Different needs created different Blues. Many “Blue” terms are used to describe the different programs and products of Blue Cross and Blue Shield of Nebraska designed to meet your needs and of our members.

Each program/product is unique in its focus and because it carries the term “Blue,” you can be assured that it is supported by our mission to deliver the health and wellness solutions people value most.

When there is a discrepancy between the terminology in this manual and covered person contract language, the specific contract language will prevail.

The information in this manual is subject to change. There may be deletions and additions published periodically, each with its own effective date. We encourage you to utilize the most current version of the manual by visiting and clicking on “Providers” and then “Policies and Procedures” in the left column.

Revisions are often published in our UPDATE provider newsletter and in direct mailings to your office. Newsletters can also be viewed at by clicking on “Providers,” then “Newsletters” in the left column. To receive an e-mail each time we post a new issue of the newsletter on the provider website, click on “Sign up for our newsletters” on the Newsletter page. In addition, we encourage you to visit our website at and view our comprehensive online provider library.

The information in this manual should not be considered all-inclusive. This is general information that applies to many but not all group endorsements. Groups can and do request variations of endorsements.

Health care providers should take advantage of our online provider portal through NaviNet to verify member eligibility and benefits, verify claim status, or access a remittance advice. Go to our provider page on, or to register or log-in. This information has been made available for you free of charge by BCBSNE, and should be your primary source of verification.

Call 800-635-0579, our toll-free voice response system, to research answers to questions about a claim or BCBSNE benefit coverage that may not be available on NaviNet.



The percentage of the bill you pay after your deductible has been met.


A fixed amount you pay when you get a covered health service.

Tiered benefit plan

A health care plan featuring multiple levels of benefits based on the network status of a particular provider. 


The annual amount you pay for covered health services before your insurance begins to pay.

emergency care services

Any covered services received in a hospital emergency room setting.


Includes behavioral health treatment, counseling, and psychotherapy

in-network provider

A provider contracted by your insurance company to accept an agreed upon payment for covered services. 

OUT-OF-network provider

A term for providers that aren’t contracting with your insurance company. (Your out-of-pocket costs will tend to be more expensive if you go to an out-of-network provider.)


Your expenses for medical care that aren’t reimbursed by insurance, including deductibles, coinsurance and co-payments.


If you can afford health insurance, but choose not to buy it, you must have a health coverage exemption or pay a tax penalty on your federal income tax return.


The amount you pay to your health insurance company each month. 

Preventive services

Health care services that focus on the prevention of disease and health maintenance.


Services and devices to help you recover if you are injured or have surgery. This includes physical, occupational and speech therapy.

special enrollment period

The time after the Open Enrollment Period when you can still purchase health insurance only if you have a qualifying life event (losing other health coverage, having a baby, getting married, moving).


A physician who has a majority of his or her practice in fields other than internal or general medicine, obstetrics/gynecology, pediatrics or family practice.