HeartlandBlue Bronze 0% Coinsurance after Deductible NEtwork Blue PPO - 29678NE1510002 Health Insurance Plan
Blue Cross and Blue Shield of Nebraska health insurance plan with the Plan ID 29678NE1510002. The plan is called HeartlandBlue Bronze 0% Coinsurance after Deductible NEtwork Blue PPO.
Based on the AV Calculator by CMS.gov, the plan has an actuarial value of 59.65% (we converted the output of AV Calculator to percentage to compare with data provided by Issuer, it shows the percentage of total average costs for covered benefits that a plan will cover). So, on average, you would be responsible for 40.35% of the costs of all covered benefits (according to the AV Calculator by CMS.gov). More information about AV Calculator methodology.
| Health Insurance Plan ID | 29678NE1510002 | ||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Health Insurance Plan Year | 2025 | ||||||||||||||||||
| State | Nebraska | ||||||||||||||||||
| Health Insurance Issuer | Blue Cross and Blue Shield of Nebraska | ||||||||||||||||||
| Plan Formulary Description URL | Formulary URL | ||||||||||||||||||
| Plan Marketing Materials URL | Marketing URL | ||||||||||||||||||
| Health Insurance Plan Variant | 29678NE1510002-00 | ||||||||||||||||||
| Provider Network(s) | PREFERRED | ||||||||||||||||||
| In Network Doctors
*The data available in our database based on Health Insurance Company Open Data (update: Tue, 03 Dec 2024 06:24 GMT). |
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| Available Variants of the Health Plan | Standard Off Exchange Plan - 29678NE1510002-00 Standard On Exchange Plan - 29678NE1510002-01 |
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| Last Plan Update Date | Wed, 09 Oct 2024 00:00 GMT | ||||||||||||||||||
| Last Import Date | Tue, 03 Dec 2024 06:24 GMT |
Benefits of HeartlandBlue Bronze 0% Coinsurance after Deductible NEtwork Blue PPO Health Insurance Plan, 29678NE1510002-00
| Benefit | Covered | In Network | Out Of Network |
|---|---|---|---|
| Abortion for Which Public Funding is Prohibited
|
NO | ||
| Accidental Dental
|
YES | No Charge after deductible |
No Charge after deductible |
| Acupuncture
|
NO | ||
| Allergy Testing
|
YES | No Charge after deductible |
No Charge after deductible |
| Bariatric Surgery
|
NO | ||
| Basic Dental Care - Adult
|
NO | ||
| Basic Dental Care - Child
|
YES | No Charge after deductible |
No Charge after deductible |
| Chemotherapy
|
YES | No Charge after deductible |
No Charge after deductible |
| Chiropractic Care
Limit: 20.0 Visit(s) per Year |
YES | No Charge after deductible |
No Charge after deductible |
| Cosmetic Surgery
|
NO | ||
| Delivery and All Inpatient Services for Maternity Care
|
YES | No Charge after deductible |
No Charge after deductible |
| Dental Anesthesia
Based on most common prescription tier |
YES | No Charge after deductible |
No Charge after deductible |
| Dental Check-Up for Children
Limit: 1.0 Visit(s) per 6 Months |
YES | No Charge |
No Charge after deductible |
| Diabetes Care Management
|
YES | No Charge after deductible |
No Charge after deductible |
| Diabetes Education
|
YES | No Charge after deductible |
No Charge after deductible |
| Dialysis
|
YES | No Charge after deductible |
No Charge after deductible |
| Durable Medical Equipment
|
YES | No Charge after deductible |
No Charge after deductible |
| Emergency Room Services
|
YES | No Charge after deductible |
No Charge after deductible |
| Emergency Transportation/Ambulance
|
YES | No Charge after deductible |
No Charge after deductible |
| Eye Glasses for Children
Limit: 1.0 Item(s) per Year In-network deductible applies to both In and Out-Of-Network |
YES | No Charge after deductible |
No Charge after deductible |
| Gender Affirming Care
|
YES | No Charge after deductible |
No Charge after deductible |
| Generic Drugs
|
YES | No Charge after deductible |
No Charge after deductible |
| Habilitation Services
Limit: 45.0 Visit(s) per Year The limit is 45 visits per year. This limit is shared by Physical, Occupational, Speech Therapy, and Outpatient Habilitative Services |
YES | No Charge after deductible |
No Charge after deductible |
| Hearing Aids
Covered up to age 19 limited to $3,000 every 48 months |
YES | No Charge after deductible |
No Charge after deductible |
| Home Health Care Services
Limit: 60.0 Days per Year |
YES | No Charge after deductible |
No Charge after deductible |
| Hospice Services
The Covered Person must have a life expectancy of six months or less as documented in writing by the attending Physician. The Hospice Services must be ordered by a Physician. Services provided must be appropriate for palliative support or management of a Covered Person with terminal medical Illness. |
YES | No Charge after deductible |
No Charge after deductible |
| Imaging (CT/PET Scans, MRIs)
|
YES | No Charge after deductible |
No Charge after deductible |
| Infertility Treatment
|
NO | ||
| Infusion Therapy
|
YES | No Charge after deductible |
No Charge after deductible |
| Inpatient Hospital Services (e.g., Hospital Stay)
|
YES | No Charge after deductible |
No Charge after deductible |
| Inpatient Physician and Surgical Services
|
YES | No Charge after deductible |
No Charge after deductible |
| Laboratory Outpatient and Professional Services
|
YES | No Charge after deductible |
No Charge after deductible |
| Long-Term/Custodial Nursing Home Care
|
NO | ||
| Major Dental Care - Adult
|
NO | ||
| Major Dental Care - Child
|
YES | No Charge after deductible |
No Charge after deductible |
| Mental/Behavioral Health Inpatient Services
|
YES | No Charge after deductible |
No Charge after deductible |
| Mental/Behavioral Health Outpatient Services
The cost sharing that displays applies to outpatient office visits only. All other outpatient services [e.g., consider including a non-exhaustive list of examples] may be subject to additional cost sharing. Please refer to the plan policy documents for detailed information. |
YES | No Charge after deductible |
No Charge after deductible |
| Non-Preferred Brand Drugs
|
YES | No Charge after deductible |
No Charge after deductible |
| Nutritional Counseling
Only for diabetes management as provided by the plan. |
YES | No Charge after deductible |
No Charge after deductible |
| Off Label Prescription Drugs
|
YES | No Charge after deductible |
No Charge after deductible |
| Orthodontia - Adult
|
NO | ||
| Orthodontia - Child
There is a 24-month waiting period for this benefit |
YES | No Charge after deductible |
No Charge after deductible |
| Other Practitioner Office Visit (Nurse, Physician Assistant)
|
YES | No Charge after deductible |
No Charge after deductible |
| Outpatient Facility Fee (e.g., Ambulatory Surgery Center)
|
YES | No Charge after deductible |
No Charge after deductible |
| Outpatient Rehabilitation Services
Limit: 45.0 Visit(s) per Year The limit is 45 visits per year. This limit is shared by Physical, Occupational, Speech Therapy, and Outpatient Rehabilitation |
YES | No Charge after deductible |
No Charge after deductible |
| Outpatient Surgery Physician/Surgical Services
|
YES | No Charge after deductible |
No Charge after deductible |
| Preferred Brand Drugs
|
YES | No Charge after deductible |
No Charge after deductible |
| Prenatal and Postnatal Care
|
YES | No Charge after deductible |
No Charge after deductible |
| Preventive Care/Screening/Immunization
|
YES | No Charge |
No Charge after deductible |
| Primary Care Visit to Treat an Injury or Illness
Unlimited telehealth/virtual care visits to the in-network doctor of your choice with $0 copay |
YES | No Charge after deductible |
No Charge after deductible |
| Private-Duty Nursing
|
NO | ||
| Prosthetic Devices
|
YES | No Charge after deductible |
No Charge after deductible |
| Radiation
|
YES | No Charge after deductible |
No Charge after deductible |
| Reconstructive Surgery
Available only post-mastectomy or when required to restore, reconstruct or correct any bodily function that was lost, impaired or damaged as a result of Injury or Illness. |
YES | No Charge after deductible |
No Charge after deductible |
| Rehabilitative Occupational and Rehabilitative Physical Therapy
Limit: 45.0 Visit(s) per Year The limit is 45 visits per year. This limit is shared by Physical, Occupational, Speech Therapy, and Outpatient Rehabilitation |
YES | No Charge after deductible |
No Charge after deductible |
| Rehabilitative Speech Therapy
Limit: 45.0 Visit(s) per Year The limit is 45 visits per year. This limit is shared by Physical, Occupational, Speech Therapy, and Outpatient Rehabilitation |
YES | No Charge after deductible |
No Charge after deductible |
| Routine Dental Services (Adult)
|
NO | ||
| Routine Eye Exam (Adult)
|
NO | ||
| Routine Eye Exam for Children
Limit: 1.0 Visit(s) per Year |
YES | No Charge |
No Charge after deductible |
| Routine Foot Care
|
NO | ||
| Skilled Nursing Facility
Limit: 60.0 Days per Year |
YES | No Charge after deductible |
No Charge after deductible |
| Specialist Visit
|
YES | No Charge after deductible |
No Charge after deductible |
| Specialty Drugs
|
YES | No Charge after deductible |
No Charge after deductible |
| Substance Abuse Disorder Inpatient Services
|
YES | No Charge after deductible |
No Charge after deductible |
| Substance Abuse Disorder Outpatient Services
|
YES | No Charge after deductible |
No Charge after deductible |
| Tier 2 Generic Drugs
|
YES | No Charge after deductible |
No Charge after deductible |
| Tier 2 Specialty Drugs
|
YES | No Charge after deductible |
No Charge after deductible |
| Transplant
|
YES | No Charge after deductible |
No Charge after deductible |
| Treatment for Temporomandibular Joint Disorders
|
YES | No Charge after deductible |
No Charge after deductible |
| Urgent Care Centers or Facilities
|
YES | No Charge after deductible |
No Charge after deductible |
| Weight Loss Programs
|
NO | ||
| Well Baby Visits and Care
|
YES | No Charge |
No Charge after deductible |
| X-rays and Diagnostic Imaging
|
YES | No Charge after deductible |
No Charge after deductible |
HeartlandBlue Bronze 0% Coinsurance after Deductible NEtwork Blue PPO Health Insurance Plan Variant 29678NE1510002-00 Attributes
| Plan Attribute | Value |
|---|---|
| AV Calculator Output Number | 0.5965205611925151 |
| Begin Primary Care Cost-Sharing After Number Of Visits | 0 |
| Begin Primary Care Deductible Coinsurance After Number Of Copays | 0 |
| Business Year | 2025 |
| Child-Only Offering | Allows Adult and Child-Only |
| Composite Rating Offered | No |
| CSR Variation Type | Standard Bronze Off Exchange Plan |
| Dental Only Plan | No |
| Design Type | Not Applicable |
| Disease Management Programs Offered | Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs |
| EHB Percent of Total Premium | 1.0 |
| First Tier Utilization | 100% |
| Formulary ID | NEF018 |
| Formulary URL | URL |
| HIOS Product ID | 29678NE151 |
| Import Date | 2024-10-09 20:01:46 |
| Limited Cost Sharing Plan Variation - Estimated Advanced Payment | $0.00 |
| Inpatient Copayment Maximum Days | 0 |
| HSA Eligible | No |
| New/Existing Plan | New |
| Notice Required for Pregnancy | No |
| Is a Referral Required for Specialist? | No |
| Issuer ID | 29678 |
| Issuer Marketplace Marketing Name | Blue Cross and Blue Shield of Nebraska |
| Market Coverage | Individual |
| Medical Drug Deductibles Integrated | Yes |
| Medical Drug Maximum Out of Pocket Integrated | Yes |
| Metal Level | Expanded Bronze |
| Multiple In Network Tiers | No |
| National Network | Yes |
| Network ID | NEN001 |
| Out of Country Coverage | Yes |
| Out of Country Coverage Description | Emergency Services |
| Out of Service Area Coverage | Yes |
| Out of Service Area Coverage Description | Coverage for emergency health services and urgent care center visits at in-network benefit level. All other services use the standard BlueCard PPO network to determine the level of benefits. |
| Plan Brochure | URL |
| Plan Effective Date | 2025-01-01 |
| Plan Expiration Date | 2025-12-31 |
| Plan ID (Standard Component ID with Variant) | 29678NE1510002-00 |
| Plan Marketing Name | HeartlandBlue Bronze 0% Coinsurance after Deductible NEtwork Blue PPO |
| Plan Type | PPO |
| Plan Variant Marketing Name | HeartlandBlue Bronze 0% Coinsurance after Deductible NEtwork Blue PPO |
| QHP/Non QHP | Both |
| SBC Scenario, Having a Baby, Coinsurance | $0 |
| SBC Scenario, Having a Baby, Copayment | $0 |
| SBC Scenario, Having a Baby, Deductible | $9,200 |
| SBC Scenario, Having a Baby, Limit | $60 |
| SBC Scenario, Having Diabetes, Coinsurance | $0 |
| SBC Scenario, Having Diabetes, Copayment | $0 |
| SBC Scenario, Having Diabetes, Deductible | $5,300 |
| SBC Scenario, Having Diabetes, Limit | $70 |
| SBC Scenario, Treatment of a Simple Fracture, Coinsurance | $0 |
| SBC Scenario, Treatment of a Simple Fracture, Copayment | $0 |
| SBC Scenario, Treatment of a Simple Fracture, Deductible | $2,800 |
| SBC Scenario, Treatment of a Simple Fracture, Limit | $0 |
| Service Area ID | NES006 |
| Source Name | SERFF |
| Plan ID | 29678NE1510002 |
| State Code | NE |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Family Per Group | per group not applicable |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Family Per Person | per person not applicable |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Individual | Not Applicable |
| Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Family Per Group | per group not applicable |
| Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Family Per Person | per person not applicable |
| Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Individual | Not Applicable |
| Combined Medical and Drug EHB Deductible, In Network (Tier 1), Default Coinsurance | 0.00% |
| Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family Per Group | $18400 per group |
| Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family Per Person | $9200 per person |
| Combined Medical and Drug EHB Deductible, In Network (Tier 1), Individual | $9,200 |
| Combined Medical and Drug EHB Deductible, Out of Network, Family Per Group | $36800 per group |
| Combined Medical and Drug EHB Deductible, Out of Network, Family Per Person | $18400 per person |
| Combined Medical and Drug EHB Deductible, Out of Network, Individual | $18,400 |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Group | $18400 per group |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Person | $9200 per person |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual | $9,200 |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family Per Group | $36800 per group |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family Per Person | $18400 per person |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Individual | $18,400 |
| Unique Plan Design | No |
| URL for Enrollment Payment | URL |
| URL for Summary of Benefits & Coverage | URL |
| Wellness Program Offered | Yes |
Copay & Coinsurance of HeartlandBlue Bronze 0% Coinsurance after Deductible NEtwork Blue PPO Health Insurance Plan, 29678NE1510002
| Drug Tier | Pharmacy Type | Copay amount | Copay option | Coinsurance rate | Coinsurance option | Mail Order |
|---|
Frequently Asked Questions(FAQ) about HeartlandBlue Bronze 0% Coinsurance after Deductible NEtwork Blue PPO, 29678NE1510002 Health Insurance Plan, 29678NE1510002
-
Does HeartlandBlue Bronze 0% Coinsurance after Deductible NEtwork Blue PPO Health Insurance Plan, 29678NE1510002 support Mail Ordering?
Unfortunately, this health insurance plan does not support mail ordering or the plan data in not available.
Does (29678NE1510002) Health Insurance Plan, Variant (29678NE1510002-00) offer Disease Management Programs?
Does (29678NE1510002) Health Insurance Plan, Variant (29678NE1510002-00) have Out Of Country Coverage?
Does (29678NE1510002) Health Insurance Plan, Variant (29678NE1510002-00) have Out of Service Area Coverage?
Does (29678NE1510002) Health Insurance Plan, Variant (29678NE1510002-00) offer Disease Management Programs?
Does HeartlandBlue Bronze 0% Coinsurance after Deductible NEtwork Blue PPO Health Insurance Plan, Variant (29678NE1510002-00) offer Disease Management Programs for Asthma?
Does HeartlandBlue Bronze 0% Coinsurance after Deductible NEtwork Blue PPO Health Insurance Plan, Variant (29678NE1510002-00) offer Disease Management Programs for Heart disease?
Does HeartlandBlue Bronze 0% Coinsurance after Deductible NEtwork Blue PPO Health Insurance Plan, Variant (29678NE1510002-00) offer Disease Management Programs for Depression?
Does HeartlandBlue Bronze 0% Coinsurance after Deductible NEtwork Blue PPO Health Insurance Plan, Variant (29678NE1510002-00) offer Disease Management Programs for Diabetes?
Does HeartlandBlue Bronze 0% Coinsurance after Deductible NEtwork Blue PPO Health Insurance Plan, Variant (29678NE1510002-00) offer Disease Management Programs for High blood pressure & high cholesterol?
Does HeartlandBlue Bronze 0% Coinsurance after Deductible NEtwork Blue PPO Health Insurance Plan, Variant (29678NE1510002-00) offer Disease Management Programs for Low back pain?
Does HeartlandBlue Bronze 0% Coinsurance after Deductible NEtwork Blue PPO Health Insurance Plan, Variant (29678NE1510002-00) offer Disease Management Programs for Pregnancy?
Does HeartlandBlue Bronze 0% Coinsurance after Deductible NEtwork Blue PPO Health Insurance Plan, Variant (29678NE1510002-00) offer Disease Management Programs for Weight loss programs?
Disclaimer: This is based on the import(Date: Tue, 03 Dec 2024 06:24 GMT) of the data from Healthcare Issuers listed by CMS. While we make every effort to ensure that data is accurate, you should assume all results are unvalidated. Source: CMS.gov, HealthPorta HEALTHCARE MRF API