2026 Blue Cross and Blue Shield Service Benefit Plan - Standard and Basic Option
Section 5. Benefits

 

Section 5. Benefits

 

See Section 2 for how our benefits changed this year and towards the end of the brochure for a benefits summary of each option. Make sure that you review the benefits that are available under the option in which you are enrolled.

Section 5. Standard and Basic Option Overview - 37
Section 5(a). Medical Services and Supplies Provided by Physicians and Other Healthcare Professionals - 38
Diagnostic and Treatment Services - 39
Lab, X-ray and Other Diagnostic Tests - 40
Preventive Care, Adult - 42
Preventive Care, Child - 45
Maternity Care - 47
Family Planning - 49
Reproductive Services - 50
Allergy Care - 51
Treatment Therapies - 52
Physical Therapy, Occupational Therapy, Speech Therapy, and Cognitive Rehabilitation Therapy - 53
Hearing Services (Testing, Treatment, and Supplies) - 54
Vision Services (Testing, Treatment, and Supplies) - 54
Foot Care - 55
Orthopedic and Prosthetic Devices - 56
Durable Medical Equipment (DME) - 57
Medical Supplies - 58
Home Health Services - 59
Manipulative Treatment - 59
Alternative Treatments - 60
Educational Classes and Programs - 60
Section 5(b). Surgical and Anesthesia Services Provided by Physicians and Other Healthcare Professionals - 62
Surgical Procedures - 63
Reconstructive Surgery - 64
Oral and Maxillofacial Surgery - 65
Organ/Tissue Transplants - 66
Anesthesia - 72
Section 5(c). Services Provided by a Hospital or Other Facility, and Ambulance Services - 74
Inpatient Hospital - 75
Outpatient Hospital or Ambulatory Surgical Center - 77
Blue Distinction® Specialty Care - 81
Residential Treatment Center - 82
Extended Care Benefits/Skilled Nursing Care Facility Benefits - 83
Hospice Care - 84
Ambulance - 86
Section 5(d). Emergency Services/Accidents - 88
Accidental Injury - 89
Medical Emergency - 90
Ambulance - 91
Section 5(e). Mental Health and Substance Use Disorder Benefits - 92
Professional Services - 93
Inpatient Hospital or Other Covered Facility - 94
Residential Treatment Center - 94
Outpatient Hospital or Other Covered Facility - 95
Not Covered (Inpatient or Outpatient) - 95
Section 5(f). Prescription Drug Benefits - 97
Covered Medications and Supplies - 113
Section 5(g). Dental Benefits - 120
Accidental Injury Benefit - 120
Dental Benefits - 121
Section 5(h). Wellness and Other Special Features - 124
Health Tools - 124
Services for the Deaf and Hearing Impaired - 124
Web Accessibility for the Visually Impaired - 124
Travel Benefit/Services Overseas - 124
Healthy Families - 124
Diabetes Management Program - 124
Blue Health Assessment - 124
Pregnancy Care Incentive Program - 125
Annual Incentive Limitation - 126
Reimbursement Account for Basic Option Members Enrolled in Medicare Part A and Part B - 126
MyBlue® Customer eService - 126
National Doctor & Hospital Finder - 126
Care Management Programs - 126
Flexible Benefits Option - 127
Telehealth Services - 128
The fepblue Mobile Application - 128
Weight Loss Management Program - 128
Section 5(i). Services, Drugs, and Supplies Provided Overseas - 129
Non-FEHB Benefits Available to Plan Members - 132