Nebraska health plan · 2025

HeartlandBlue Gold $0 PCP Visit 1500 NEtwork Blue PPO · 29678NE1510011

Blue Cross and Blue Shield of Nebraska offers this marketplace health insurance plan (Plan ID 29678NE1510011) so you can compare premiums, coverage levels, and provider access against other health plan insurance options. Use the modules below to decide whether this is the best health insurance plan for your household or if another insurance health plan fits better.

Metal level: Gold Plan type: PPO CSR: Limited Cost Sharing Plan Variation Issuer: Blue Cross and Blue Shield of Nebraska
Telehealth Data pending HSA eligible No Dental Child Vision Child
Pay / Manage Plan View issuer site

CMS AV Calculator output: 79.35% (20.65% member share on average). Learn about AV methodology.

2025 cost summary

Key premiums & cost sharing

Rates mirror the latest CMS import (Tue, 02 Dec 2025 06:13 GMT). Personalize costs with your ZIP, age, and subsidies in the plan finder.

Monthly premium

$565 – $2310

Before subsidies

Estimate after subsidies

Deductible

$1,500

$3000 per group

See deductible details

Max out-of-pocket

$7,500

$15000 per group

Review MOOP rules

Office visits

Primary care No Charge
Specialist 30.00% Coinsurance after deductible
HSA Not eligible

Drug tiers

Generic $3.00
Preferred brand $100.00

View formulary tiers

$774 / mo before subsidies

≈ $9288 per year before tax credits.

Start with this unsubsidized premium, then apply marketplace tax credits to see your final monthly payment.

  • Ideal for shoppers comparing Bronze vs. Silver budgets.
  • Update your Marketplace application to apply premium tax credits.

$2477 / mo before subsidies

≈ $29722 per year before tax credits.

Pre-subsidy rate for a couple with one dependent. Switch to Silver CSR plans if you qualify to reduce these numbers.

  • Compares well against PPO vs HMO networks when planning for childcare and telehealth needs.
  • CSR savings require a Silver variant. Use the plan finder to load Silver options if you need lower deductibles.

$3019 / mo before subsidies

≈ $36225 per year before tax credits.

Pairs with cost-sharing reductions (CSR) when you select a Silver tier and qualify based on income.

  • Use this estimate before adding childcare, dental, or vision extras.
  • CSR Silver variants can lower deductibles dramatically for eligible incomes.
  • CSR savings require a Silver variant. Use the plan finder to load Silver options if you need lower deductibles.

$1888 / mo before subsidies

≈ $22653 per year before tax credits.

Shows the combined pre-subsidy rate for two adults. Add dependents or subsidies in your application to refine it.

  • Great for households deciding between PPO and HMO networks.
  • Telehealth and HSA perks (when offered) apply to both members.
Issuer profile See benefits

Preventive Care/Screening/Immunization

No Charge

Emergency Room Services

30.00% Coinsurance after deductible

Durable Medical Equipment

30.00% Coinsurance after deductible

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Enrollment guidance

Stay on top of 2025 ACA deadlines

Open Enrollment window

Marketplace enrollment for 2025 coverage typically runs Nov 1 – Jan 15 (dates may vary slightly in Nebraska). Submit changes before the deadline to avoid a coverage gap.

  • Enroll by Dec 15 for Jan 1 starts.
  • Finalize plan switches before the window closes.

Special Enrollment Periods

You can change plans mid-year if you experience a qualifying life event (move, childbirth, marriage, loss of other coverage).

  • Report the event within 60 days.
  • Keep documentation handy for Healthcare.gov or your state exchange.

CSR & subsidy reminders

Premium tax credits and cost-sharing reductions (CSR) update annually when you re-submit your marketplace application.

  • Enter accurate income to maximize Advanced Premium Tax Credits.
  • Limited Cost Sharing Plan Variation plans like this one keep deductibles and copays lower if you qualify.

Thinking about switching?

Before you leave your current plan, compare networks, drug coverage, and total cost using the cards on this page.

  • Match provider networks so ongoing care isn’t disrupted.
  • Confirm prescriptions stay on-formulary or budget for tier changes.

Top covered benefits

How this plan handles key care scenarios

Preventive Care/Screening/Immunization

No Charge

Emergency Room Services

30.00% Coinsurance after deductible

Durable Medical Equipment

30.00% Coinsurance after deductible

Premium snapshot

Plan identifiers & filings

Track the official identifiers, documents, and filing dates tied to this plan. Open the marketing or formulary links whenever you need the latest PDF from the issuer.

Plan ID 29678NE1510011
Coverage year 2025
State Nebraska
Issuer Blue Cross and Blue Shield of Nebraska
Formulary document Download formulary
Marketing materials View marketing kit
Variant ID 29678NE1510011-03
Available variants

Standard Off Exchange Plan · 29678NE1510011-00

Standard On Exchange Plan · 29678NE1510011-01

Open to Indians below 300% FPL · 29678NE1510011-02

Open to Indians above 300% FPL · 29678NE1510011-03
Last plan update Wed, 09 Oct 2024 00:00 GMT
Last HealthPorta import Tue, 02 Dec 2025 06:13 GMT

Network stats

Provider access snapshot

Review the network branding plus the number of in-network clinicians we track from issuer filings. Counts update with each CMS import (Tue, 02 Dec 2025 06:13 GMT).

All providers in Nebraska 18093
PCPs in Nebraska 1913
Telehealth support Data pending
Nationwide providers 70206
18,093 doctors statewide 1,913 PCPs 56 OB/GYN

Provider network(s)

Providers Nebraska All US states
All 18093 70206
PCP 1913 2330
Allergy 5 6
OB/GYN 56 82
Dentists 745 801

Drug coverage overview

3,968 drugs tracked

Inspect tier distribution plus authorization, step therapy, and quantity-limit counts sourced from HealthPorta’s formulary import.

Tier Covered drugs
HIGH-COST-GENERIC 2,387
NON-PREFERRED-BRAND 829
NON-PREFERRED-SPECIALTY 752
Prior authorization Drugs
Required 690
Not Required 3,278
Step therapy Drugs
Required 15
Not Required 3,953
Quantity limits Drugs
Has Limit 601
No Limit 3,367

Customer highlights

What stands out for members

  • Issuer: Blue Cross and Blue Shield of Nebraska · Plan ID 29678NE1510011 · 2025 filing.
  • Disease management programs available: Asthma, Depression, Diabetes, Heart Disease, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs.
  • Download the latest formulary directly from the issuer here.
  • Review marketing brochures and SBC PDFs via the issuer marketing repository.
  • Variant 29678NE1510011-03 (Open to Indians above 300% FPL) currently displayed.
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Benefits

Covered services & limitations

Everyday care

Office visits, preventive care, labs, imaging, and home health.

Chiropractic Care

30.00% Coinsurance after deductible
Tier 1 in-network 30.00% Coinsurance after deductible
Out-of-network 50.00% Coinsurance after deductible

Limit: 20.0 Visit(s) per Year

nan

Exclusions: nan

Diabetes Care Management

30.00% Coinsurance after deductible
Tier 1 in-network 30.00% Coinsurance after deductible
Out-of-network 50.00% Coinsurance after deductible

nan

Exclusions: nan

Diabetes Education

30.00% Coinsurance after deductible
Tier 1 in-network 30.00% Coinsurance after deductible
Out-of-network 50.00% Coinsurance after deductible

nan

Exclusions: nan

Home Health Care Services

30.00% Coinsurance after deductible
Tier 1 in-network 30.00% Coinsurance after deductible
Out-of-network 50.00% Coinsurance after deductible

Limit: 60.0 Days per Year

nan

Exclusions: nan

Laboratory Outpatient and Professional Services

30.00% Coinsurance after deductible
Tier 1 in-network 30.00% Coinsurance after deductible
Out-of-network 50.00% Coinsurance after deductible

nan

Exclusions: nan

Other Practitioner Office Visit (Nurse, Physician Assistant)

30.00% Coinsurance after deductible
Tier 1 in-network 30.00% Coinsurance after deductible
Out-of-network 50.00% Coinsurance after deductible

nan

Exclusions: nan

Preventive Care/Screening/Immunization

No Charge
Tier 1 in-network No Charge
Out-of-network 50.00% Coinsurance after deductible

nan

Exclusions: nan

Primary Care Visit to Treat an Injury or Illness

No Charge
Tier 1 in-network No Charge
Out-of-network 50.00% Coinsurance after deductible

Unlimited telehealth/virtual care visits to the in-network doctor of your choice with $0 copay

Exclusions: nan

Rehabilitative Occupational and Rehabilitative Physical Therapy

30.00% Coinsurance after deductible
Tier 1 in-network 30.00% Coinsurance after deductible
Out-of-network 50.00% Coinsurance after deductible

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

Exclusions: nan

Rehabilitative Speech Therapy

30.00% Coinsurance after deductible
Tier 1 in-network 30.00% Coinsurance after deductible
Out-of-network 50.00% Coinsurance after deductible

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

Exclusions: nan

Specialist Visit

30.00% Coinsurance after deductible
Tier 1 in-network 30.00% Coinsurance after deductible
Out-of-network 50.00% Coinsurance after deductible

nan

Exclusions: nan

Urgent Care Centers or Facilities

$50.00
Tier 1 in-network $50.00
Out-of-network 50.00% Coinsurance after deductible

nan

Exclusions: nan

X-rays and Diagnostic Imaging

30.00% Coinsurance after deductible
Tier 1 in-network 30.00% Coinsurance after deductible
Out-of-network 50.00% Coinsurance after deductible

nan

Exclusions: nan

Hospital & urgent

Emergency room, inpatient stays, ambulance, and surgeries.

Chemotherapy

30.00% Coinsurance after deductible
Tier 1 in-network 30.00% Coinsurance after deductible
Out-of-network 50.00% Coinsurance after deductible

nan

Exclusions: nan

Delivery and All Inpatient Services for Maternity Care

30.00% Coinsurance after deductible
Tier 1 in-network 30.00% Coinsurance after deductible
Out-of-network 50.00% Coinsurance after deductible

nan

Exclusions: nan

Dialysis

30.00% Coinsurance after deductible
Tier 1 in-network 30.00% Coinsurance after deductible
Out-of-network 50.00% Coinsurance after deductible

nan

Exclusions: nan

Durable Medical Equipment

30.00% Coinsurance after deductible
Tier 1 in-network 30.00% Coinsurance after deductible
Out-of-network 50.00% Coinsurance after deductible

nan

Exclusions: nan

Emergency Room Services

30.00% Coinsurance after deductible
Tier 1 in-network 30.00% Coinsurance after deductible
Out-of-network 30.00% Coinsurance after deductible

nan

Exclusions: nan

Emergency Transportation/Ambulance

30.00% Coinsurance after deductible
Tier 1 in-network 30.00% Coinsurance after deductible
Out-of-network 30.00% Coinsurance after deductible

nan

Exclusions: nan

Hospice Services

30.00% Coinsurance after deductible
Tier 1 in-network 30.00% Coinsurance after deductible
Out-of-network 50.00% Coinsurance after deductible

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.

Exclusions: nan

Inpatient Hospital Services (e.g., Hospital Stay)

30.00% Coinsurance after deductible
Tier 1 in-network 30.00% Coinsurance after deductible
Out-of-network 50.00% Coinsurance after deductible

nan

Exclusions: nan

Inpatient Physician and Surgical Services

30.00% Coinsurance after deductible
Tier 1 in-network 30.00% Coinsurance after deductible
Out-of-network 50.00% Coinsurance after deductible

nan

Exclusions: nan

Mental/Behavioral Health Inpatient Services

30.00% Coinsurance after deductible
Tier 1 in-network 30.00% Coinsurance after deductible
Out-of-network 50.00% Coinsurance after deductible

nan

Exclusions: nan

Mental/Behavioral Health Outpatient Services

No Charge
Tier 1 in-network No Charge
Out-of-network 50.00% Coinsurance after deductible

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.

Exclusions: nan

Outpatient Facility Fee (e.g., Ambulatory Surgery Center)

30.00% Coinsurance after deductible
Tier 1 in-network 30.00% Coinsurance after deductible
Out-of-network 50.00% Coinsurance after deductible

nan

Exclusions: nan

Outpatient Rehabilitation Services

30.00% Coinsurance after deductible
Tier 1 in-network 30.00% Coinsurance after deductible
Out-of-network 50.00% Coinsurance after deductible

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

Exclusions: nan

Outpatient Surgery Physician/Surgical Services

30.00% Coinsurance after deductible
Tier 1 in-network 30.00% Coinsurance after deductible
Out-of-network 50.00% Coinsurance after deductible

nan

Exclusions: nan

Radiation

30.00% Coinsurance after deductible
Tier 1 in-network 30.00% Coinsurance after deductible
Out-of-network 50.00% Coinsurance after deductible

nan

Exclusions: nan

Skilled Nursing Facility

30.00% Coinsurance after deductible
Tier 1 in-network 30.00% Coinsurance after deductible
Out-of-network 50.00% Coinsurance after deductible

Limit: 60.0 Days per Year

nan

Exclusions: nan

Substance Abuse Disorder Inpatient Services

30.00% Coinsurance after deductible
Tier 1 in-network 30.00% Coinsurance after deductible
Out-of-network 50.00% Coinsurance after deductible

nan

Exclusions: nan

Substance Abuse Disorder Outpatient Services

No Charge
Tier 1 in-network No Charge
Out-of-network 50.00% Coinsurance after deductible

nan

Exclusions: nan

Transplant

30.00% Coinsurance after deductible
Tier 1 in-network 30.00% Coinsurance after deductible
Out-of-network 50.00% Coinsurance after deductible

nan

Exclusions: nan

Pregnancy & family

Maternity, newborn, pediatric dental and vision extras.

Basic Dental Care - Child

30.00% Coinsurance after deductible
Tier 1 in-network 30.00% Coinsurance after deductible
Out-of-network 50.00% Coinsurance after deductible

nan

Exclusions: nan

Hearing Aids

30.00% Coinsurance after deductible
Tier 1 in-network 30.00% Coinsurance after deductible
Out-of-network 50.00% Coinsurance after deductible

Covered up to age 19 limited to $3,000 every 48 months

Exclusions: nan

Major Dental Care - Child

30.00% Coinsurance after deductible
Tier 1 in-network 30.00% Coinsurance after deductible
Out-of-network 50.00% Coinsurance after deductible

nan

Exclusions: nan

Prenatal and Postnatal Care

30.00% Coinsurance after deductible
Tier 1 in-network 30.00% Coinsurance after deductible
Out-of-network 50.00% Coinsurance after deductible

nan

Exclusions: nan

Routine Eye Exam for Children

No Charge
Tier 1 in-network No Charge
Out-of-network 50.00% Coinsurance after deductible

Limit: 1.0 Visit(s) per Year

nan

Exclusions: nan

Well Baby Visits and Care

No Charge
Tier 1 in-network No Charge
Out-of-network 50.00% Coinsurance after deductible

nan

Exclusions: nan

Pharmacy & drugs

Generic, brand, specialty, and mail order tiers.

Generic Drugs

$3.00
Tier 1 in-network $3.00
Out-of-network 50.00% Coinsurance after deductible

nan

Exclusions: nan

Non-Preferred Brand Drugs

55.00% Coinsurance after deductible
Tier 1 in-network 55.00% Coinsurance after deductible
Out-of-network 50.00% Coinsurance after deductible

nan

Exclusions: nan

Off Label Prescription Drugs

30.00% Coinsurance after deductible
Tier 1 in-network 30.00% Coinsurance after deductible
Out-of-network 50.00% Coinsurance after deductible

nan

Exclusions: nan

Preferred Brand Drugs

$100.00
Tier 1 in-network $100.00
Out-of-network 50.00% Coinsurance after deductible

nan

Exclusions: nan

Specialty Drugs

60.00% Coinsurance after deductible
Tier 1 in-network 60.00% Coinsurance after deductible
Out-of-network 100.00%

nan

Exclusions: nan

Tier 2 Generic Drugs

$10.00
Tier 1 in-network $10.00
Out-of-network 50.00% Coinsurance after deductible

nan

Exclusions: nan

Tier 2 Specialty Drugs

70.00% Coinsurance after deductible
Tier 1 in-network 70.00% Coinsurance after deductible
Out-of-network 100.00%

nan

Exclusions: nan

Wellness & extras

Vision, dental, therapies, prosthetics, weight management.

Accidental Dental

30.00% Coinsurance after deductible
Tier 1 in-network 30.00% Coinsurance after deductible
Out-of-network 50.00% Coinsurance after deductible

nan

Exclusions: nan

Basic Dental Care - Adult

Coverage details pending

nan

Exclusions: nan

Dental Anesthesia

30.00% Coinsurance after deductible
Tier 1 in-network 30.00% Coinsurance after deductible
Out-of-network 50.00% Coinsurance after deductible

Based on most common prescription tier

Exclusions: nan

Dental Check-Up for Children

No Charge
Tier 1 in-network No Charge
Out-of-network 50.00% Coinsurance after deductible

Limit: 1.0 Visit(s) per 6 Months

nan

Exclusions: nan

Infusion Therapy

30.00% Coinsurance after deductible
Tier 1 in-network 30.00% Coinsurance after deductible
Out-of-network 50.00% Coinsurance after deductible

nan

Exclusions: nan

Major Dental Care - Adult

Coverage details pending

nan

Exclusions: nan

Nutritional Counseling

30.00% Coinsurance after deductible
Tier 1 in-network 30.00% Coinsurance after deductible
Out-of-network 50.00% Coinsurance after deductible

Only for diabetes management as provided by the plan.

Exclusions: nan

Orthodontia - Adult

Coverage details pending

nan

Exclusions: nan

Orthodontia - Child

70.00% Coinsurance after deductible
Tier 1 in-network 70.00% Coinsurance after deductible
Out-of-network 70.00% Coinsurance after deductible

There is a 24-month waiting period for this benefit

Exclusions: nan

Prosthetic Devices

30.00% Coinsurance after deductible
Tier 1 in-network 30.00% Coinsurance after deductible
Out-of-network 50.00% Coinsurance after deductible

nan

Exclusions: nan

Routine Dental Services (Adult)

Coverage details pending

nan

Exclusions: nan

Weight Loss Programs

Coverage details pending

nan

Exclusions: nan

Additional benefits

Other plan-specific services and limitations.

Abortion for Which Public Funding is Prohibited

Coverage details pending

nan

Exclusions: nan

Acupuncture

Coverage details pending

nan

Exclusions: nan

Allergy Testing

30.00% Coinsurance after deductible
Tier 1 in-network 30.00% Coinsurance after deductible
Out-of-network 50.00% Coinsurance after deductible

nan

Exclusions: nan

Bariatric Surgery

Coverage details pending

nan

Exclusions: nan

Cosmetic Surgery

Coverage details pending

nan

Exclusions: nan

Eye Glasses for Children

50.00% Coinsurance after deductible
Tier 1 in-network 50.00% Coinsurance after deductible
Out-of-network 50.00% Coinsurance after deductible

Limit: 1.0 Item(s) per Year

In-network deductible applies to both In and Out-Of-Network

Exclusions: nan

Gender Affirming Care

30.00% Coinsurance after deductible
Tier 1 in-network 30.00% Coinsurance after deductible
Out-of-network 50.00% Coinsurance after deductible

nan

Exclusions: nan

Habilitation Services

30.00% Coinsurance after deductible
Tier 1 in-network 30.00% Coinsurance after deductible
Out-of-network 50.00% Coinsurance after deductible

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

Exclusions: nan

Imaging (CT/PET Scans, MRIs)

30.00% Coinsurance after deductible
Tier 1 in-network 30.00% Coinsurance after deductible
Out-of-network 50.00% Coinsurance after deductible

nan

Exclusions: nan

Infertility Treatment

Coverage details pending

nan

Exclusions: nan

Long-Term/Custodial Nursing Home Care

Coverage details pending

nan

Exclusions: nan

Private-Duty Nursing

Coverage details pending

nan

Exclusions: nan

Reconstructive Surgery

30.00% Coinsurance after deductible
Tier 1 in-network 30.00% Coinsurance after deductible
Out-of-network 50.00% Coinsurance after deductible

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.

Exclusions: nan

Routine Eye Exam (Adult)

Coverage details pending

nan

Exclusions: nan

Routine Foot Care

Coverage details pending

nan

Exclusions: nan

Treatment for Temporomandibular Joint Disorders

30.00% Coinsurance after deductible
Tier 1 in-network 30.00% Coinsurance after deductible
Out-of-network 50.00% Coinsurance after deductible

nan

Exclusions: nan

Variant attributes

HeartlandBlue Gold $0 PCP Visit 1500 NEtwork Blue PPO · Variant 29678NE1510011-03

Plan identifiers & tier

Issuer-provided metadata for this variant.

Business Year

2025

CSR Variation Type

Limited Cost Sharing Plan Variation

HIOS Product ID

29678NE151

Metal Level

Gold

Plan ID (Standard Component ID with Variant)

29678NE1510011-03

Plan Marketing Name

HeartlandBlue Gold $0 PCP Visit 1500 NEtwork Blue PPO

Plan Variant Marketing Name

HeartlandBlue Gold $0 PCP Visit 1500 NEtwork Blue PPO

Issuer & service area

Issuer-provided metadata for this variant.

Issuer ID

29678

Issuer Marketplace Marketing Name

Blue Cross and Blue Shield of Nebraska

Market Coverage

Individual

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.

Service Area ID

NES006

State Code

NE

URL for Summary of Benefits & Coverage

Open link

Cost sharing & actuarial values

Issuer-provided metadata for this variant.

AV Calculator Output Number

0.793508453454721

Begin Primary Care Deductible Coinsurance After Number Of Copays

0

Inpatient Copayment Maximum Days

0

Medical Drug Deductibles Integrated

Yes

Medical Drug Maximum Out of Pocket Integrated

Yes

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 Diabetes, Coinsurance

$0

SBC Scenario, Having Diabetes, Copayment

$800

SBC Scenario, Having Diabetes, Deductible

$600

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

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, In Network (Tier 1), Default Coinsurance

30.00%

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 Group

$30000 per group

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family Per Person

$15000 per person

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Individual

$15,000

Enrollment & documents

Issuer-provided metadata for this variant.

Formulary ID

NEF021

Formulary URL

Open link

Plan Brochure

Open link

SBC Scenario, Having a Baby, Limit

$60

SBC Scenario, Having Diabetes, Limit

$70

SBC Scenario, Treatment of a Simple Fracture, Limit

$0

URL for Enrollment Payment

Open link

Additional attributes

Issuer-provided metadata for this variant.

Begin Primary Care Cost-Sharing After Number Of Visits

0

Child-Only Offering

Allows Adult and Child-Only

Composite Rating Offered

No

Dental Only Plan

No

Design Type

Not Applicable

Disease Management Programs Offered

Asthma, Depression, Diabetes, Heart Disease, 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%

Import Date

2024-10-09 20:01:46

Limited Cost Sharing Plan Variation - Estimated Advanced Payment

$0.00

HSA Eligible

No

New/Existing Plan

New

Notice Required for Pregnancy

No

Is a Referral Required for Specialist?

No

Plan Effective Date

2025-01-01

Plan Expiration Date

2025-12-31

Plan Type

PPO

QHP/Non QHP

Both

Source Name

SERFF

Plan ID

29678NE1510011

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), 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

Combined Medical and Drug EHB Deductible, Out of Network, Family Per Group

$6000 per group

Combined Medical and Drug EHB Deductible, Out of Network, Family Per Person

$3000 per person

Combined Medical and Drug EHB Deductible, Out of Network, Individual

$3,000

Unique Plan Design

No

Wellness Program Offered

Yes

Copay & coinsurance

Pharmacy cost sharing by tier

Drug tier Pharmacy type Copay amount Copay option Coinsurance rate Coinsurance option Mail order

Questions & answers

Frequently asked questions

How do I choose the right ACA plan in Nebraska?

HeartlandBlue Gold $0 PCP Visit 1500 NEtwork Blue PPO (29678NE1510011) is a Gold PPO from Blue Cross and Blue Shield of Nebraska in Nebraska for the 2025 coverage year.

Compare it against other options with the HealthPorta plan finder to confirm premiums, deductibles, and network access fit your household.

Does HeartlandBlue Gold $0 PCP Visit 1500 NEtwork Blue PPO support telehealth or virtual urgent care?

The issuer has not published telehealth details yet. Review the Summary of Benefits and Coverage to confirm if virtual visits are included.

Is HeartlandBlue Gold $0 PCP Visit 1500 NEtwork Blue PPO HSA-eligible and does it include dental or vision coverage?

It is not marked as HSA-eligible, so confirm with the issuer before relying on tax-advantaged savings.

Dental add-ons: Child.

Vision add-ons: Child.

Does HeartlandBlue Gold $0 PCP Visit 1500 NEtwork Blue PPO support mail-order prescriptions?

Mail order coverage is not listed for this plan, so confirm with the issuer before relying on home delivery.

Which disease management programs come with HeartlandBlue Gold $0 PCP Visit 1500 NEtwork Blue PPO?

The issuer lists disease management resources for: Asthma, Depression, Diabetes, Heart Disease, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs.

Is there out-of-country coverage for HeartlandBlue Gold $0 PCP Visit 1500 NEtwork Blue PPO?

Yes, limited out-of-country coverage is available. Review the Summary of Benefits for reimbursement steps. Details: Emergency Services

Does HeartlandBlue Gold $0 PCP Visit 1500 NEtwork Blue PPO cover care outside the service area?

Yes, you have limited out-of-area coverage. See the plan documents for referral and prior authorization rules. Details: 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.

Disclaimer: Based on the Tue, 02 Dec 2025 06:13 GMT HealthPorta import from CMS issuer filings. Data is best-effort and should be validated with the issuer directly. Sources: CMS.gov and the HealthPorta Healthcare MRF API.
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