Here are 2024 FEP benefit changes

Blue Cross and Blue Shield Federal Employee Program^® 2024 benefit changes will take effect Jan. 1, 2024. Below is an overview of the changes.

Cost share

• Copay for Preferred primary care, Preferred specialist or other health care professional and, when applicable, Preferred facilities has increased by $5. See the Service Benefit Plan brochure for copay information.
• FEP Blue Focus only
• Catastrophic out-of-pocket maximum for FEP Blue Focus members increased.

Gender affirming care

• Basic Option, Standard Option and FEP Blue Focus
• We now cover breast augmentation for male to female.
• We now cover a mastectomy beginning at age 16 for female to male.
• Six months of continuous hormone therapy appropriate to the member’s gender identity is required, unless medically contraindicated.
• We now cover certain facial surgeries for gender affirming care. There is no longer a limit on medically necessary gender affirming surgical service to once per lifetime.
• One referral letter documenting the diagnosis of gender dysphoria and other criteria is required.

Genetic testing

• Basic Option, Standard Option and FEP Blue Focus
• Prior approval is required for genetic testing and based on medical necessity for members who may be susceptible or at high risk for certain conditions.

Hearing aids

• Basic Option and Standard Option
• Prior approval is required for hearing aids.

Mental health

• Basic Option, Standard Option and FEP Blue Focus
• We now cover marital and family counseling and psychotherapy services.

Pharmacy

• FEP Medicare Prescription Drug Program
• There is a new prescription drug benefit for Blue Cross and Blue Shield Federal Employee Program members with Medicare A or B primary.
• For Basic and Standard Option, see Page 108 of the brochure for details.
• For FEP Blue Focus, see Page 91 of the brochure for details.

Radiation therapy

• Basic Option, Standard Option and FEP Blue Focus
• Prior authorization is no longer required for:
• Intensity-modulated radiation therapy
• Proton beam therapy for members aged 21 and younger, or when care is related to the treatment of neoplasms of the nervous system, malignant neoplasms of the thymus Hodgkin and non-Hodgkin lymphomas.

Reproductive care

• Basic Option, Standard Option and FEP Blue Focus
• We now cover individuals meeting the definition of infertility for artificial insemination procedures and related drugs, with prior approval for:
• Intracervical insemination
• Intrauterine insemination
• Intravaginal insemination
• Coverage for invitro fertilization related drugs is limited to three cycles annually once prior approval has been obtained for individuals meeting the definition of infertility.
• See the brochure for the definition of infertility:
• Basic and Standard Option  Page 154
• FEP Blue Focus  Page 132
• Standard Option only
• We now cover assisted reproductive technology procedures for members who obtain prior approval.

Residential Treatment Center

• Basic Option, Standard Option and FEP Blue Focus
• Case management signed consent is no longer required prior to a residential treatment center admission.
• FEP Blue Focus only
• Residential treatment center is now covered for medically necessary stays with no annual limitation.

Skilled nursing facility

• Standard Option only
• A case management signed consent form is no longer required prior to skilled nursing facility admission for members without Medicare Part A.

Surgery

• Basic Option, Standard Option and FEP Blue Focus
• We now cover bariatric surgery in accordance with FEP medical policy.
• Prior authorization is no longer required for the following surgeries:
• Surgical treatment of a congenital anomaly.
• Stereotactic radiosurgery, for details see:
• For Basic and Standard Option, Page 22 of the brochure
• For FEP Blue Focus, Page 22 of the brochure

Transplants

• Basic Option, Standard Option and FEP Blue Focus
• We updated diagnoses for allogenic and autologous blood or marrow stem cell plants clinical trial requirements.
• Allogeneic and autologous blood or marrow stem cell transplant are only covered when performed as part of a clinical trial.
• For diagnosis details, see the following:
• For Basic and Standard Option, pages 67 to 70 of the brochure
• For FEP Blue Focus, pages 61 to 62 of the brochure
• FEP Blue Focus only
• Kidney transplants now require prior approval.
• We now cover corneal transplants under the regular surgical benefit.

For complete 2024 Blue Cross and Blue Shield Service Benefit Plan benefit information, go to fepblue.org/brochure or call Customer Service at 1-800-482-3600.