2026 Blue Cross and Blue Shield Service Benefit Plan - Standard and Basic Option
Section 2. Changes for 2026
Changes to our Basic Option only

 

Changes to our Basic Option only
 
  • Your cost-share for oral and transdermal contraceptives is now 35% of the Plan allowance when obtained from a Preferred provider and care is provided for other than contraception. (See page 49.)
     
  • Your cost-share for reproductive services is now 35% of the Plan allowance when obtained from a Preferred provider. (See page 50.)
     
  • Your cost-share for certain vision services (testing, treatment and supplies) is now 35% of the Plan allowance when obtained from a Preferred provider. (See page 54.)
     
  • Your cost-share for orthopedic and prosthetic devices is now 35% of the Plan allowance when obtained from a Preferred provider. (See page 56.)
     
  • Your cost-share for durable medical equipment (DME) is now 35% of the Plan allowance when obtained from a Preferred provider. (See page 57.)
     
  • Your cost-share for medical supplies is now 35% of the Plan allowance when obtained from a Preferred provider. (See page 58.)
     
  • Your copayment for an inpatient admission is now a $425 per day copayment for up to $2,975. (See pages 75, 76, 82, 83, 94 and 95.)
     
  • The copayment associated with the charges incurred during delivery will be waived if you give birth in a Blue Distinction Center for Maternity. (See page 75.)
     
  • Your copayment for outpatient observation services performed and billed by a hospital or freestanding ambulatory facility is now a $425 copayment per day for up to $2,975. (See page 78.)
     
  • Your cost share for outpatient drugs, medical devices, and durable medical equipment billed for by a Preferred facility is now 35% of the Plan allowance. (See page 81.)
     
  • Your cost-share for outpatient hospital emergency room services and supplies, including professional provider services, diagnostic studies, radiology services, laboratory tests, and pathology services, when billed by the hospital is now a $425 per day per facility copayment. (See pages 89-91.)
     
  • For members enrolled in our regular pharmacy drug program, your responsibility for a Tier 2 (preferred brand-name drug) is now 35% of the Plan allowance ($150 maximum) for each purchase of up to a 30-day supply ($400 maximum for a 31 to 90-day supply). (See page 102.)
     
  • For members enrolled in our regular pharmacy drug program who also have Medicare Part B primary, your responsibility for a Tier 2 (preferred brand-name drug) is now 35% of the Plan allowance ($100 maximum) for each purchase of up to a 30-day supply ($300 maximum for a 31 to 90-day supply). (See page 103.)
     
  • For members enrolled in our regular pharmacy drug program who have Medicare Part B primary, your responsibility for a Tier 2 (preferred brand-name drug) purchased through the Mail Service Prescription Drug Program is now 35% of the Plan allowance up to a $225 maximum. (See page 104.)
     
  • For members enrolled in our regular pharmacy drug program who have Medicare Part B primary, your responsibility for a Tier 3 (non-preferred brand-name drug) purchased through the Mail Service Prescription Drug Program is now 35% of the Plan allowance up to a $250 maximum. (See page 104.)
     
  • Your cost for the reduced retail Tier 3 (non-preferred brand name drug) benefit for members enrolled in our regular pharmacy drug program who have Medicare Part B as primary is now 60% of the Plan allowance for each purchase of up to a 90-day supply. (See page 102).
     
  • For members enrolled in our regular pharmacy drug program, your responsibility for a Tier 4 (preferred specialty drug) obtained from a Preferred retail pharmacy is now 35% of the Plan allowance ($250 maximum) for a purchase of up to a 30-day supply. (See page 102.)
     
  • For members enrolled in our regular pharmacy drug program who have Medicare Part B primary, your responsibility for a Tier 4 (preferred specialty drug) obtained from a Preferred retail pharmacy is now 35% of the Plan allowance ($200 maximum) for a purchase of up to a 30-day supply. (See page 103.)
     
  • For members enrolled in our regular pharmacy drug program, your responsibility for a Tier 4 (preferred specialty drug) obtained from the Specialty Drug Pharmacy Program is now 35% of the Plan allowance ($250 maximum) limited to one purchase of up to 30-day supply ($700 for a 31 to 90-day supply). (See page 105.)
     
  • For members enrolled in our regular pharmacy drug program who also have Medicare Part B primary, your responsibility for a Tier 4 (preferred specialty drug) is now 35% of the Plan allowance ($200 maximum) for a purchase of up to a 30-day supply ($450 maximum for a 31 to 90-day supply) when obtained through the Specialty Drug Pharmacy Program. (See page 105.)
     
  • For members enrolled in our regular pharmacy drug program, your responsibility for a Tier 5 (non-preferred specialty drug) obtained at a Preferred Retail Pharmacy is now 35% of the Plan allowance ($500 maximum) for a purchase of up to a 30-day supply. (See page 102.)
     
  • For members enrolled in our regular pharmacy drug program who have Medicare Part B primary, your responsibility for a Tier 5 (non-preferred specialty drug) obtained at a Preferred retail pharmacy is now 35% of the Plan allowance ($450 maximum) limited to up to a 30-day supply. (See page 103.)
     
  • For members enrolled in our regular pharmacy drug program, your responsibility for a Tier 5 (non-preferred specialty drug) obtained through the Specialty Drug Pharmacy Program is now 35% of the Plan allowance ($500 maximum) limited to up to a 30-day supply ($850 for a 31 to 90-day supply). (See page 105.)
     
  • For members enrolled in our regular pharmacy drug program who have Medicare Part B primary, your responsibility for a Tier 5 (non-preferred specialty drug) is now 35% of the Plan allowance ($450 maximum) limited to up to a 30-day supply ($625 maximum for up to a 90-day supply) when obtained through the Specialty Drug Pharmacy Program. (See page 105.)
     
  • Your cost-share for covered prescription drugs and supplies not obtained at a retail pharmacy or through the Specialty Drug Pharmacy Program, is now 35% of the Plan allowance. (See page 118.)
     
  • Your cost-share to treat an accidental dental injury is now 35% of the Plan allowance. (See page 120.)
     
  • 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.)