Fepblue basic pdf calendar

Ppo 1 of 6 the summary of benefits and coverage sbc document will help you choose a health plan. Under basic option, there is no calendar year deductible. Blue cross and blue shield service benefit plan opm. Under basic option, benefits are not available for services performed by nonpreferred providers, except in certain situations such as emergency care. Blue cross and blue shield service benefit plan fep blue. Ppo 1 of 6 the summary of benefits and coverage sbc document will. To see a complete list of exclusions, download the fep blue focus brochure at brochure. Basic option benefits chart blue cross and blue shields. The calendar year refers to the plan year, which is defined as january 1. Nothing for the first 4 prescription fills or refills when you switch from certain brand name drugs to. You pay nothing for preventive dental services up to 2 cleanings a year. Below is an overview of available benefits for basic option members using a preferred provider. If you need to send in a paper claim you may download a claim form from fep. If you are covered under the fep medical basic option and fep bluedental, you are.

You can receive a free manual or electric ameda breast pump kit each year through the. Basic option does not have a calendar year deductible. Benefit coverage deductible there is no deductible. Cross and blue shield service benefit plan brochure fep blue focus. Basic option and fep blue focus members can only use preferred providers. Breast pump kit, limited to one of the two kits listed below, per calendar year, for members who are pregnant andor nursing. Create calendar pdf with holidays of any country using our online tool. Were excited to offer a third plan with our existing standard and basic option plans. A printable 2020 calendar pdf template with the prior and next month. You can combine this discount with the hearing aid benefit above.

These are tests not related to pregnancy, preventive care or accidental injury. Download the 2020 blue cross and blue shield service benefit plan brochure standard and basic. See section 5f of the 2017 service benefit plan brochure for more information on pharmacy benefits. Diagnostic and preventive payable at 100% of the ppo fee schedule with no deductible. A printable 2020 monthly calendar pdf template with us holidays in landscape format. Certificationcertificationandcompliancdownloadsapprovedtransplantprograms. Blue cross and blue shield service benefit plan fep. Plus one or self and family, or vice versa, during the calendar year, please call.

Dental benefits standard option members can receive topical application of fluoride or fluoride. The sbc shows you how you and the plan would share the cost for covered health care services. Blue cross and blue shields federal employee program. Self only, self plus one or self and family plan type.