2026 Blue Cross and Blue Shield Service Benefit Plan - Standard and Basic Option
Section 2. Changes for 2026
Page 16

 

Section 2. Changes for 2026

 

Do not rely only on these change descriptions; this Section is not an official statement of benefits. For that, go to Section 5 (Benefits). Also, we edited and clarified language throughout the brochure; any language change not shown here is a clarification that does not change benefits.
 

 

Changes to our Standard Option only
 
  • There is no longer a reduced Preferred retail pharmacy Tier 1 (generic drug) benefit for members enrolled in our regular pharmacy drug program who have Medicare Part B as primary. You will pay the same cost-share as those who are enrolled in our regular pharmacy drug program that do not have Medicare Part B primary when purchased from a Preferred retail pharmacy. (See page 105.)
     
  • There is no longer a reduced Tier 1 (generic drug) copayment for the Mail Service Prescription Drug Program for members enrolled in our regular prescription drug program who have Medicare Part B primary. You will pay the same cost-share as those enrolled in our regular prescription drug program who do not have Medicare Part B primary, when purchased through the Mail Service Prescription Drug Program. (See page 107.)
     
  • For members enrolled in our regular pharmacy drug program, you are now responsible for a $140 copay for a Tier 2 (preferred brand-name drug) purchased through the Mail Service Prescription Drug Program. (See page 107.)
     
  • For members enrolled in our regular pharmacy drug program, you are now responsible for $175 copay for Tier 3 (non-preferred brand-name drug) obtained through the Mail Order Service Prescription Drug Program. (See page 107.)
     
  • For members enrolled in our regular pharmacy drug program, your Tier 4 (preferred specialty drug) copayment will be $100 for each purchase up to a 30-day supply ($300 copay for 31 to 90-day supply), when purchased through the Specialty Drug Pharmacy Program. (See page 108.)
     
  • For members enrolled in our regular pharmacy drug program, your Tier 5 (non-preferred specialty drug) copayment will be $135 for each purchase up to a 30-day supply ($405 copay for 31 to 90-day supply), when purchased through the Specialty Drug Pharmacy Program. (See page 108.)
     
  • For members enrolled in our regular prescription drug program, certain asthma controller medications under our Tier 2 (preferred brand-name drug) are now only a $35 copayment for each purchase of up to a 30-day supply ($105 copayment for a 31 to 90-day supply) when purchased at a Preferred retail pharmacy. (See page 108.)

Changes to our Basic Option only
 
  • Your cost-share for oral and transdermal contraceptives is now 35% of the Plan allowance when obtained from a Preferred provider. (See page 52.)
     
  • Your cost share for reproductive services is now 35% of the Plan allowance when obtained from a Preferred provider. (See page 53.)
     
  • Your cost-share for certain vision services (testing, treatment and supplies) is now 35% of the Plan allowance when obtained from a Preferred provider. (See page 57.)
     
  • Your cost-share for orthopedic and prosthetic devices is now 35% of the Plan allowance when obtained from a Preferred provider. (See page 59.)
     
  • Your cost-share for durable medical equipment (DME) is now 35% of the Plan allowance when obtained from a Preferred provider. (See page 60.)
     
  • Your cost-share for medical supplies is now 35% of the Plan allowance when obtained from a Preferred provider. (See page 61.)
     
  • Your copayment for an inpatient admission is now a $425 per day copayment. (See pages 78, 85 and 97.)
     
  • The copayment associated with the charges incurred during delivery will be waived if you give birth in a Blue Distinction Center for Maternity. (See page 78.)
     
  • Your copayment for outpatient observation services performed and billed by a hospital or freestanding ambulatory facility is now a $425 per day copayment. (See page 81.)