BlueCross.

/. BlueShield.

Federal Employee Program.

This card is used to obtain covered benefits und

Blue Cross and Blue Shield Service Benefit Plan Basic

oe You MUST use Preferred providers to get

enefits.

Precertification is required for all hospital admissions

and is ultimately your responsibility. Benefits are

reduced by $500 if precertification is not obtained. For

instructions, call the local Blue Cross and Blue Shield

Plan serving the area where you are treated. In some

areas, Preferred hospitals will obtain precertification

for you. Certain other services require prior approval.

Please consult your benefit Brochure for more

information.

Use of this card constitutes acceptance of the terms

and conditions in the Service Benefit Plan Brochure

(RI 71-005) for the applicable contract year, which is

the only legal description of benefits.

www.fepblue.org

Customer Service: 1-800-***-****

Precertification: 1-800-***-****

Mental Health / Substance Abuse

Precertification: 1-800-***-****

Retail Pharmacy: 1-800-***-****

Assistance Overseas

(Call Collect): 1-804-***-****

Nurse Line/Consumer 1-888-***-****

Tools:

re

Blue Cross and Blue Shield of Florida, Inc.

An independent licensee of the BlueCross

and BlueShield Association

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