The Federal Employee Program (FEP) is a nationwide Federal Employees Health Benefits program administered through local Blue Cross and Blue Shield Association plans. This program should not be confused with HMSA's Federal Employees Health Benefits (FEHB) program (coverage code 87). The FEP membership cards are identified by coverage codes 104, 105, and 106 for the Standard Option and 111, 112, and 113 for the Basic Option. FEP Blue Focus enrollment codes are 131, 132 and 133.
Basic Option members must use preferred providers for all medical care (with some exceptions, such as emergency care). There's a copayment for most services and no deductible.
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Normal co-pays vary by Blue Cross member plan, but the maximum copay is $49, said Janet Fava, the Blues' vice president of market solutions development and delivery.
You mentioned out-of-pocket maximum, what does that mean? In the examples we used, we mentioned the term out-of-pocket maximum. An out-of-pocket maximum is the annual limit on the amount of money that you would have to pay for health care services, not including monthly premiums. Press Release: Blue Cross and Blue Shield Federal Employee Program Waives Cost Shares and Prior Authorization to Support Members’ Care for Coronavirus For information on available incentive programs, please call 919-765-2413.
Providers should always verify member eligibility via HHIN under Blue Exchange or by calling the Federal Employee Program (FEP) of Blue Cross Blue Shield of Hawaii.
Information on member benefits and claims status is also available on HHIN or by calling the Federal Employee Program (FEP) of Blue Cross Blue Shield of Hawaii.
Pre-certification
FEP requires precertification prior to your inpatient admission. Precertification may be required for members despite having another insurance carrier primary to FEP.
When FEP is the secondary insurance carrier and the patient's primary insurance limits are met, FEP becomes their primary insurance carrier.
If you have an emergency inpatient admission due to a condition that you reasonably believe puts your life in danger or could cause serious damage to bodily functions, you, your representative, the physician or the hospital must call us within two business days following the day of the emergency admission, even if you have been discharged from the hospital.
We will reduce our benefits for the inpatient hospital stay by $500 even if you have obtained prior approval for the services or procedure being performed during the stay, if no one contacts us for precertification.
Medical Admissions
To get precertification before an inpatient hospital admission, please call the Federal Employee Program (FEP) of Blue Cross Blue Shield of Hawaii.
Behavioral Health Admissions
Bcbs Federal Copay
Prior approval is no longer required for outpatient professional or outpatient facility care for mental health and substance abuse treatment.
Inpatient mental health or alcohol and substance abuse services require precertification. A provider with the appropriate clinical background (e.g., M.D., Ph.D., Psy.D., C.S.W., C.S.A.C. or R.N.) and who is knowledgeable about the patient's clinical condition should call or fax HMSA's Behavioral Health Services - Commercial, FEP, Fed 87 (Beacon Health Options) to open a case file for the patient, arrange an initial evaluation, and precertify any services. Be sure to have the following information available:
- The patient's name and FEP member ID number.
- The name of the facility/program to which the member will be admitted.
- The name and provider number of the admitting psychiatrist or psychologist.
- The date of the proposed admission.
- Clinical information about the patient, including the diagnosis and proposed treatment regimen.
We'll give a verbal precertification at the time of the initial phone call for an admission requested by a specially contracted provider. FEP/HMSA will send a follow-up letter within seven working days with the following information:
- A precertification number.
- The number of inpatient days approved.
- The effective date of the precertification.
- Please note that a precertification from FEP/HMSA confirms that the services are necessary and appropriate but doesn't guarantee the availability of benefits.
To precertify ongoing services, a provider with the appropriate clinical background (e.g., M.D., Ph.D., Psy.D., C.S.W., C.S.A.C. or R.N.) should make subsequent calls to HMSA with clinical data to discuss the patient's status.
Prior Approval
The following services require prior approval for members with Basic Option plan:
- Gene therapy and cellular immunotherapy, for example CAR-T and T-Cell receptor therapy;
- Air ambulance Transport (non-emergent);
- Outpatient sleep studies performed outside the home;
- Applied behavior analysis(ABA);
- BRCA testing and testing for large genomic rearrangements in the BRCA1 and BRCA2 genes- you must receive genetic counseling and evaluation services before preventive BRCA testing is performed.
Surgical services - The surgical services on the following list require prior approval for care performed by Preferred, Participating/Member, and Non-participating/Non-member professional and facility providers:
- Outpatient surgery for morbid obesity;
- Outpatient surgical correction of congenital anomalies;
- Outpatient surgery needed to correct accidental injuries to jaw, cheeks, lips, tongue, and the roof and floor of the mouth;
- Gender reassignment surgery.
Outpatient Intensity Modulated Radiation Therapy (IMRT)- Prior approval is required for all outpatient IMRT services except IMRT related to the treatment of the head, neck, breast, prostate or anal cancer. Brain cancer is not considered a form of head or neck cancer therefore, prior approval is required for IMRT treatment of brain cancer.
- Hospice care - Prior approval is required for home hospice, continuous home hospice or inpatient hospice care services. We will advise you which home hospice care agencies we have approved.
- Organ/tissue transplants - Prior approval is required for both the procedure and the facility.
- Organ transplant procedure
- Blood or marrow stem cell transplants must be performed in a facility with a transplant program accredited by the Foundation for the Accreditation of Cellular Therapy (FACT) or in a facility designated as a Blue Distinction Center for Transplants or as a Cancer Research Facility.
- Clinical trials for certain blood or marrow stem cell transplants
- Prescription drugs and supplies- Contact CVS Caremark, our Pharmacy Program administrator to request prior approval or to obtain a list of drugs and supplies that require prior approval.
- Medical Foods covered under the pharmacy benefit require prior approval.
To get preauthorization for the services listed above, call the Federal Employee Program (FEP) of Blue Cross Blue Shield of Hawaii.
To get preauthorization for select prescription drugs, call the Federal Employee Program (FEP) of Blue Cross Blue Shield of Hawaii's Retail Pharmacy.
Morbid Obesity
Preauthorization is required for outpatient surgery for morbid obesity.
Benefits for the surgical treatment of morbid obesity, performed on an inpatient or outpatient basis, are subject to the following pre-surgical requirements
- Diagnosis of morbid obesity for a period of two years prior to surgery.
- Participation in a medically supervised weight loss program, including nutritional counseling, for at least three months prior to the date of surgery. (Note: Benefits aren't available for commercial weight loss programs
. - Pre-operative nutritional assessment and nutritional counseling about pre- and post-operative nutrition, eating, and exercise.
- Evidence that attempts at weight loss one year before surgery have been ineffective.
- Psychological assessment of the member's ability to understand and adhere to the pre- and post-operative program, performed by a psychiatrist, clinical psychologist, psychiatric social worker, or psychiatric nurse.
- Patient hasn't smoked in the six months before surgery.
- Patient hasn't been treated for substance abuse for one year before surgery.
Benefits for subsequent surgery for morbid obesity, performed on an inpatient or outpatient basis, are subject to the following additional pre-surgical requirements:
- All criteria listed above for the initial procedure must be met again.
- Previous surgery for morbid obesity was at least two years before the repeat procedure.
- Weight loss from the initial procedure was less than 50 percent of the member's excess body weight at the time of the initial procedure.
- Member complied with previously prescribed postoperative nutrition and exercise program.
Claims for the surgical treatment of morbid obesity must include documentation from the patient's provider(s) that all pre-surgical requirements have been met.
Dental, Vision and Physical Therapy Benefits
Dental benefits on Basic Option plans cover preventive dental care services only. Predetermination/preauthorization is not required for dental benefits. Information on covered dental benefits is available at www.fepblue.org or by calling the Federal Employee Program (FEP) of Blue Cross Blue Shield of Hawaii.
Vision benefits for Basic Option plans includes eye examinations related to a specific medical condition and one pair of eyeglasses, replacement lenses, or contact lenses per incident to correct an impairment directly caused by a single instance of accidental ocular injury or intraocular surgery. Information on eligibility and benefits is available on HHIN or by calling the Federal Employee Program (FEP) of Blue Cross Blue Shield of Hawaii.
Physical, Occupational, and Speech Therapy Benefits
Bcbs Federal Copay 2020
Physical therapy benefits for FEP Blue Focus plans include outpatient physical, occupational, and speech therapy limited to 50 visits total for all three services per person per year. FEP doesn't require authorization through Landmark. Benefit information is available on www.fepblue.org or by calling the Federal Employee Program (FEP) of Blue Cross Blue Shield of Hawaii
Claims Filing Information
For services in Hawaii, please submit claims on a CMS-1500 or UB-04 form, as appropriate, to the Federal Employee Program (FEP) of Blue Cross Blue Shield of Hawaii.
Information on eligibility, benefits, and claims status is available on HHIN or by calling the Federal Employee Program (FEP) of Blue Cross Blue Shield of Hawaii.
Provider Fee schedules are available on HHIN.
How to Submit a Provider Reconsideration
Please mail your request for reconsideration in writing, along with any additional information, to the Federal Employee Program (FEP) of Blue Cross Blue Shield of Hawaii, Attn: Reconsiderations.
FEP will notify you of its decision no later than 30 days after receiving all documentation reasonably needed to render a decision.
If FEP decides in your favor, payment will be made. If the determination isn't in your favor, the letter will explain your rights to an appeal.
WASHINGTON, Oct. 15, 2020 /PRNewswire/ -- Today, the Blue Cross® and Blue Shield® Federal Employee Program® (FEP®) announced 2021 benefits, including newly expanded telemedicine benefits, along with a new tool to help provide greater cost transparency for members. Additionally, FEP will keep the rates the same in 2021 for its newest product, FEP Blue Focus®, as well as for Blue Cross Blue Shield FEP Vision℠. Rates for Blue Cross Blue Shield FEP Dental℠ products will remain at 2020 levels.
FEP’s medical, dental and vision plans are available to eligible participants in the Federal Employees Health Benefits (FEHB) Program and the Federal Employees Dental and Vision Insurance Program (FEDVIP). FEP provides quality and affordable healthcare to approximately 66 percent of federal employees, retirees and their families across the nation. FEP members enjoy access to a robust provider network with 95 percent of professional providers and over 96 percent of hospitals in the United States alone.
Highlights of What's New for 2021
New Telemedicine Benefits
The COVID-19 pandemic has caused many members to turn to remote, virtual care services to manage their health as they attempt to socially distance and limit their exposure to the coronavirus. FEP was at the forefront expanding its benefits in 2020 during the pandemic to cover members having virtual visits with their primary and specialty doctors. Recognizing that virtual visits are becoming a permanent part of health care, in 2021 FEP will cover virtual consultations, and medical evaluation and management services with primary care providers and specialists as a regular benefit even after the pandemic is over. Members will pay the regular office visit copayments/coinsurance under Standard Option, Basic Option and FEP Blue Focus.
FEP Healthcare Cost Advisor
Available in 2021, FEP members will have access to the FEP Healthcare Cost Advisor application, which provides users with a complete view of their healthcare spending to make better financial planning and healthcare decisions. The tool can also help identify the FEP health plan option that offers the best value for each member’s specific needs.
Newly Redesigned Website
Significant to facilitating an easier online experience for federal employees, FEP has launched Phase 1 of the public website redesign, www.fepblue.org®, Visitors can more easily navigate the vast amount of information the Program has to offer in a more intuitive and welcoming site. Additional enhancements will leverage customer experiences and feedback.
“The COVID-19 pandemic has altered the healthcare landscape, so it is important that we adapt our products and services to meet the changing care needs of our members,” said William A. Breskin, senior vice president of government programs for the Blue Cross Blue Shield Association. “Alongside great coverage at reasonable prices, members should feel confident knowing we’re adding new telemedicine and virtual care benefits that allow them to easily get the care they need from the safety of their home. FEP will continue to be the best value for the federal workforce – wherever they may be.”
Dental and Vision Plan Updates
FEP is announcing several changes to improve access to care and outreach to eligible FEDVIP participants, including the uniformed services members. One thing we’re doing is changing our product names to make clear up front that your coverage is from the most trusted name in health insurance–Blue Cross Blue Shield FEP Dental and Blue Cross Blue Shield FEP Vision. FEP will continue to offer the same comprehensive benefits with a few new benefit and network changes for 2021 such as increased frame allowances and more e-commerce in network options for vision and removing orthodontia waiting periods for dental.
New Dental and Vision Digital Platforms
In addition, in order to streamline, guide and modernize the member experience both the dental and vision websites have been redesigned to be more responsive and user friendly. Both BCBS FEP Dental and BCBS FEP Vision will be launching mobile applications for users to leverage as well which includes quick and easy access to local providers and benefit information. For prospective and existing members, the launch of new product selection dental and vision tools, AskBlueSM BCBS FEP Dental Plan Finder and AskBlueSM BCBS FEP Vision Plan Finder, will help determine right product for one’s needs.
2021 Approved Rates:
Standard Option:
Self Only biweekly premiums will be $123.45
Self Plus One biweekly premiums will be $280.81
Self and Family biweekly premiums will be $300.12
Basic Option:
Self Only biweekly premiums will be $78.60
Self Plus One biweekly premiums will be $189.17
Self and Family biweekly premiums will be $201.27
FEP Blue Focus:
Self Only biweekly premiums will be $53.14
Self Plus One biweekly premiums will be $114.25
Self and Family biweekly premiums will be $125.67
Blue Cross Blue Shield FEP Vision Premiums in 2021:
High Option:
Self Only biweekly premiums will be $5.49
Self Plus One biweekly premiums will be $10.97
Self and Family biweekly premiums will be $16.46
Standard Option:
Self Only biweekly premiums will be $3.50
Self Plus One biweekly premiums will be $6.99
Self and Family biweekly premiums will be $10.49
Blue Cross Blue Shield FEP Dental Premiums in 2021*
High Option:
Self Only biweekly premiums will be $17.31
Self Plus One biweekly premiums will be $34.63
Self and Family biweekly premiums will be $51.94
Standard Option:
Self Only biweekly premiums will be $9.16
Self Plus One biweekly premiums will be $18.32
Self and Family biweekly premiums will be $27.49
*Blue Cross Blue Shield FEP Dental rates depend upon the rate region in which a member lives. The rates presented here are for BCBS FEP Dental’s most populous region, Region 1. Please go to bcbsfepdental.com to see the full list of regional rates.
All changes will take effect Jan. 1, 2021. Eligible participants will have an opportunity to make their health care coverage decisions during Open Season, which runs from Nov. 9 through Dec. 14, 2020.
Additional information about 2021 benefits is available at www.fepblue.org/whatsnew. Members can also call the National Information Center at 1-800-411-BLUE (2583).
About The Blue Cross and Blue Shield Service Benefit Plan (FEP®)
The Blue Cross and Blue Shield Service Benefit Plan, also known as the Federal Employee Program® (FEP®), has been part of the Federal Employees Health Benefits (FEHB) Program since its inception in 1960. It covers roughly 5.5 million federal employees, retirees and their families out of the more than 8 million people who receive their benefits through the FEHB Program. The Blue Cross Blue Shield Association negotiates annually with the U.S. Office of Personnel Management (OPM) to determine the benefits and premiums for the Blue Cross and Blue Shield Service Benefit Plan. The 36 local member companies of the Blue Cross Blue Shield Association are the primary points of contact for Service Benefit Plan members. They are responsible for processing claims and providing customer service to our members. To locate the address and telephone number for a local Blue Cross and Blue Shield company, please visit the Contact Us section on fepblue.org.