Section 5G
This type of dental damage is covered only if caused by an external force such as a blow or fall.
What is accidental injury to sound natural teeth?
This percentage of orthodontic treatment costs does the Plan pay, up to $1,000 per course of treatment, every five years.
What is 50%?
These types of therapy are covered for autism and developmental delays.
What are physical, occupational, and speech therapy?
This program offers members a personalized medication assessment to help manage their prescriptions.
What is the Personal Medication Coach Program?
This digital program offers personalized coaching for weight management, tobacco cessation, and sleep improvement.
What is the Digital Coach Program?
The percentage you pay for accidental dental services received in-network.
What is 20% of the Plan allowance (after deductible)?
This program lets members get up to a 90-day supply of maintenance drugs with reduced copays.
What is the Mail Order Prescription Drug Program?
This type of room is only covered if required for contagion isolation.
What is a private room?
This service allows members to receive up to a 90-day supply of covered drugs through mail order.
What is the Mail Service Prescription Drug Program?
This platform provides holistic support for family planning, fertility, pregnancy, parenting, and menopause.
What is the Maven Digital Health Platform?
The amount you pay for preventive dental exams that exceed the Plan’s scheduled allowance
What are all charges above $13?
The scheduled allowance for a routine dental cleaning for an adult under the High Option.
What is $23?
This vendor provides behavioral telehealth services for members outside the 50 U.S. states.
What is Lyra Health?
This type of drug is subject to a $60 minimum copayment for a 30-day supply and $175 minimum for a 31–90-day supply.
What are Tier 4 specialty drugs?
This program offers support for over 40 lifestyle and medical conditions, including stress and pain management.
What is the Lifestyle and Condition Coaching Program?
The maximum the Plan will pay for one course of orthodontic treatment per person.
What is $1,000?
This must be obtained before inpatient mental health hospitalization or partial hospitalization services under the High Option plan.
What is prior approval or precertification?
This percentage of the Plan allowance you pay for outpatient mental health services with a non-network provider.
What is 30%?
This type of drug is not covered under the FSBP prescription drug benefits.
What are over-the-counter (OTC) smoking and tobacco cessation medications without a prescription?
Members overseas have 24/7 access to these two support services.
What are nurse advice and emergency translation lines?
This surgery, involving the removal of infected gum tissue, has a scheduled allowance of $50 per quadrant.
What is a gingivectomy?
This telehealth vendor provides general medical services 24/7/365 to members in the 50 United States only.
What is Teladoc®?
ABA therapy is covered for dependents up to this age.
What is age 18?
The 2025 FSBP requires prior authorization for this type of medication before coverage is approved under the prescription drug benefits.
What are specialty drugs?
This program offers digital exercise therapy sessions for back, knee, hip, neck, and shoulder pain.
What is Hinge Health?