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Compare Our Plans

See the differences between benefits and coverage for our three plan options side by side.

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Coronavirus Update

FEP will waive any copays or deductibles for medically necessary diagnostic tests or treatment that are consistent with CDC guidance if diagnosed with COVID-19.

Learn more here.

Get the Details

Get a convenient summary of these coverage options.

 Download the 2021 Benefit Summary Book

Standard Option

• Has a deductible
• Can see any provider, even outside the network
• Out-of-pocket costs include deductible, copays and coinsurance
• Access to Mail Service Pharmacy Program
• Earn up to $170 in rewards with the Wellness Incentive Program

Basic Option

• Has no deductible
• Must see Preferred providers
• Most out-of-pocket costs are copays
• Can get Medicare Part B premium reimbursement
• Earn up to $170 in rewards with the Wellness Incentive Program

 

FEP Blue Focus

• Has a deductible
• Must see Preferred providers
• Out-of-pocket costs include deductible, copays and coinsurance
• Earn a reward for getting annual physical

Standard Option

Enrollment code Bi-weekly Monthly
Self
(104)
$123.45 $267.48
Self + 1
(106)
$280.81 $608.43
Self & Family
(105)
$300.12 $650.26

Basic Option

Enrollment code Bi-weekly Monthly
Self
(111)
$78.60 $170.31
Self + 1
(113)
$189.17 $409.87
Self & Family
(112)
$201.27 $436.08

FEP Blue Focus

Enrollment code Bi-weekly Monthly
Self
(131)
$53.14 $115.15
Self + 1
(133)
$114.25 $247.55
Self & Family
(132)
$125.67 $272.29

Standard Option

Enrollment code Bi-weekly Category 1 Bi-weekly Category 2
Self
(104)
$120.09 $110.03
Self + 1
(106)
$273.62 $252.06
Self & Family
(105)
$292.31 $268.89

Basic Option

Enrollment code Bi-weekly Category 1 Bi-weekly Category 2
Self
(111)
$75.46 $65.24
Self + 1
(113)
$181.98 $160.42
Self & Family
(112)
$193.46 $170.04

FEP Blue Focus

Enrollment code Bi-weekly Category 1 Bi-weekly Category 2
Self
(131)
$51.02 $44.11
Self + 1
(133)
$109.68 $94.83
Self & Family
(132)
$120.65 $104.31
These rates do not apply to all enrollees. If you are in a special enrollment category, contact the agency or Tribal employer that manages your health benefits enrollment.

Compare Benefit Options

See costs for typical services when you use Preferred providers.

  Download the 2021 Benefits at a Glance brochure

Standard Option Basic Option FEP Blue Focus
Preventive Care You pay nothing You pay nothing You pay nothing
Physician Care $25 for primary care
$35 for specialists
$30 for primary care1
$40 for specialists1
$10 per visit for your first 10 primary
and/or specialty care visits combined medical and mental health substance use1
Virtual doctor visits by Teladoc® $0 for first 2 visits
$10 all additional visits
$0 for first 2 visits
$15 all additional visits
$0 for first 2 visits
$10 all additional visits
Urgent Care Center Accidental Injury: $0
Medical Emergency: $30 copay
$35 copay $25 copay
Prescription Drugs Preferred Retail Pharmacy^:
If you have Medicare Part B primary, your costs for prescription drugs may be lower. 
Tier 1 (Generics): $7.50 copay
Tier 2 (Preferred brand): 30% of our allowance
Tier 3 (Non-preferred brand): 50% of our allowance
Tier 4 (Preferred specialty): 30% of our allowance
Tier 5 (Non-preferred specialty): 30% of our allowance

Mail Service Pharmacy:
Tier 1 (Generics): $15 copay
Tier 2 (Preferred brand): $90 copay
Tier 3 (Non-preferred brand): $125 copay

Specialty Pharmacy:
Tier 4 (Preferred specialty): $65
copay
Tier 5 (Non-preferred specialty): $85 copay
Preferred Retail Pharmacy^:

If you have Medicare Part B primary, your costs for prescription drugs may be lower.

Tier 1 (Generics): $10 copay

Tier 2 (Preferred brand): $55 copay

Tier 3 (Non-preferred brand): 60% of our allowance ($75 minimum)

Tier 4 (Preferred specialty): $65 copay

Tier 5 (Non-preferred specialty): $90 copay

 

Mail Service Pharmacy:

Available to members with Medicare Part B primary only. Visit the Medicare page for more information.

Tier 1 (Generics):  $20

Tier 2 (Preferred brand): $100 copay

Tier 3 (Non-preferred brand):  $125 copay

 

Specialty Pharmacy:

Tier 4 (Preferred specialty): $85 copay

Tier 5 (Non-preferred specialty): $110 copay

Preferred Retail Pharmacy^:

Tier 1 (Generics): $5 copay

Tier 2 (Preferred brand): 40% of our allowance ($350 max)

 

Mail Service Pharmacy:

Not a benefit

 

Specialty Pharmacy:

Tier 2 (Preferred Generic specialty, and Preferred brand specialty): 40% of our allowance ($350 maximum)

Maternity Care $0 copay $175 inpatient
$0
outpatient

$0 for doctor's visits

$1,500 for facility care

Hospital Care Inpatient (Precertification is required): $350 per admission
Outpatient: 15% of our allowance*
Inpatient (Precertification is required): $175 per day; up to $875 per admission
Outpatient: $100 per day per facility1
Inpatient (Precertification is required): 30% of our allowance*
Outpatient: 30% of our allowance*
Surgery

15% of our allowance*

$150 in an office setting1
$200
in a non-office setting1

30% of our allowance*

ER (accidental injury) $0 within 72 hours $175 per day per facility $0 within 72 hours
ER (medical emergency) 15% of our allowance* $175 per day per facility 30% of our allowance*
Lab work (such as blood tests) 15% of our allowance* $0 copay1 $0 for first 10 specific lab tests**
Diagnostic services (such as sleep studies, CT scans) 15% of our allowance* Up to $100 in an office1
Up to $150 in a hospital1
30% of our allowance*
Chiropractic Care $25 per visit; up to 12 visits per year $30 per visit; up to 20 visits per year1 $25 per visit; for up to 10 visits a year1,2
Dental Care The difference between the fee schedule amount and the Maximum Allowable Charge (MAC)

$30 per evaluation; up to 2 evaluations per year

Not a benefit

Rewards Program

Earn $50 for completing the Blue Health Assessment3

Earn up to $120 for completing three eligible Online Health Coach goals3

Earn $50 for completing the Blue Health Assessment3

Earn up to $120 for completing three eligible Online Health Coach goals3

Earn a reward, such as a Fitbit®, at no out-of-pocket cost for getting an annual physical4
Network Coverage In-network and out-of-network care In-network care only, except in certain situations like emergency care In-network care only, except in certain situations like emergency care
Out-of-Pocket Maximum (PPO) Self Only: $5,000
Self + One and Self & Family: $10,000
Self Only: $5,500
Self + One and Self & Family: $11,000
Self Only: $7,500
Self + One and Self & Family: $15,000
Annual Deductible

Self Only: $350

Self + One and Self & Family: $700

No deductible

Self Only: $500

Self + One and Self & Family: $1,000


Standard Option Plan Page

Basic Option Plan Page

FEP Blue Focus Plan Page

Cost sharing may not apply or may be different if Medicare is your primary coverage (it pays first).

* Deductible applies.
** Please see brochure for covered lab services.
^ What you’ll pay for a 30-day supply of covered drugs.
1 You pay 30% of our allowance for agents, drugs and/or supplies you receive during your care.
2 Up to 10 visits combined for chiropractic care and acupuncture.
3 You must be the contract holder or spouse, 18 or older, on a Standard or Basic Option plan to earn incentive rewards.
4 You must be the contract holder or spouse, 18 or older, on an FEP Blue Focus plan to earn this reward.

This is a summary of the features of the Blue Cross and Blue Shield Service Benefit Plan. Before making a final decision, please read the Plan’s Federal brochures (Standard Option and Basic Option: RI 71-005; FEP Blue Focus: 71-017). All benefits are subject to the definitions, limitations and exclusions set forth in the Federal brochures.