Here are the FEP benefit updates for 2019

Following are the benefit changes for the 2019 Federal Employee Program Standard and Basic Options.

1. Preventive care benefits
1. No limitation for adult preventive booster of the tetanus, diphtheria, pertussis (Tdap) vaccine
2. Pathology services associated with preventive colonoscopies or sigmoidoscopies
   
   
2. Appropriate site of care
1. Benefits for inpatient admissions to nonmember hospitals or other facilities for emergency (maternity) deliveries and base payment on the billed amount. Benefits for inpatient admissions to nonmember hospitals and other facilities for non-emergency (routine maternity) deliveries and base payment on the local plan allowance
   
2. Blue Cross plan allowance used to reimburse outpatient nonmember facilities for non-emergency services
3. Nonparticipating provider calculation process for emergency medical services performed in the emergency department of a nonmember facility will reference Blue Cross plan allowance instead of the usual, customary and reasonable, or UCR, amount
4. Telehealth services for dermatology care – diagnosis, treatment and prevention of diseases of the skin, hair, nails and body
   
   
3. Gender reassignment surgery
1. Members are required to be under the care of a behavioral health professional for a minimum of 12 months prior to treatment
2. Electrolysis added as part of the preparation for gender reassignment surgery
   
   
4. Miscellaneous benefit changes
1. Acupuncture facility-billed claims for services will accumulate toward the annual visit maximum, except when performed as an anesthesia service
2. Limit dental diagnostic imaging benefit to intraoral complete series
3. Medical benefits for the infusion medication Remicade and its two biosimilars, Renflexis and Inflectra.
4. Bariatric surgery benefit for members who have a diagnosis of morbid obesity for a period of one year prior to surgery
5. Air ambulance prior approval required for non-emergency transports
6. Outpatient facility home-based sleep study claims will be assessed a $40 copayment
7. Prior approval for gene therapy and cellular immunotherapy, e.g., CAR-T and T-cell receptor therapy
8. For information regarding FEP pharmacy benefits, contact CVS Caremark at 1-800-624-5060 or go to fepblue.org/pharmacy. To view the pharmacy formulary, go to fepblue.org/formulary.