Here are the 2023 FEP benefit changes

Blue Cross and Blue Shield Federal Employee Program^® 2023 benefit changes will take effect Jan. 1, 2023. Below is an overview of the changes.

Acupuncture

• Basic Option only
• We now cover 12 acupuncture visits per calendar year.

Bariatric surgery

• Standard Option, Basic Option and FEP Blue Focus
• We now provide benefits for medically necessary bariatric surgery beginning at age 16.

Diagnostic services

• Basic Option only
• The coinsurance for laboratory tests (such as blood tests and urinalysis), pathology services and EKGs is now 15%.

Facility

• Basic Option only
• The copayment for an inpatient admission is now $250 per day for up to $1,500 per admission for unlimited days.
• The copayment for outpatient surgical and treatment services performed and billed by a facility is now $150 per day per facility.
• The copayment for outpatient observation services performed and billed by a hospital or freestanding ambulatory facility is now $250 per day up to $1,500.
• The copayment 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 $250 per day per facility.
• The copayment for outpatient diagnostic testing and treatment services performed and billed by a facility is now $200 per day per facility.

Infertility

• Standard Option, Basic Option and FEP Blue Focus
• We now cover one year of sperm and egg storage for individuals facing iatrogenic infertility.

Maternity

• Standard Option, Basic Option and FEP Blue Focus
• We now provide eight visits per calendar year to treat depression associated with pregnancy with no member out-of-pocket costs when a Preferred provider is used.
• We now provide individuals who are pregnant with a free blood pressure monitor when ordered through the FEP vendor.

Medical food

• Standard Option, Basic Option and FEP Blue Focus
• We now cover medical foods for the treatment of inborn errors of amino acid metabolism regardless of age.

Pharmacy

• Standard Option, Basic Option and FEP Blue Focus
• We now cover the generic naloxone nasal spray with zero out-of-pocket costs for the first purchase of up to a 90-day supply per calendar year.
• We now provide coverage for weight loss medications to treat obesity when obtained through one of the FEP pharmacy drug programs.
• We now cover over-the-counter condoms for all members with zero member out-of-pocket costs when they have a prescription from their physician and are purchased in a Preferred retail pharmacy.
• Standard Option only
• Preferred insulins are now covered with a $35 copayment for up to a 30-day supply or a $65 copayment for a 31 to 90-day supply, when dispensed by a Preferred retail pharmacy.
• Updates have been made to the approved drug list.
• Basic Option only
• The copayment for Tier 1 (generic drugs) without Medicare Part B primary is now $15 for each purchase of up to a 30-day supply ($40 for a 31 to 90-day supply).
• The copayment for Tier 2 (preferred brand-name) drugs without Medicare Part B primary is now $60 for each purchase of up to a 30-day supply ($180 for a 31 to 90-day supply).
• Members are now responsible for up to a $90 minimum copayment for Tier 3 (non-preferred brand-name) drugs for up to a 30-day supply ($250 minimum for a 31 to 90-day supply) without Medicare Part B primary.
• Updates have been made to the approved drug list.
• FEP Blue Focus only
• Updates have been made to the approved drug list.

Preventive care

• Standard Option, Basic Option and FEP Blue Focus
• We now cover computed tomography colonography under the adult preventive benefit for colorectal cancer tests.
• We now cover preventive low-dose CT screenings for lung cancer for members aged 50 to 80.
• FEP will make changes as soon as possible and provide preventive benefits for the U.S. Preventive Services Task Force A and B, the Advisory Committee on Immunization Practices, Health Resources and Services Administration, and Bright Futures recommendations as they occur throughout the year.

New prior approval requirements

• Standard Option, Basic Option and FEP Blue Focus
• We now require prior approval for certain high-cost drugs obtained outside of a pharmacy setting.
• We now require prior approval for proton beam therapy.
• We now require prior approval for stereotactic radiosurgery and stereotactic body radiation therapy.

Transplants

• Standard Option, Basic Option and FEP Blue Focus
• We no longer limit the number of non-full sibling donor screening tests for transplants.
  

For complete 2023 Blue Cross and Blue Shield Service Benefit Plan benefit information, go to fepblue.org/brochure or call Customer Service at 1-800-482-3600.