January 2022
Summary of 2022 Federal Employee Program® (FEP®) Benefit Changes
The following is a summary of updates to FEP member benefits effective Jan. 1, 2022. For more information regarding member benefits, please call the telephone number on the back of the member ID card. Please confirm FEP member benefits with the 2022 benefit brochures, available at fepblue.org/brochure, prior to rendering services.
Organ Transplant:
Kidney transplants will now require Prior Approval and are now part of the Blue Distinction Centers for Transplants® (BDCT) Program. This means members may be eligible for BDCT travel and lodging benefits when criteria are met.
Pancreas transplants have been removed from the BDCT program but still require Prior Approval.
Gender Reassignment Surgery (GRS):
- Includes nipple reconstruction
- Top‑only surgery
- Hormone therapy no longer required
- Only 1 referral letter needed
- Non‑gender identity can be considered a form of gender dysphoria, and therefore can be covered if all other criteria are met
Electrocardiogram (EKG):
EKG will no longer be considered part of the preventive benefit with annual exams. EKG will be subject to post‑service review for medical necessity.
Maternity:
FEP Maternity benefit now offers a breast pump and milk storage bags for members who are pregnant and/or nursing when ordered through our new fulfillment vendor. For more information, contact Customer Service.
Pharmacy:
Specialty drug pharmacy will now be administered by CVS Caremark. For information about the FEP specialty drug pharmacy program, visit fepblue.org/specialtypharmacy or call us at 888‑346‑3731.
For FEP Blue FocusSM: AllianceRx Walgreens Prime and Duane Reade Pharmacies will no longer be in‑network effective Jan. 1, 2022.
Air Ambulance:
Non‑emergent air ambulance transport from one facility to another requires Prior Approval and like emergent air ambulance transport falls under the federal No Surprise Billing Act.
Emergency Medical Services:
For emergency medical services performed in the emergency department of a hospital or urgent care centers licensed for, and permitted to provide, emergency services, that does not contract with Blue Cross and Blue Shield of New Mexico, payment allowance is determined in accordance with applicable law, such as the federal No Surprise Billing Act.
Questions?
Contact FEP Customer Service at 800‑245‑1609.
Verification of eligibility and/or benefit information is not a guarantee of payment. Benefits will be determined once a claim is received and will be based upon, among other things, the member’s eligibility, any claims received during the interim period and the terms of the member’s certificate of coverage applicable on the date services were rendered.