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HeartlandBlue Slvr Stnd PSBC CSR 73

Field Data
Health Insurance Plan ID29678NE1470010
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 DateSun, 28 May 2023 00:00 GMT
Last Import DateSun, 28 May 2023 07:51 GMT
Health Insurance Plan Variant29678NE1470010-05
 
Available Variants of the Health Plan

29678NE1470010-00

29678NE1470010-01

29678NE1470010-02

29678NE1470010-03

29678NE1470010-04

29678NE1470010-05

29678NE1470010-06

Nebraska HeartlandBlue Silver Standard 5800 PSBC Health Insurance Plan Variant 29678NE1470010-05 Attributes

Plan Attribute Value
AV Calculator Output Number 0.870484534
Begin Primary Care Cost-Sharing After Number Of Visits 0
Begin Primary Care Deductible Coinsurance After Number Of Copays 0
Business Year 2023
Child-Only Offering Allows Adult and Child-Only
Composite Rating Offered No
CSR Variation Type 87% AV Level Silver Plan
Dental Only Plan No
Design Type Design 1
Disease Management Programs Offered Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy
EHB Percent of Total Premium 1
First Tier Utilization 100%
Formulary ID NEF014
Formulary URLURL
HIOS Product ID 29678NE147
Import Date 9/27/2022 20:01
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 Silver
Multiple In Network Tiers No
National Network No
Network ID NEN002
Out of Country Coverage Yes
Out of Country Coverage Description Emergency Services
Out of Service Area Coverage Yes
Out of Service Area Coverage Description Emergency Services
Plan BrochureURL
Plan Effective Date 1/1/2023
Plan Expiration Date 12/31/2023
Plan ID (Standard Component ID with Variant) 29678NE1470010-05
Plan Marketing Name Nebraska HeartlandBlue Silver Standard 5800 PSBC
Plan Type EPO
Plan Variant Marketing Name Nebraska HeartlandBlue Silver Standard 5800 PSBC
QHP/Non QHP Both
SBC Scenario, Having a Baby, Coinsurance $1,500
SBC Scenario, Having a Baby, Copayment $0
SBC Scenario, Having a Baby, Deductible $5,700
SBC Scenario, Having a Baby, Limit $60
SBC Scenario, Having Diabetes, Coinsurance $0
SBC Scenario, Having Diabetes, Copayment $700
SBC Scenario, Having Diabetes, Deductible $500
SBC Scenario, Having Diabetes, Limit $70
SBC Scenario, Treatment of a Simple Fracture, Coinsurance $0
SBC Scenario, Treatment of a Simple Fracture, Copayment $10
SBC Scenario, Treatment of a Simple Fracture, Deductible $2,800
SBC Scenario, Treatment of a Simple Fracture, Limit $0
Service Area ID NES002
Source Name SERFF
Plan ID 29678NE1470010
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 30.00%
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family Per Group $1600 per group
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family Per Person $800 per person
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Individual $800
TEHBDedOutOfNetFamilyPerGroup per group not applicable
TEHBDedOutOfNetFamilyPerPerson per person not applicable
Combined Medical and Drug EHB Deductible, Out of Network, Individual Not Applicable
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Group $6000 per group
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Person $3000 per person
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual $3,000
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family Per Group per group not applicable
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family Per Person per person not applicable
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Individual Not Applicable
Unique Plan Design No
URL for Enrollment PaymentURL
URL for Summary of Benefits & CoverageURL
Wellness Program Offered Yes

Copay & Coinsurance of HeartlandBlue Slvr Stnd PSBC CSR 73 Health Insurance Plan, 29678NE1470010

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

Frequently Asked Questions(FAQ) about HeartlandBlue Slvr Stnd PSBC CSR 73, 29678NE1470010 Health Insurance Plan, 29678NE1470010

Does HeartlandBlue Slvr Stnd PSBC CSR 73 Health Insurance Plan, 29678NE1470010 support Mail Ordering?

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

Does (29678NE1470010) Health Insurance Plan, Variant (29678NE1470010-05) 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 (29678NE1470010) Health Insurance Plan, Variant (29678NE1470010-05) have Out Of Country Coverage?

Yes. Details: Emergency Services

Does (29678NE1470010) Health Insurance Plan, Variant (29678NE1470010-05) have Out of Service Area Coverage?

Yes. Details: Emergency Services

Does (29678NE1470010) Health Insurance Plan, Variant (29678NE1470010-05) 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 Silver Standard 5800 PSBC Health Insurance Plan, Variant (29678NE1470010-05) offer Disease Management Programs for Asthma?

Yes, the Nebraska HeartlandBlue Silver Standard 5800 PSBC Health Insurance Plan Variant 29678NE1470010-05 offers Disease Management Program for Asthma.

Does Nebraska HeartlandBlue Silver Standard 5800 PSBC Health Insurance Plan, Variant (29678NE1470010-05) offer Disease Management Programs for Heart disease?

Yes, the Nebraska HeartlandBlue Silver Standard 5800 PSBC Health Insurance Plan Variant 29678NE1470010-05 offers Disease Management Program for Heart disease.

Does Nebraska HeartlandBlue Silver Standard 5800 PSBC Health Insurance Plan, Variant (29678NE1470010-05) offer Disease Management Programs for Depression?

Yes, the Nebraska HeartlandBlue Silver Standard 5800 PSBC Health Insurance Plan Variant 29678NE1470010-05 offers Disease Management Program for Depression.

Does Nebraska HeartlandBlue Silver Standard 5800 PSBC Health Insurance Plan, Variant (29678NE1470010-05) offer Disease Management Programs for Diabetes?

Yes, the Nebraska HeartlandBlue Silver Standard 5800 PSBC Health Insurance Plan Variant 29678NE1470010-05 offers Disease Management Program for Diabetes.

Does Nebraska HeartlandBlue Silver Standard 5800 PSBC Health Insurance Plan, Variant (29678NE1470010-05) offer Disease Management Programs for High blood pressure & high cholesterol?

Yes, the Nebraska HeartlandBlue Silver Standard 5800 PSBC Health Insurance Plan Variant 29678NE1470010-05 offers Disease Management Program for High blood pressure & high cholesterol.

Does Nebraska HeartlandBlue Silver Standard 5800 PSBC Health Insurance Plan, Variant (29678NE1470010-05) offer Disease Management Programs for Low back pain?

Yes, the Nebraska HeartlandBlue Silver Standard 5800 PSBC Health Insurance Plan Variant 29678NE1470010-05 offers Disease Management Program for Low back pain.

Does Nebraska HeartlandBlue Silver Standard 5800 PSBC Health Insurance Plan, Variant (29678NE1470010-05) offer Disease Management Programs for Pain management?

Yes, the Nebraska HeartlandBlue Silver Standard 5800 PSBC Health Insurance Plan Variant 29678NE1470010-05 offers Disease Management Program for Pain management.

Does Nebraska HeartlandBlue Silver Standard 5800 PSBC Health Insurance Plan, Variant (29678NE1470010-05) offer Disease Management Programs for Pregnancy?

Yes, the Nebraska HeartlandBlue Silver Standard 5800 PSBC Health Insurance Plan Variant 29678NE1470010-05 offers Disease Management Program for Pregnancy.

 

Disclaimer: This is based on the import(Date: Sun, 28 May 2023 07:51 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