Here are 2025 FEP benefit changes

Blue Cross and Blue Shield Federal Employee Program^® 2025 benefit changes will take effect Jan. 1, 2025. Below is an overview of the changes.

Cost share

• FEP Basic Option only
• For Self Only contracts, the Preferred provider catastrophic out-of-pocket maximum is now $7,500. For Self, Self Plus One and Self and Family contracts, the Preferred provider catastrophic out-of-pocket maximum is now $15,000. (See Page 32 of the FEP Blue Standard and FEP Blue Basic Option brochure.)
• FEP Basic Option and FEP Blue Focus
• The pharmacy drug out-of-pocket catastrophic maximum has been reduced to $2,000 for FEP Blue Basic and FEP Blue Focus members enrolled in the FEP Medicare Prescription Drug Program. (See Page 111 of the FEP Blue Standard and FEP Blue Basic Option brochure. See Page 94 of the FEP Blue Focus brochure.)

Emergency room

• Basic Option only
• The 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 $350 per day per facility copayment. (See pages 90 and 91 of the FEP Blue Standard and FEP Blue Basic Option brochure.)

Gende-affirming care

• Basic Option, Standard Option and FEP Blue Focus
• Under the gender-affirming surgical benefits, coverage is now provided for suction-assisted chest lipectomy related to a mastectomy. (See Page 64 of the FEP Blue Standard and FEP Blue Basic Option brochure. See Page 57 of the FEP Blue Focus brochure.)

Inpatient admission

• Basic Option only
• The copayment for an inpatient admission is now a $350 per day copayment for up to $1,750 per admission for unlimited days. (See pages 75, 82 and 95 of the FEP Blue Standard and FEP Blue Basic Option brochure.)

Office visits

• Basic Option only
• The copayment for office visits, allergy care, treatment therapies and services, physical therapy, occupational therapy, speech therapy, cognitive rehabilitation therapy, hearing services, vision services, foot care services, alternative treatments and diabetic education, when performed by Preferred specialists, is now $50 per visit. (See pages 36, 38, 50, 51, 52, 53, 54, 59, 60, 151 and 165 of the FEP Blue Standard and FEP Blue Basic Option brochure.)

Outpatient laboratory services

• Basic Option only
• The cost share for outpatient diagnostic testing and treatment services performed and billed by a facility is now a $250 copayment per day per facility. (See Page 79 of the FEP Blue Standard and FEP Blue Basic Option brochure.)

Outpatient observation services

• Basic Option only
• The copayment for outpatient observation services performed and billed by a hospital or freestanding ambulatory facility is now a $350 per day copayment up to $1,750. (See Page 78 of the FEP Blue Standard and FEP Blue Basic Option brochure.)

Outpatient surgical and treatment

• Basic Option only
• The cost share for outpatient surgical and treatment services performed and billed by a facility is now a $250 copayment per day per facility. (See Page 77 of the FEP Blue Standard and FEP Blue Basic Option brochure.)

Pharmacy

• Basic Option, Standard Option and FEP Blue Focus
• The separate Medicare Prescription Drug Program catastrophic protection out-of-pocket maximum will no longer be combined with the regular medical catastrophic protection out-of-pocket maximum. (See pages 32 and 111 of the FEP Blue Standard and FEP Blue Basic Option brochure. See pages 31 and 94 of the FEP Blue Focus brochure.)
• Standard Option only
• For members enrolled in the Medicare Prescription Drug Program, a $35 copayment for each purchase of up to a 30-day supply ($105 copayment for a 31 to 90-day supply), with no deductible for Tier 2 preferred brand-name drugs. (See Page 111 of the FEP Blue Standard and FEP Blue Basic Option brochure.)
• For members enrolled in the Medicare Prescription Drug Program, a $20 copayment for each purchase of up to a 30-day supply ($60 copayment for a 31- to 90-day supply), with no deductible for Tier 2 preferred brand-name asthma medications. (See Page 113 of the FEP Blue Standard and FEP Blue Basic Option brochure.)
• For members enrolled in the Medicare Prescription Drug Program, a $20 copayment for each purchase of up to a 30-day supply ($50 copayment for a 31 to 90-day supply), with no deductible for Tier 2 preferred diabetic medications and supplies. (See Page 113 of the FEP Blue Standard and FEP Blue Basic Option brochure.)
• Basic Option only
• For members enrolled in the regular pharmacy program, the copayment for Tier 2 (preferred brand-name drugs) without Medicare Part B primary is now $75 for each purchase of up to a 30-day supply ($200 for a 31- to 90-day supply). (See Page 103 of the FEP Blue Standard and FEP Blue Basic Option brochure.)
• For members enrolled in the regular pharmacy program, the copayment for a Tier 4 (preferred specialty drug) is now $120 for a 30-day supply at a Preferred Retail Pharmacy or through the Specialty Drug Pharmacy Program, and $350 for a 31- to 90-day supply through the Specialty Drug Pharmacy Program. (See pages 103 and 105 of the FEP Blue Standard and FEP Blue Basic Option brochure.)
• For members enrolled in the regular pharmacy program, the copayment for a Tier 5 (non-preferred specialty drug) is now $200 for a 30-day supply at a Preferred Retail Pharmacy or through the Specialty Drug Pharmacy Program, and $500 for a 31- to 90-day supply through the Specialty Drug Pharmacy Program. (See FEP Blue Standard and FEP Blue Basic Option brochure pages 103 and 105.)

Reproductive care

• Basic Option, Standard Option and FEP Blue Focus
• Under family planning services, coverage is now provided for salpingectomies. (See Page 48 of the FEP Blue Standard and FEP Blue Basic Option brochure. See Page 45 of the FEP Blue Focus brochure.)

Urgent care center

• Basic Option only
• The cost share for professional provider services, diagnostic studies, radiology services, laboratory tests and pathology services, when billed by an urgent care center, is now $50. (See pages 90 and 92 of the FEP Blue Standard and FEP Blue Basic Option brochure.)
  

For complete 2025 Blue Cross and Blue Shield Service Benefit Plan benefit information, go to fepblue.org/brochure or call Customer Service at 1-800-482-3600.