Dec. 10, 2021
Please confirm the benefits prior to submission with the 2022 Federal Employee Program Service
Benefit Plan Brochure for Standard and Basic Option or Blue Focus Option
Kidney transplants will now require Prior Approval and are now part of the Blue Distinction Centers for Transplants® (BDCT) Program. This means members will be eligible for BDCT travel and lodging benefits when criteria are met.
Pancreas transplants have been removed from the BDCT program but still require Prior Approval.
Gender Reassignment Surgery (GRS):
- Benefit update will now include nipple reconstruction.
- Top-only surgery – hormone therapy no longer required and only one referral letter needed.
- Non-gender identity can be considered a form of gender dysphoria, therefore can be covered if all other criteria are met.
EKG will no longer be considered part of the preventive benefit. There must be a medical necessity.
Maternity benefit now offers a breast pump and milk storage bags for members who are pregnant and/or nursing when ordered through our fulfillment vendor, Harte Hanks.
Specialty drug pharmacy will be administered by CVS Caremark. (fepblue.org/specialtypharmacy Learn more about third-party links or call us at 888-346-3731). For Blue Focus: Walgreens and Duane Reade Pharmacies will no longer be in-network.
Air Ambulance (non-emergent) transport from one facility to another requires Prior Approval and falls under the No Surprise Billing Act.
For emergency medical services performed in the emergency department of a hospital or urgent care centers licensed as and permitted to provide emergency services that do not contract with our Blue Cross and Blue Shield Plan, our allowance is determined in accordance with federal laws and regulations, such as the No Surprise Billing Act.
For questions contact Customer Service at 800-634-3569.