Blue Cross Blue Shield FEP Vision
Table of Contents
Table of Contents
Table of Contents
Introduction 1
Table of Contents 2
FEDVIP Program Highlights 4
Section 1 Eligibility 6
Section 8 Claims Filing and Disputed Claims Processes 28
Summary of Benefits 32
Rate Information 35
Table of Contents 2
FEDVIP Program Highlights 4
A Choice of Plans and Options 4
Enroll Through BENEFEDS 4
Dual Enrollment 4
Coverage Effective Date 4
Pre-Tax Salary Deduction for Employees 4
Annual Enrollment Opportunity 4
Continued Group Coverage After Retirement 4
How We Have Changed For 2023 5Enroll Through BENEFEDS 4
Dual Enrollment 4
Coverage Effective Date 4
Pre-Tax Salary Deduction for Employees 4
Annual Enrollment Opportunity 4
Continued Group Coverage After Retirement 4
Section 1 Eligibility 6
Federal Employees 6
Federal Annuitants 6
Survivor Annuitants 6
Compensationers 6
TRICARE-eligible individual 6
Family Members 6
Not Eligible 7
Section 2 Enrollment 8Federal Annuitants 6
Survivor Annuitants 6
Compensationers 6
TRICARE-eligible individual 6
Family Members 6
Not Eligible 7
Enroll Through BENEFEDS 8
Enrollment Types 8
Dual Enrollment 8
Opportunities to Enroll or Change Enrollment 8
When Coverage Stops 10
Continuation of Coverage 11
FSAFEDS/High Deductible Health Plans and FEDVIP 11
Section 3 How You Obtain Care 12Enrollment Types 8
Dual Enrollment 8
Opportunities to Enroll or Change Enrollment 8
When Coverage Stops 10
Continuation of Coverage 11
FSAFEDS/High Deductible Health Plans and FEDVIP 11
Identification Cards/Enrollment Confirmation 12
Plan Providers 12
In-Network 12
Out-of-Network 12
Pre-Authorization 12
FEHB First Payor 13
Coordination of Benefits 13
Limited Access Areas 13
Section 4 Your Cost for Covered Services 14Plan Providers 12
In-Network 12
Out-of-Network 12
Pre-Authorization 12
FEHB First Payor 13
Coordination of Benefits 13
Limited Access Areas 13
Copayment 14
In-Network Services 14
Out-of-Network Services 14
Section 5 Vision Services and Supplies 15In-Network Services 14
Out-of-Network Services 14
Diagnostic 15
Eyewear 15
Contact Lenses 17
Section 6 International Services and Supplies 25Eyewear 15
Contact Lenses 17
International Claims Payment 25
Finding an International Provider 25
Filing International Claims 25
Customer Service Website and Phone Numbers 25
International Plan Allowances 25
Section 7 General Exclusions – Things We Do Not Cover 27Finding an International Provider 25
Filing International Claims 25
Customer Service Website and Phone Numbers 25
International Plan Allowances 25
Section 8 Claims Filing and Disputed Claims Processes 28
How to File a Claim for Covered Services 28
Deadline for Filing Your Claim 28
Disputed Claims Process 28
Section 9 Definitions of Terms We Use in This Brochure 30Deadline for Filing Your Claim 28
Disputed Claims Process 28
Annuitants 30
BENEFEDS 30
Benefits 30
Enrollee 30
FEDVIP 30
Plan Allowance 30
Pre-Authorization 30
Sponsor 30
TEI certifying family member 30
TRICARE-eligible individual (TEI) family member 30
We/Us 30
You 30
Stop Health Care Fraud! 31BENEFEDS 30
Benefits 30
Enrollee 30
FEDVIP 30
Plan Allowance 30
Pre-Authorization 30
Sponsor 30
TEI certifying family member 30
TRICARE-eligible individual (TEI) family member 30
We/Us 30
You 30
Summary of Benefits 32
Rate Information 35