This article is for providers caring for our Federal Employee Program members
Laboratories that perform genetic testing
As a reminder, you can use our Authorization Quick Lookup tool to check if authorization is required for genetic testing. If it is and the FEP member lives in Massachusetts, you can use Authorization Manager to submit the request.
For authorization questions, please contact our Clinical Intake department at 1-800-689-7219.
Beginning January 1, 2026, we will make changes to our Federal Employee Program (FEP) plans offered to federal and postal employees and their families in Massachusetts. This includes the following:
- Federal Employees Health Benefits Program members
- Postal Service Health Benefits Program members
For all plans, members may experience changes to their costs for certain services and medications. For this reason, it is important to always check your patient’s Blue Cross ID card and to verify their eligibility and benefits.
Highlights of changes for all FEP members
The following changes will be applicable to both the Postal Service Health Benefits Program and Federal Employees Health Benefits plans. This includes FEP Blue Standard, FEP Blue Basic, and FEP Blue Focus.
- Simpler access to genetic testing. We only require prior approval for members:
- Who don’t show signs/symptoms of a condition; or
- When the test is being performed to assess the risk of passing a genetic condition to a child.
You can access FEP medical policies at fepblue.org/policies.
- Surgical and pharmacy services related to sex-trait modifications are no longer covered.
- Members undergoing existing treatment who are under 19 years of age are not eligible for exceptions related to services for ongoing surgical or hormonal treatment for diagnosed gender dysphoria.
- Members who are more than 19 years of age in mid-treatment under their Plan, within a surgical or chemical regimen for sex-trait modification for diagnosed gender dysphoria can seek an exception to continue care for that treatment. Authorization is required, along with a submitted treatment plan by December 31, 2025.
- Copayment for maternity services billed by a preferred facility is increasing.
- For FEP Basic Option members, the copayment associated with charges incurred during delivery of a baby will be waived if giving birth in a Blue Distinction Center for Maternity.
- Prior approval for outpatient hospice services will no longer be required.
- Prior approval is required for elective non-urgent outpatient surgical orthopedic procedures on the hip, knee, and spine. We’ve already notified providers of this in our October 20 News Alert.
- Applies to FEP Blue Standard and FEP Blue Basic plans; it’s already a requirement for FEP Blue Focus members.
Offering a weight loss management program through Teladoc Health. Members may be eligible if diagnosed with diabetes, hypertension, and/or prediabetes and/or overweight or obese.
This change only applies to federal employees in the following plan.
FEP Blue Focus
- We will no longer be offering a separate Medicare Prescription Drug Program. Those who have Medicare primary will have the same drug benefits as those who are not enrolled in Medicare.
As always, please visit FEPblue.org to review FEP Medical Polices and Plan specific brochures for an all-inclusive list of benefits and prior authorization requirements.