Document list

Document Name Document Number
Terms and Conditions and Privacy Policy SB-FBF-002
Cover page V25.00.1.1
Introduction V25.00.1.2
Table of Contents V25.00.1.3
A Choice of Plans and Options V25.00.2.1
Enroll Through BENEFEDS V25.00.2.2
Dual Enrollment V25.00.2.3
Coverage Effective Date V25.00.2.4
Pre-Tax Salary Deduction for Employees V25.00.2.5
Annual Enrollment Opportunity V25.00.2.6
Continued Group Coverage After Retirement V25.00.2.7
How We Have Changed for 2025 V25.00.3
Federal Employees V25.01.1
Temporary/Seasonal Employees V25.01.2
Federal Annuitants V25.01.3
Survivor Annuitants V25.01.4
Compensationers V25.01.5
TRICARE-eligible individual V25.01.6
Family Members V25.01.7
Not Eligible V25.01.8
Enroll Through BENEFEDS V25.02.1
Enrollment Types V25.02.2
Dual Enrollment V25.02.3
Opportunities to Enroll or Change Enrollment V25.02.4
When Coverage Stops V25.02.5
Continuation of Coverage V25.02.6
FSAFEDS/High-Deductible Health Plans and FEDVIP V25.02.7
Identification Cards/Enrollment Confirmation V25.03.1
Plan Providers V25.03.2
In-Network V25.03.3
Out-of-Network V25.03.4
Pre-Authorization V25.03.5
FEHB/PSHB First Payor V25.03.6
Coordination of Benefits V25.03.7
Limited Access Areas V25.03.8
Copayment V25.04.1
In-Network Services V25.04.2
Out-of-Network Services V25.04.3
Section 5 Vision Services and Supplies V25.05.0
Diagnostic V25.05.1
Eyewear V25.05.2
Contact Lenses V25.05.3
Warranty V25.05.3.1
Child Benefit V25.05.4
Medical Condition Benefit V25.05.5
Low Vision V25.05.6
Medically Necessary Contact Lenses V25.05.7
Discounts V25.05.8
Tools and Resources V25.05.9
Section 6 International Services and Supplies V25.06.0
International Claims Payment V25.06.1
Finding an International Provider V25.06.2
Filing International Claims V25.06.3
Customer Service Website and Phone Numbers V25.06.4
International Plan Allowances V25.06.5
Section 7 General Exclusions – Things We Do Not Cover V25.07
How to File a Claim for Covered Services V25.08.1
Deadline for Filing Your Claim V25.08.2
Disputed Claims Process V25.08.3
Annuitants V25.09.01
BENEFEDS V25.09.02
Benefits V25.09.03
Enrollee V25.09.04
FEDVIP V25.09.05
Plan Allowance V25.09.06
Pre-Authorization V25.09.07
Sponsor V25.09.08
TEI certifying family member V25.09.09
TRICARE-eligible individual (TEI) family member V25.09.10
We/Us V25.09.11
You V25.09.12
Stop Health Care Fraud! V25.10
Summary of Benefits V25.11
Rate Information V25.12