134Services 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
Non-PSHB Benefits Available to Plan Members - 137