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Plan Profile

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You are here: FEHB Home > 2002 Plan Comparison > FFS Plan Profile: Blue Cross and Blue Shield Service Benefit Plan-Std

General Information
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Plan Name: Blue Cross and Blue Shield Service Benefit Plan-Std
Service Area: Nationwide
Brochure: PDF Version
Brochure: Text Version
NCQA Accreditation: n/a
JCAHO Accreditation: n/a
URAC Accreditation: n/a
Plan Type: FFS
Enrollment Code-Self: 104
Enrollment Code-Self & Family: 105
Link to Plan Home Page: http://www.fepblue.org
Telephone: Local phone #
Summary results of the 2001 consumers assessment of health plans survey
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Benefits
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PPO
Non PPO
Deductible Per Person Calendar Year $250 $250
Deductible Per Person-Prescription Drug None None
Deductible Per Hospital Stay-Inpatient $100 $300
Copay Coinsurance Doctors & Outpatient Tests 10% 25%
Copay Coinsurance Hospital Inpatient R & B Nothing 30%
Copay Coinsurance Hospital Inpatient Other Nothing 30%
Copay Coinsurance Hospital Outpatient 10% 25%
Copay Coinsurance Prescription Drugs Home Delivery Generic $10-M/25%-I 45%-I
Copay Coinsurance Prescription Drugs Home Delivery Brand Name $35-M/25%-I 45%-I
Copay Coinsurance Prescription Drugs Generic 25% 45%
Copay Coinsurance Prescription Drugs Brand Name 25% 45%
Copay Coinsurance Prescription Drugs Nonformulary 25% 45%
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Rates
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Non-Postal
Biweekly Self: $41.12 Self: & Family: $94.83
Monthly Self: $89.09 Self: & Family: $205.46
Twice Biweekly Self: $82.24 Self: & Family: $189.66
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Annuitants
Monthly Self: $89.09 Self: & Family: $205.46
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U.S. Postal Service Employees (Type A)
Monthly Self: $50.83 Self: & Family: $118.06
Biweekly Self: $23.46 Self: & Family: $54.49
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U.S. Postal Service Employees (Type B)
Monthly Self: $64.45 Self: & Family: $180.05
Biweekly Self: $29.75 Self: & Family: $83.10
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Worker's Compensation Recipients
Twice Biweekly Self: $82.24 Self: & Family: $189.66
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Certain Temporary Employees
Monthly Self: $301.12 Self: & Family: $689.52
Biweekly Self: $138.98 Self: & Family: $318.24
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Former Spouse Enrollees
Monthly Self: $301.12 Self: & Family: $689.52
Biweekly Self: $138.98 Self: & Family: $318.24
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Temporary Continuation of Coverage
Biweekly Self: $141.76 Self: & Family: $324.60
Monthly Self: $307.14 Self: & Family: $703.31
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FDIC
Biweekly Self: $23.46 Self: & Family: $54.49
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Department of Defense Demo Project
Monthly Self: $74.04 Self: & Family: $170.99
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Department of Defense Demo Project Temporary Continuation of Coverage
Monthly Self: $291.79 Self: & Family: $668.15
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