Frequently Asked Questions

Is individual health insurance right for me?

What is the difference between group and individual coverage?

How does my deductible affect my premium?

How does the size of my family affect my insurance premium?

How do deductibles, coinsurance and copayments work?

How do out-of-pocket maximums work?

What is the difference between in-network and out-of-network benefits?

What is the difference between a Regional vs. State-Wide Network?

What is a PPO (Preferred Provider Organization)?

Do I qualify for a catastrophic plan?

What is a High Deductible Health Plan?

What is a Health Savings Account?

What is the Cost Estimator Tool?

What is Telehealth?

How do I know if my plan covers my prescription drug?

How can I find a pharmacy?

What if I travel outside of the State? Or Country?

What is the BlueCard program?

How to read your Explanation of Benefits?

What is Coordination of Benefits?

What is the Special Enrollment Period?

Why are preventive services important?

What are essential health benefits?

Does my health plan cover breast pumps?

Is individual health insurance right for me?

Individual coverage is health insurance you purchase on your own. It may be right for you if your employer does not offer coverage, you are in between jobs, self-employed, or no longer covered by a parent's health care plan.

View available plans.

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What is the difference between group and individual coverage?

Group coverage is provided to employees by an employer or to members by an association. Individual coverage is health insurance you purchase on your own.

Group coverage may:

  • Give you a choice of health insurance plans
  • Pay for all or some of your monthly premium
  • Automatically deduct your monthly premium from your paycheck
  • Help answer questions about your plan
  • Provide you with plan documents

Individual coverage means you will:

  • Shop for and choose the plan based on your needs and budget
  • Pay monthly premiums
  • Manage your health coverage and benefits

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How does my deductible affect my premium?

Plans with a higher deductible usually have a lower monthly premium and plans with a lower deductible usually have a higher monthly premium. Therefore, it is important to select a plan based on your needs and budget.

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How does the size of my family affect my insurance premium?

The number of people on your plan does not affect how much you pay. For example, when you add a spouse or child onto a plan, your monthly payment increases. This is because you are charged for each person covered by your plan. For example, family premiums are calculated by adding together the premium for each parent, plus the premium for each covered child age 21 and older, plus the premium for each of the three oldest children under age 21.

For more information view our individual and family health insurance plans or call an agent (888) 233-8143.

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How do deductibles, coinsurance and copayments work?

Deductibles are the amount you pay for health care services before your plan starts to pay. There are two deductibles: individual and family.

For example. if your individual deductible is $1,000 you must pay $1,000 before your insurance starts to pay. If you have a family plan, the deductible would be two times the individual deductible. For example, if the individual deductible is $1,000, the family deductible would be $2,000.

Coinsurance is the share of the costs you pay, calculated as a percentage (for example, you pay 20%, insurance pays 80%).

Copayments (copay) is a fixed amount you pay, usually at the time of healthcare service. Copayments are separate from and do not accumulate to the deductible. This amount can vary by the type of service. You may also have a copay when you get a prescription filled. 

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How do out-of-packet maximums work?

The out-of-pocket maximum is the amount each covered person must pay in a calendar year before your insurance covers at 100%. The out-of-pocket limit includes deductible, coinsurance and copayment amounts for medical and pharmacy services. The out-of-pocket limit does not include premium amounts over the allowable charge, charges for non-covered services, or penalties for failure to comply with certification requirements or as imposed under the Rx Nebraska Prescription Drug Program.

For example, if your out-of-pocket maximum is $10,000 you must meet this amount before your insurance covers services at 100%. Please note there are in-network and out-of-network out-of-pocket maximums. This means you may not pay for in-network services, but for out-of-network services still receive a bill.

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What is the difference between in-network and out-of-network benefits?

In-network benefits are benefits provided by a licensed practitioner of the healing arts, a licensed facility or other qualified provider of health care services who has contracted with us to provide services as a part of a preferred network in Nebraska. These benefits mean less out-of-pocket for members.

Out-of-network benefits are benefits provided by a provider who has not contracted with us to provide services as a part of the preferred provider organization in Nebraska. These benefits mean more out-of-pocket for members when services are incurred.

This means a doctor's visit at an in-network provider would cost a member less than the same appointment with an out-of-network doctor.

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What is the difference between a Regional vs. State-Wide Network?

Blue Cross and Blue Shield of Nebraska offers both Regional and State-Wide Network plan options. Our Regional Network, Premier Select BlueChoice, includes a smaller area of coverage. Plans on a Regional Network, SelectBlue, may have lower monthly premiums. Our State-Wide Network, NEtwork Blue, covers the entire state. Plans on a State-Wide Network, BlueEssentials, may have higher monthly premiums due to the larger coverage area.

View Network options available in your area.

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What is a PPO (Preferred Provider Organization)?

A Preferred Provider Organization (PPO) is a panel of Hospital, Physicians and other health care Providers who belong to a network of Preferred Providers, which agrees to more effectively manage healthcare costs.

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Do I qualify for a catastrophic plan?

A Catastrophic plan covers essential health benefits but has high deductibles. Only adults under 30 are allowed to purchase catastrophic plans. These plans do have low monthly premiums, eliminate the risk of a tax penalty for not being covered, cover preventive care services, and cover the first three office visits with primary physician at a 100%.

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What is a High Deductible Health Plan?

A High Deductible Health Plan (HDHP) works in combination with a Health Savings Account (HSA) to offer sound, affordable coverage that features low out-of-pocket costs. These plans are designed to help you maximize your dollars and minimize your health care expenses.

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What is a Health Savings Account?

A health savings account (HSA) is a tax-advantaged savings account that can be funded by individuals whose only health care coverage is a high deductible health plan (HDHP). An HSA is an alternative way for you to pay for your qualified health care expenses and save for future qualified health care expenses on a tax-free basis. Expenses such as out-of-pocket costs for office visits, prescription drugs, dental expenses and laboratory tests may be paid for from your HSA. 

Find out more about Health Savings Accounts. 

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What is the Cost Estimator Tool?

The cost estimator tool allows you to estimate how much you will spend for medical procedures and services. It helps you determine the best value for your money.To get started, go to "Find a Doctor" and in the drop-down box on the far left-hand side, choose "Cost." Then enter the procedure or service.

Members can login to myNebraskaBlue to access cost estimates and cost comparisons for a variety of treatments and services. By logging in, your individual plan will be applied to your estimate so you can see costs based on your coverage.

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What is Telehealth?

Telehealth is a fast, easy way to see a doctor. It lets Blue Cross and Blue Shield of Nebraska members have live visits over their computer, tablet or phone with a doctor anytime. Telehealth visits cost less than emergency room, urgent care, or even in-office doctor visits. It is easy to use, affordable, private and secure.

Learn more about Telehealth and Register for an account.

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How do I know if my plan covers my prescription drug?

The Blue Cross and Blue Shield of Nebraska (BCBSNE) Preferred Prescription Drug List, also called a formulary, is a list of drugs included in most prescription drug benefits. Coverage of these drugs is subject to your prescription benefit plan design. Please review your prescription drug plan along with the formulary list to determine coverage. In order to do so, you may log in to your myNebraskaBlue online account and search for covered formulary drugs, or you may contact the Member Services Department at the phone number listed on the back of your BCBSNE member ID card.

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How can I find a pharmacy?

Members may find a pharmacy by logging into their myNebraskaBlue account or by visiting Find a Pharmacy.

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What if I travel outside of the State? Or Country?

As a Blue Cross and Blue Shield of Nebraska member, you have access to a national network called the BlueCard Program. When you're a Blue member, you take your health care benefits with you. The BlueCard Program gives you access to doctors and hospitals almost everywhere within the United States. You're covered whether you need care in urban or rural areas.

Outside of the United States, you have access to doctors and hospitals in nearly 200 countries and territories around the world through the BlueCard Worldwide Program.

To locate providers nationwide: Visit "Find a Doctor" or call (800) 810-2583.

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What is the BlueCard program?

BlueCard is a national program that enables members of one Blue Plan to obtain health care services while traveling or living in another Blue Plan's service area. The program links participating healthcare providers with Blue Plans across the country and internationally through a single electronic network for claims processing and reimbursement.

To locate providers nationwide: Visit "Find a Doctor" or call (800) 810-2583.

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How to read your Explanation of Benefits?

Each time a claim is processed, we send an Explanation of Benefits (EOB) form. This EOB shows how we processed available benefits according to the terms of your coverage. If the claims filed were for a spouse or other adult member, the EOB is sent to that person. The EOB's for minor dependents are generally sent to the parent/employee. Most states define an adult as a person 18 years of age and older.

View an online Guide to Your Explanation of Benefits

OR

Members may view EOB's online using their myNebraskaBlue.com account.

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What is Coordination of Benefits?

Coordination of benefits is the process used when a member has two health insurance plans. This process allows the two plans to work together getting you the most out of your coverage. One plan becomes your primary plan, paying your claims first. The second plan becomes your secondary plan, which may pay toward the remaining cost, depending on the plan. Understanding which plan is your primary and which plan is your secondary is important to help prevent delays in claims processing.

Members may complete this form online on myNebraskaBlue.com or by downloading the Coordination of Benefits Form.

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What is the Special Enrollment Period?

A period during which an individual is allowed to enroll because of a loss of coverage, an adoption, placement for adoption, birth or marriage, without being considered a late enrollee, subject to certain criteria as further described in the contract.

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Why are preventive services important?

Many health conditions can be prevented or detected early by making healthy lifestyle choices such as eating nutritional foods, getting appropriate exercise, and visiting your doctor for preventive care. View the Preventive Health Guidelines and Benefits for Preventive Services to see what screenings, immunizations and other preventive measures are recommended by the experts for your age group and gender. Use these guidelines to help maintain a healthy lifestyle, but talk with your doctor about your specific health concerns, and follow your doctor's advice.

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What are essential health benefits?

Essential health benefits are services covered as required under the Affordable Care Act. The essential health benefits include:

  • Outpatient services
  • Emergency services
  • Hospitalization
  • Maternity and newborn care
  • Mental health and substance use disorder services, including behavioral health treatment
  • Prescription drugs
  • Rehabilitative and habilitative services and devices
  • Laboratory services
  • Pediatric services, including dental and vision care
  • Preventive and wellness services and chronic disease management

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Does my health plan cover breast pumps?

Benefits are provided for breastfeeding support, supplies and counseling at little or no cost to you when you use an in-network doctor/hospital/pharmacy. Out-of-network doctors/hospitals/pharmacies will be reimbursed only up to the maximum allowable amount. Benefits include one pump per pregnancy. To verify that breast pumps are covered under your specific plan, call the number on the back of your member ID card.

Find out how to get a breast pump. 

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HEALTH INSURANCE TERMS


COINSURANCE

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

COPAY

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. 

DEDUCTIBLE

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.

SUBSTANCE ABUSE DISORDER SERVICES

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.)

out-of-pocket

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

penalty

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.

premium

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.

rehab SERVICES

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).

specialist

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.