March 2024
Federal Employee Program® Updates to Prior Approval Requirements and Benefits
As of January 1, 2024, the following changes will be in effect for FEP® policy types:
- For Standard and Basic, Hearing Aids will require Prior Approval and will NOT be covered with a post service review. Blue Focus will continue to have hearing aids not covered.
- All genetic testing will require Prior Approval.
- Proton Beam Therapy, Stereotactic Radiosurgery and Stereotactic Body Radiation Therapy require prior approval.
- Certain High-Cost High Dollar Drugs will require Prior Approval in addition to all Gene Therapy and CAR-T drugs.
- All transplants require Prior Approval, regardless of policy type, except corneal.
- Gender Affirming Care is being broadened to include breast augmentation and certain facial surgeries. All Gender Affirming Services still require Prior Approval.
- We now provide coverage for Artificial Insemination; Prior Approval is required.
- Benefits for drugs associated with AI procedures, where the procedure has been prior approved, may be covered.
- In vitro fertilization related drugs are limited to three cycles annually, prior approval required, and must be completed through the pharmacy benefit.
- For Standard members, we now provide coverage for Assisted Reproductive Technology procedures and services, limited to $25,000 annually for some infertility diagnosis and Prior Approval required.
- We no longer require written consent in a case management program prior to admission for inpatient care provided by a Residential Treatment Center or Skilled Nursing Facility.
- We now provide coverage for marital and family counseling.
- For eligible members who do not opt out, prescription drug benefits will now be provided under a new FEP Medicare Prescription Drug Program (Medicare Part D).
Please note you may submit a request via Availity®, IVR, submitting a fax along with a Recommended Clinical Review (Predetermination) form, or calling our Preauth department. For benefit questions, please contact the number on the back of the member's card or Customer Service. You may also get more information about the Federal Employee Program, including the benefit brochure, through the website fepblue.org.
Fax numbers: 877-404-6455 or 888-368-3406
Preauth number: 800-672-2378
Customer Service number: 800-722-3130
