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Nebraska HeartlandBlue Gold $0 PCP Visit 1500 NB - 29678NE1450011 Health Insurance Plan

Blue Cross and Blue Shield of Nebraska health insurance plan with the Plan ID 29678NE1450011. The plan is called Nebraska HeartlandBlue Gold $0 PCP Visit 1500 NB.

Based on the AV Calculator by CMS.gov, the plan has an actuarial value of 79.51% (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 20.49% of the costs of all covered benefits (according to the AV Calculator by CMS.gov). More information about AV Calculator methodology.

Field Data
Health Insurance Plan ID29678NE1450011
Health Insurance Plan Year2023
StateNebraska
Health Insurance IssuerBlue Cross and Blue Shield of Nebraska
Plan Formulary Description URLFormulary URL
Plan Marketing Materials URLMarketing URL
Last Plan Update DateTue, 27 Sep 2022 00:00 GMT
Last Import DateFri, 22 Sep 2023 22:07 GMT
Health Insurance Plan Variant29678NE1450011-00
 
Available Variants of the Health Plan

29678NE1450011-00

29678NE1450011-01

29678NE1450011-02

29678NE1450011-03

Nebraska HeartlandBlue Gold $0 PCP Visit 1500 NB Health Insurance Plan Variant 29678NE1450011-00 Attributes

Plan Attribute Value
AV Calculator Output Number0.795081897
Begin Primary Care Cost-Sharing After Number Of Visits0
Begin Primary Care Deductible Coinsurance After Number Of Copays0
Business Year2023
Child-Only OfferingAllows Adult and Child-Only
Composite Rating OfferedNo
CSR Variation TypeStandard Gold Off Exchange Plan
Dental Only PlanNo
Design TypeNot Applicable
Disease Management Programs OfferedAsthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy
EHB Percent of Total Premium 1
First Tier Utilization100%
Formulary IDNEF011
Formulary URLURL
HIOS Product ID29678NE145
Import Date9/27/2022 20:01
Limited Cost Sharing Plan Variation - Estimated Advanced Payment$0.00
Inpatient Copayment Maximum Days0
HSA EligibleNo
New/Existing PlanNew
Notice Required for PregnancyNo
Is a Referral Required for Specialist?No
Issuer ID29678
Issuer Marketplace Marketing NameBlue Cross and Blue Shield of Nebraska
Market CoverageIndividual
Medical Drug Deductibles IntegratedYes
Medical Drug Maximum Out of Pocket IntegratedYes
Metal LevelGold
Multiple In Network TiersNo
National NetworkNo
Network IDNEN001
Out of Country CoverageYes
Out of Country Coverage DescriptionEmergency Services
Out of Service Area CoverageYes
Out of Service Area Coverage DescriptionEmergency Services
Plan BrochureURL
Plan Effective Date1/1/2023
Plan Expiration Date12/31/2023
Plan ID (Standard Component ID with Variant) 29678NE1450011-00
Plan Marketing NameNebraska HeartlandBlue Gold $0 PCP Visit 1500 NB
Plan TypeEPO
Plan Variant Marketing NameNebraska HeartlandBlue Gold $0 PCP Visit 1500 NB
QHP/Non QHPBoth
SBC Scenario, Having a Baby, Coinsurance$3,200
SBC Scenario, Having a Baby, Copayment$10
SBC Scenario, Having a Baby, Deductible$1,500
SBC Scenario, Having a Baby, Limit$60
SBC Scenario, Having Diabetes, Coinsurance$0
SBC Scenario, Having Diabetes, Copayment$800
SBC Scenario, Having Diabetes, Deductible$600
SBC Scenario, Having Diabetes, Limit$70
SBC Scenario, Treatment of a Simple Fracture, Coinsurance$400
SBC Scenario, Treatment of a Simple Fracture, Copayment$0
SBC Scenario, Treatment of a Simple Fracture, Deductible$1,500
SBC Scenario, Treatment of a Simple Fracture, Limit$0
Service Area IDNES003
Source NameSERFF
Plan ID29678NE1450011
State CodeNE
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Family Per Groupper group not applicable
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Family Per Personper person not applicable
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, IndividualNot Applicable
Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Family Per Groupper group not applicable
Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Family Per Personper person not applicable
Combined Medical and Drug EHB Deductible, Combined In/Out of Network, IndividualNot Applicable
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Default Coinsurance30.00%
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family Per Group$3000 per group
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family Per Person$1500 per person
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Individual$1,500
TEHBDedOutOfNetFamilyPerGroupper group not applicable
TEHBDedOutOfNetFamilyPerPersonper person not applicable
Combined Medical and Drug EHB Deductible, Out of Network, IndividualNot Applicable
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Group$15000 per group
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Person$7500 per person
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual$7,500
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family Per Groupper group not applicable
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family Per Personper person not applicable
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, IndividualNot Applicable
Unique Plan DesignNo
URL for Enrollment PaymentURL
URL for Summary of Benefits & CoverageURL
Wellness Program OfferedYes

Copay & Coinsurance of Nebraska HeartlandBlue Gold $0 PCP Visit 1500 NB Health Insurance Plan, 29678NE1450011

Drug Tier Pharmacy Type Copay amount Copay option Coinsurance rate Coinsurance option Mail Order

Frequently Asked Questions(FAQ) about Nebraska HeartlandBlue Gold $0 PCP Visit 1500 NB, 29678NE1450011 Health Insurance Plan, 29678NE1450011

Does Nebraska HeartlandBlue Gold $0 PCP Visit 1500 NB Health Insurance Plan, 29678NE1450011 support Mail Ordering?

Unfortunately, this health insurance plan does not support mail ordering or the plan data in not available.

Does (29678NE1450011) Health Insurance Plan, Variant (29678NE1450011-00) offer Disease Management Programs?

Yes, and here is the list of available programs: Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy

Does (29678NE1450011) Health Insurance Plan, Variant (29678NE1450011-00) have Out Of Country Coverage?

Yes. Details: Emergency Services

Does (29678NE1450011) Health Insurance Plan, Variant (29678NE1450011-00) have Out of Service Area Coverage?

Yes. Details: Emergency Services

Does (29678NE1450011) Health Insurance Plan, Variant (29678NE1450011-00) offer Disease Management Programs?

Yes, and here is the list of available programs: Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy

Does Nebraska HeartlandBlue Gold $0 PCP Visit 1500 NB Health Insurance Plan, Variant (29678NE1450011-00) offer Disease Management Programs for Asthma?

Yes, the Nebraska HeartlandBlue Gold $0 PCP Visit 1500 NB Health Insurance Plan Variant 29678NE1450011-00 offers Disease Management Program for Asthma.

Does Nebraska HeartlandBlue Gold $0 PCP Visit 1500 NB Health Insurance Plan, Variant (29678NE1450011-00) offer Disease Management Programs for Heart disease?

Yes, the Nebraska HeartlandBlue Gold $0 PCP Visit 1500 NB Health Insurance Plan Variant 29678NE1450011-00 offers Disease Management Program for Heart disease.

Does Nebraska HeartlandBlue Gold $0 PCP Visit 1500 NB Health Insurance Plan, Variant (29678NE1450011-00) offer Disease Management Programs for Depression?

Yes, the Nebraska HeartlandBlue Gold $0 PCP Visit 1500 NB Health Insurance Plan Variant 29678NE1450011-00 offers Disease Management Program for Depression.

Does Nebraska HeartlandBlue Gold $0 PCP Visit 1500 NB Health Insurance Plan, Variant (29678NE1450011-00) offer Disease Management Programs for Diabetes?

Yes, the Nebraska HeartlandBlue Gold $0 PCP Visit 1500 NB Health Insurance Plan Variant 29678NE1450011-00 offers Disease Management Program for Diabetes.

Does Nebraska HeartlandBlue Gold $0 PCP Visit 1500 NB Health Insurance Plan, Variant (29678NE1450011-00) offer Disease Management Programs for High blood pressure & high cholesterol?

Yes, the Nebraska HeartlandBlue Gold $0 PCP Visit 1500 NB Health Insurance Plan Variant 29678NE1450011-00 offers Disease Management Program for High blood pressure & high cholesterol.

Does Nebraska HeartlandBlue Gold $0 PCP Visit 1500 NB Health Insurance Plan, Variant (29678NE1450011-00) offer Disease Management Programs for Low back pain?

Yes, the Nebraska HeartlandBlue Gold $0 PCP Visit 1500 NB Health Insurance Plan Variant 29678NE1450011-00 offers Disease Management Program for Low back pain.

Does Nebraska HeartlandBlue Gold $0 PCP Visit 1500 NB Health Insurance Plan, Variant (29678NE1450011-00) offer Disease Management Programs for Pain management?

Yes, the Nebraska HeartlandBlue Gold $0 PCP Visit 1500 NB Health Insurance Plan Variant 29678NE1450011-00 offers Disease Management Program for Pain management.

Does Nebraska HeartlandBlue Gold $0 PCP Visit 1500 NB Health Insurance Plan, Variant (29678NE1450011-00) offer Disease Management Programs for Pregnancy?

Yes, the Nebraska HeartlandBlue Gold $0 PCP Visit 1500 NB Health Insurance Plan Variant 29678NE1450011-00 offers Disease Management Program for Pregnancy.

 

Disclaimer: This is based on the import(Date: Fri, 22 Sep 2023 22:07 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