FEP Blue Focus
the limit is $8,500 for self only or $17,000 for self plus one or family when you use Preferred Providers
What is Catastrophic Amount limit?
2- Evaluations, Prophys (cleanings), fluoride per calendar year, Palliative treatment, intra oral complete series
What is the Dental Benefit?
CPAP devices are a part of this benefit
What is Durable Medical Equipment (DME)?
Admission to noncovered facilities, such as nursing homes, extended care facilities, schools, or residential treatment centers
What is not covered?
Removal of impacted teeth.
What is a type of Oral and Maxillofacial Surgery?
$500 individual $1000 self plus one or family coverage
What is deductible?
Routine foot care when you are under active treatment for a metabolic or peripheral vascular disease, such as diabetes
What is Foot Care benefit?
Bone density test copay with PPO providers?
What is a $100 copay?
Inpatient facility copay for PPO providers Basic
What is $175 copay per day, up to $875 maximum per admission
Shoes (including diabetic shoes), over- the- counter orthotics, arch supports, heel pads and heel cups
What is not covered under Orthopedic and Prosthetic Devices?
Covered only when you are under active treatment for a metabolic or peripheral vascular disease, such as diabetes.
What is Routine Foot Care?
Provocative food testing
What is not covered for Allergy Care?
Although this is not a covered benefit for FEP members, I’ll be happy to take the member’s information. We will refer this to a nurse care manager who can work with the member and family on the most appropriate option for the member. The care manager may identify an alternative benefit.)
What is the FBO (flexible benefit option) disclaimer?
Inpatient Facility Non-Member Copay Standard Option
What is Patient is responsible for $450 copay per admission for unlimited days?
We pay preventive care benefits on the first claim we process for each of the above tests you receive in a calendar year. Regular coverage criteria and benefit levels apply to subsequent claims for those types of tests if performed in the same year.
What are the benefits for the fist diagnostic colonoscopy a member receives in a calendar year?
After 10th visit: Patient is responsible for 30% of plan allowance, after deductible of $500 ind/$1000 self plus one or family
What is Office visit benefit?
Vasectomy- Benefits are provided at 100% of the plan allowance, for all eligible services (no deductible)
What is Family Planning PPO Benefit?
This is a federal law that provides you with protections against "surprise billing" and "balance billing" under certain circumstances.
What is the No Surprises Act (NSA)?
Inpatient PPO Benefit FEP Blue Focus
What is Patient is responsible for 30% of plan allowance after deductible of $500/$1,000 self plus one or family?
Bone-anchored hearing aids benefits
Bone-anchored hearing aids when medically necessary, limited to $5,000 per calendar year.
Patient is responsible for $1,500 copay.
What is Maternity Care Facility?
Prior approval is required for these services and all related services, including assessments, evaluations, and treatments.
What is ABA Autism Therapy?
Skilled Nursing Facility (SNF)
What are no benefits available?
Inpatient Hospice Benefit Standard Option PPO provider
What is plan provides benefits at 100% of plan allowance (no deductible)?
Individual and group psychotherapy, Pharmacologic (medication) management, Partial hospitalization, and Intensive outpatient treatment requires a $30 copay per visit.
What is the Basic Outpatient facility mental health and substance abuse disorder copay?