Individual and Family Health Plans

Armor Health is an alternative to ACA coverage for individuals who are under the age of 65 and can pass medical underwriting. The effective date of the policy may begin on the first day of any month. No open enrollment period is required. Coverage lasts for 12 months and may be renewed by reapplying. Subsequent applications will be subject to underwriting.

When you apply and are approved for an Armor Health policy, the contract and rates are good for 12 months. Once the 12 months are up, you must reapply for a new coverage period. Subsequent applications will be subject to underwriting. Depending on medical history, rates may change or coverage may be declined. There is no limit to the number of times you can reapply for coverage.

Armor Health is a major medical policy modeled after ACA products, meaning it covers many of the same health care services that standard ACA plans cover. The main differences between Armor Health and ACA plans are that Armor Health has a lifetime benefit maximum of $1 million and does not cover maternity, inpatient mental illness, inpatient substance abuse, pediatric dental or pediatric vision services. Armor Health has a 12-month waiting period for pre-existing conditions on new sold business.

Nebraska residents under the age of 65 can apply for Armor Health. This policy is ideal for those who are looking for affordable coverage and aren’t receiving a subsidy on an ACA plan. Single (including child-only memberships from age 1-19) and family coverage options are available. Newborns are covered automatically for the first 31 days, then are subject to medical underwriting to continue coverage beyond the 31st day. Dependent children are eligible through the age of 26. 

No, you can apply for coverage at any time of the year even without a qualifying event. 

Yes, Armor Health policies are fully underwritten each contract period. Premium rates are determined based on medical history. It’s possible you or your dependent children will be declined coverage based on medical underwriting. That will be determined at the time of enrollment.

Please note: BCBSNE is terminating all existing pre-ACA individual policies, effective Jan. 1, 2020. For the initial launch of Armor Health, BCBSNE will offer impacted members an Armor Health policy. BCBSNE will base member rates on medical claims history. Members on existing pre-ACA individual policies who elect Armor Health for a Jan. 1, 2020, effective date will not be subject to the 12 month pre-existing waiting period.

Armor Health has a waiting period of 12 months for pre-existing conditions. After the first coverage period, members that choose to re-enroll will have their waiting periods waived if there has been no lapse in Armor Health coverage. 

Members on individual pre-ACA policies who elect Armor Health for a Jan. 1, 2020, effective date will not be subject to the 12 month pre-existing waiting period. 

Yes, preventive services, as defined by the ACA, are covered at 100% when in-network providers are used. Preventive services include, but are not limited to, annual exams, well-child visits, immunizations and colorectal and breast cancer screenings. 

Yes, Armor Health provides prescription drug coverage. Preferred and non-preferred generics are subject to a copay. Members may get covered brand name and specialty drugs at the BCBSNE negotiated rate. You can view in-network pharmacies (Network J) and the prescription drug list (PDL 40) online. 

Please note that pharmacy copays do not apply to the out-of-pocket maximum. 

Armor Health is not an ACA-compliant policy. This means that losing Armor Health coverage does not qualify for a Special Enrollment Period (SEP) to purchase an ACA plan. Because this is not an ACA-compliant plan, you cannot purchase Armor Health from HealthCare.gov.

Comparing Armor Health to an ACA plan

	Armor Health (Option 1)	ACA Plan (for comparison purposes only)2
Lifetime Maximum
	$1,000,000	No lifetime maximum under ACA
Pre-existing Conditions
	Covered after a 12-month waiting period1 Rates will vary based on health condition	Covered
Renewability
	Renewed each month when premiums are paid for a period of 364 days and will be guaranteed renewable for one (1) day or two (2) days during a Leap Year	Guaranteed Renewable
Primary Care Office Services
	$30 Office Services Copay	Deductible & 35% Coinsurance
Pharmacy Benefits
Preferred Generic Drugs	$0 Copay	$5 Copay
Specialty Drugs	Member Pays 100%	$600 Copay
Pregnancy and Maternity
	Not Covered3	Deductible & 35% Coinsurance
Mental Illness and Substance Abuse Services
Inpatient	Not Covered	Deductible & 35% Coinsurance
Outpatient	Deductible & 20% Coinsurance	Deductible & 35% Coinsurance
Preventive Care Services
ACA required preventive services (may be subject to limits that include, but are not limited to, age, gender, and frequency)	Plan Pays 100%	Plan Pays 100%
ACA required covered preventive services (outside of limits)	Plan Pays 100%	See Plan Details
Other covered preventive services not required by ACA, such as
Laboratory tests as specified by Us, including urinalysis and complete blood count; general health panel; comprehensive metabolic panel; prostate cancer screening (PSA) and hearing exams	Plan Pays 100%	See Plan Details
All other laboratory tests; radiology, cardiac stress tests; EKG; pulmonary function and other screenings and services	Same as an illness	See Plan Details
Emergency Care
Urgent Care Facility Services	$75 copay first 3 visits then Deductible & Coinsurance	Deductible & 35% Coinsurance
Emergency Care Services	Deductible & 50% Coinsurance	Deductible & 35% Coinsurance
Inpatient Hospital	Deductible & 20% Coinsurance	Deductible & 35% Coinsurance
Ambulance Services	Deductible & 20% Coinsurance	Deductible & 35% Coinsurance
Pediatric Vision
	Not Covered	Deducible & 35% Coinsurance
Pediatric Dental
	Not Covered	Not Covered
Network Providers
	Statewide Directory Online	This plan has to comply with the Nebraska network adequacy laws