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 25
Summary of Benefits 29
Rate Information 31
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
2024 Program Highlights 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 7
Not Eligible 7
Section 2 Enrollment 8Federal Annuitants 6
Survivor Annuitants 6
Compensationers 6
TRICARE-eligible individual 6
Family Members 7
Not Eligible 7
Enroll Through BENEFEDS 8
Enrollment Types 8
Dual Enrollment 8
Opportunities to Enroll or Change Enrollment 8
When Coverage Stops 12
Continuation of Coverage 12
FSAFEDS/High Deductible Health Plans and FEDVIP 12
Section 3 How You Obtain Care 13Enrollment Types 8
Dual Enrollment 8
Opportunities to Enroll or Change Enrollment 8
When Coverage Stops 12
Continuation of Coverage 12
FSAFEDS/High Deductible Health Plans and FEDVIP 12
Identification Cards/Enrollment Confirmation 13
Plan Providers 13
In-Network 13
Out-of-Network 13
Pre-Authorization 13
FEHB First Payor 14
Coordination of Benefits 14
Limited Access Areas 14
Section 4 Your Cost for Covered Services 15Plan Providers 13
In-Network 13
Out-of-Network 13
Pre-Authorization 13
FEHB First Payor 14
Coordination of Benefits 14
Limited Access Areas 14
Copayment 15
In-Network Services 15
Out-of-Network Services 15
Section 5 Vision Services and Supplies 16In-Network Services 15
Out-of-Network Services 15
Diagnostic 16
Eyewear 16
Contact Lenses 18
Section 6 International Services and Supplies 22Eyewear 16
Contact Lenses 18
International Claims Payment 22
Finding an International Provider 22
Filing International Claims 22
Customer Service Website and Phone Numbers 22
International Plan Allowances 22
Section 7 General Exclusions – Things We Do Not Cover 24Finding an International Provider 22
Filing International Claims 22
Customer Service Website and Phone Numbers 22
International Plan Allowances 22
Section 8 Claims Filing and Disputed Claims Processes 25
How to File a Claim for Covered Services 25
Deadline for Filing Your Claim 25
Disputed Claims Process 25
Section 9 Definitions of Terms We Use in This Brochure 27Deadline for Filing Your Claim 25
Disputed Claims Process 25
Annuitants 27
BENEFEDS 27
Benefits 27
Enrollee 27
FEDVIP 27
Plan Allowance 27
Pre-Authorization 27
Sponsor 27
TEI certifying family member 27
TRICARE-eligible individual (TEI) family member 27
We/Us 27
You 27
Stop Health Care Fraud! 28BENEFEDS 27
Benefits 27
Enrollee 27
FEDVIP 27
Plan Allowance 27
Pre-Authorization 27
Sponsor 27
TEI certifying family member 27
TRICARE-eligible individual (TEI) family member 27
We/Us 27
You 27
Summary of Benefits 29
Rate Information 31