HeartlandBlue Bronze 0% Coinsurance after Deductible NEtwork Blue PPO
Blue Cross and Blue Shield of Nebraska
Plan overview
Medical deductible
Individual: $10500
Family: $21000
Per Person: $10500
Prescription drug deductible
Individual: $0
Family: $0
Per Person: $0
Combined medical and drug out of pocket maximum
Individual: $10500
Family: $21000
Per Person: $10500
Office visit
Primary Doctor
CoPay: No Charge after deductible
CoInsurance: Not Applicable
Covered: Covered
Benefit Explanation: Unlimited telehealth/virtual care visits to the in-network doctor of your choice with $0 copay.
Specialist
CoPay: No Charge after deductible
CoInsurance: Not Applicable
Covered: Covered
Prescription drug information
Preferred brand drugs
CoPay: No Charge after deductible
CoInsurance: Not Applicable
Covered: Covered
Limit Quantity:
Limit Unit:
Benefit Explanation:
Non preferred brand drugs
CoPay: No Charge after deductible
CoInsurance: Not Applicable
Covered: Covered
Limit Quantity:
Limit Unit:
Benefit Explanation:
Generic drugs
CoPay: $10.00
CoInsurance: Not Applicable
Covered: Covered
Limit Quantity:
Limit Unit:
Benefit Explanation:
Specialty drugs
CoPay: No Charge after deductible
CoInsurance: Not Applicable
Covered: Covered
Limit Quantity:
Limit Unit:
Benefit Explanation:
Inpatient coverage
Hospital services
CoPay: No Charge after deductible
CoInsurance: Not Applicable
Covered: Covered
Inpatient services
CoPay: No Charge after deductible
CoInsurance: Not Applicable
Covered: Covered
Emergency and urgent care
Emergency room
CoPay: No Charge after deductible
CoInsurance: Not Applicable
Covered: Covered
Urgent care facility
CoPay: No Charge after deductible
CoInsurance: Not Applicable
Covered: Covered
Benefit Explanation:
Maternity
Labor and delivery hospital stay
CoPay: No Charge after deductible
CoInsurance: Not Applicable
Covered: Covered
Pre and Postnatal office visit
CoPay: No Charge after deductible
CoInsurance: Not Applicable
Covered: Covered
Vision
Routine Eye Exams for Children
CoPay: No Charge
CoInsurance: Not Applicable
Covered: Covered
Limit Quantity: 1
Limit Unit: Visit(s) per Year
Major dental care
Routine dental checkups for children
CoPay: No Charge
CoInsurance: Not Applicable
Covered: Covered
Limit Quantity: 2
Limit Unit: Exam(s) per Year
Routine dental checkups for adults
CoPay:
CoInsurance:
Covered: Not Covered
Limit Quantity:
Limit Unit:
Benefit Explanation:
These policies have exclusions, limitations, reduction of benefits, terms under which the policy may be continued in force or discontinued. For costs and complete details of the coverage, call or write your insurance agent or the company (whichever is applicable).