2019 FEP BLUE FOCUSBlue Cross and Blue Shield Service Benefit Plan Summary

fepblue.org/focus

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GET TO KNOW THE NEWEST BLUE CROSS AND BLUE SHIELD HEALTH PLAN OFFERING We’re excited to offer federal employees a new coverage option called FEP Blue Focus! We’ve designed this product to give you quality coverage at an affordable cost.

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HERE ARE SOME BASICS YOU SHOULD KNOW:

NO REFERRAL NEEDED

to see a specialist

TRAVELING?Your coverage

travels with you— even overseas

YOU MUST STAY IN-NETWORKBut no worries—96% of hospitals,

95% of doctors and over 65,000 Preferred retail pharmacies are in our network

With FEP Blue Focus, we categorized your benefits into three buckets: Core, Non-core and Wrap.

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Preventive vaccines, screenings and tests $0 copay

Visits to your primary care doctor and specialists

$10 each for the first ten visits

Telehealth services through Teladoc®

$0 for the first two visits; $10 all additional visits

Urgent care centers $25 copay

Accidental injury $0 within the first 72 hours of injury

Acupuncture and manipulations

$25 each for up to10 combined visits

FOCUSING ON GOOD HEALTHCore benefits

Your Core benefits provide coverage for all the essentials of good preventive health. We cover all the benefits in this category at little or no cost to you when you visit Preferred providers. Here are some of those benefits.

GET REWARDED FOR TAKING THE FIRST STEP IN GOOD PREVENTIVE HEALTH

Establishing a relationship with a primary care doctor is one of the best things you can do for your health. That’s why we’ll reward you for getting an annual checkup. All you have to do is visit your primary care doctor. Once we receive the claim, you’ll be eligible to earn an incentive, such as a discounted meal kit delivery service subscription or 4-month gym membership.

You must be 18 or older and the contract holder or spouse on your Plan to earn this reward. The rewards you can select vary by location. Some are limited to specific areas of the U.S., and none are available outside the U.S. Learn more at fepblue.org/focus.

We encourage you to consider possible tax implications of your rewards as part of this program, and to consult your tax, legal or accounting advisors for additional information.

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When you have an active lifestyle, you’re sure to get some bumps, bruises and unexpected surprises along the way. That’s where your Non-core and Wrap benefits come in handy.

Non-core benefits

Non-core benefits include services like:

All primary care and specialist visits beyond the first ten

Lab and diagnostic services

Allergy treatments

Surgery

Emergency care

You’ll pay the full cost of your Non-core services until you’ve paid your deductible amount for the year.

Once you’ve done this, we’ll start paying your doctors the rate we’ve set with them. You’ll pay 30% of this amount; we’ll pay the rest.

You have a deductible for Non-core services. The calendar year deductible for Self Only members is $500. For Self + One and Self & Family, it’s $1,000. The deductible doesn’t apply to Core and Wrap services.

FOCUSING ON YOUR ADDITIONAL HEALTH NEEDS

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Wrap benefits

Wrap benefits give you access to additional benefits not covered in Core or Non-core. Your out-of-pocket costs can vary for services in this category. Many of the benefits also have visit or usage limits.

Benefits in this bucket include:

Home nursing visits

Maternity care (specifically, facility care)

Physical therapy

Wrap benefits are not subject to the deductible.

WHAT’S NOT COVEREDYou get plenty of benefits with FEP Blue Focus. However, there are some things the plan doesn’t cover. Such as:

Dental care

Non-preferred drugs

Skilled nursing facility care

Hearing aids

Long-term care

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FOCUSING ON FILLING YOUR PRESCRIPTIONSFEP Blue Focus only covers Preferred drugs. This is what’s known as a “closed formulary.”

Under this plan, there are two covered drug tiers. The amount you pay for your drug depends on the tier it’s in.

If you’re currently taking a prescription, you should check to see if your drug is covered under this plan. You can see some of the drugs we cover on the next few pages. You can also view the full approved drug list at fepblue.org. If your drug is not on the approved drug list, you’ll pay the full cost of the drug.

Once you know that we cover your drug, getting your prescription filled is easy. For most drugs, all you’ll need to do is go to a Preferred retail pharmacy and show your member ID card. If your drug is a specialty medicine, you’ll need to use the Specialty Pharmacy Program.

WHAT YOU’LL PAY FOR A 30-DAY SUPPLY

Tier 1 - Preferred generics Up to $5 copay

Tier 2 - Preferred brand name, Preferred generic specialty and Preferred brand name specialty

40% of our allowance ($350 maximum)

LEARN MORE ABOUT OUR PHARMACY PROGRAMS AND FIND A PREFERRED RETAIL PHARMACYat fepblue.org/pharmacy.

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ALLERGY, COUGH AND COLD DRUGS

NAME TIER

benzonatate 1

mometasone nasal spray 1

promethazine-dm 1

CLARINEX NC

CLARINEX-D NC

NASONEX NC

ANXIETY AND DEPRESSION DRUGS

NAME TIER

duloxetine 1

alprazolam 1

lorazepam 1

sertraline hcl 1

escitalopram oxalate 1

CYMBALTA NC

LEXAPRO NC

FEP Blue Focus only covers Preferred drugs. Most of these drugs are Preferred generics, but you also receive coverage for some Preferred brand name and specialty drugs.

Here we’ve provided a list of a few of the drugs FEP Blue Focus covers and does not cover. It is not the full formulary list.

VIEW THE FULL FORMULARY AND CHECK DRUG COSTSat fepblue.org.

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ASTHMA/COPD DRUGS

NAME TIER

montelukast sodium 1

albuterol sulfate 1

PROAIR HFA 2

ADVAIR DISKUS 2

SYMBICORT 2

SINGULAIR NC

HIGH BLOOD PRESSURE DRUGS

NAME TIER

amlodipine/olmesartan 1

olmesartan/hydrochlorothiazide 1

metoprolol succinate er 1

metoprolol tartrate 1

carvedilol 1

BYSTOLIC 2

AZOR NC

BENICAR/HCTZ NC

ATTENTION DEFICIT DISORDER DRUGS

NAME TIER

amphetamine/dextroamphetamine 1

methylphenidate 1

VYVANSE 2

ADDERALL XR NC

MYDAYIS NC

If you have any questions about your pharmacy benefit, call 1-800-624-5060.

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FOCUSING ON KEEPING UP WITH YOUR BENEFITSWe designed this plan to go where you go. Download our fepblue mobile app to:

Access your member ID card

Find a provider

Check the status of a claim

Use the Interactive Benefits Tool

We encourage you to sign up for MyBlue® (our dedicated member website) as soon as you enroll. You can register via the app or on our website fepblue.org.

WHAT YOU’LL PAY

Bi-weekly MonthlyPostal

Category 1Postal

Category 2

Self Only (131)

$53.14 $115.15 $51.02 $44.11

Self + One (133)

$114.25 $247.55 $109.68 $94.83

Self & Family (132)

$125.67 $272.29 $120.65 $104.31

These rates don’t apply to all enrollees. If you are in a specific enrollment category, please contact the agency or Tribal employer that maintains your health benefits enrollment.

Questions? Call 1-800-411-BLUE (2583) from 8 a.m. to 8 p.m. Eastern time, Monday through Friday. Also, follow us on social media to keep up to date with all the Blue Cross and Blue Shield Service Benefit Plan has to offer.

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WANT TO LEARN IF THIS PLAN IS RIGHT FOR YOU?

If you’re debating whether this plan is right for you, check out our AskBlue® tool at askblue.fepblue.org. The tool will ask you a series of questions to help you make your choice.

For more information, visit fepblue.org/focus.

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This is a summary of the features of the Blue Cross and Blue Shield Service Benefit Plan – FEP Blue Focus. Before making a final decision, please read the Plan’s Federal brochure (RI 71-017). All benefits are subject to the definitions, limitations and exclusions set forth in the Federal brochure.

The Blue Cross® and Blue Shield® words and symbols, Federal Employee Program®, MyBlue®, AskBlue® and FEP® are all trademarks owned by Blue Cross Blue Shield Association.

Know your privacy rights. Visit fepblue.org/privacynotice to see our Notice of Privacy Practices.

Para obtener asistencia en español, llame al servicio de atención al cliente al número que aparece en su tarjeta de identificación.

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