2026 Blue Cross and Blue Shield Service Benefit Plan - Standard and Basic Option
Section 2. Changes for 2026
Page 17

 

  • Your cost-share for ground ambulance transport services is now $250 per day copayment and your cost-share for air or sea ambulance transport services is now $750 per day copayment. (See page 86.)
     
  • Your cost-share for laboratory tests (such as blood tests and urinalysis), pathology services, and EKGs is now a 20% coinsurance. (See pages 40 and 80.)
     
  • The copayment for outpatient diagnostic testing services performed and billed by a facility, such as cardiovascular monitoring, EEGs, Home-based/unattended sleep studies, ultrasounds, neurological testing, X-rays (including set-up of portable X-ray equipment), is now $75. (See page 79.)

Changes to both our Standard and Basic Options
 
  • Prior approval for genetic testing will be required when the test is being performed to assess the risk of passing a genetic condition to a child, or when the member has no active disease or signs or symptoms of the disease that is being screened. Prior approval is not required when a member has an active disease, signs and symptoms of a genetic condition that could be passed to a child, or when the test is needed to determine a course of treatment for a disease. If you are unsure whether your genetic test requires prior authorization, call the customer service number on the back of your ID card before scheduling. (See page 23.)
     
  • Prior approval is now required for elective non-urgent outpatient surgical orthopedic procedures on the hip, knee, and spine. (See page 23.)
     
  • Your cost-share for oral and transdermal contraceptives when related to contraception will now be $0 when obtained from a source other than the pharmacy drug program. (See page 49.)
     
  • Prior approval for outpatient hospice care will no longer be required. (See pages 84-86.)
     
  • Your FEP Medicare Prescription Drug Catastrophic Maximum is now $2,100. (See page 110.)
     
  • Surgical and pharmacy services related to sex-trait modifications are no longer covered under this program. (See page 134.)