BlueEssentialsPlus $2500 Silver

Individual Health Insurance (Obamacare)

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Benefits & Coverage

Plan Name
BlueEssentialsPlus $2500 Silver
Plan ID
29678NE1040001
Plan Year
2014
Insurance Type
Individual Health Insurance (Obamacare)
Metal Level
Silver
Plan Type
PPO
Deductible
$2,500
Out-of-Pocket Maximum
$6,350
Plan Highlights

Cost & Coverage

Estimated Monthly Base Rate
Estimated monthly premium starts at $341.57
Deductible
Individual: $2500
Family: $5000
In-Network Out-of-Pocket Limit
Individual: $6350
Family: $12700
What is included in the in-network out-of-pocket limit?
Deductible + Coinsurance
Is this plan Health Savings Account (HSA) eligible?
No
How can I find a doctor in this plan's network?
Plan Type
PPO

Health Services Options

Service
In Network
Out of Network
Primary care physician office visit
$30 Copay
50% Coinsurance after deductible
Specialist
$60 Copay
50% Coinsurance after deductible
Diagnostic Test (X-ray, blood work)
20% Coinsurance after deductible
50% Coinsurance after deductible
Outpatient Facility Fee
20% Coinsurance after deductible
50% Coinsurance after deductible
Outpatient Physician/Surgeon Fee
20% Coinsurance after deductible
50% Coinsurance after deductible
Hospital facility fee
20% Coinsurance after deductible
50% Coinsurance after deductible
Hospital physician/surgeon fee
20% Coinsurance after deductible
50% Coinsurance after deductible
Emergency Room
$300 Copay after deductible
$300 Copay after deductible

Drug Services

Generic Drugs
Coverage: 20% Coinsurance after deductible
Preferred Brand Drugs
Coverage: 20% Coinsurance after deductible
Specialty Drugs
Coverage: 20% Coinsurance after deductible
What drugs are covered in the formulary?

Mental Health or Substance Abuse Services

Service
In Network
Out of Network
Mental/behavioral health outpatient services
$30 Copay
50% Coinsurance after deductible
Mental/behavioral health inpatient services
20% Coinsurance after deductible
50% Coinsurance after deductible
Substance use disorder inpatient services
20% Coinsurance after deductible
50% Coinsurance after deductible
Substance use disorder outpatient services
$30 Copay
50% Coinsurance after deductible

Maternity Services

Service
In Network
Out of Network
Prenatal/postnatal care
20% Coinsurance after deductible
50% Coinsurance after deductible
Delivery and all inpatient services for maternity care
20% Coinsurance after deductible
50% Coinsurance after deductible

Coverage Options Summary

Included Benefits
  • Chiropractic
  • Dental check up children
  • Durable medical equipment
  • Emergency Transportation
  • Eye exam adult
  • Eye glasses children
  • Habilitation
  • Home health care
  • Hospice
  • Imaging (CT/PET scans, MRIs)
  • Inpatient rehabilitation
  • Non-emergency care outside U.S.
  • Non-preferred brand drugs
  • Skilled nursing care
  • Other practitioner office visit
  • Outpatient rehabilitation
  • Preventive care, screening, immunization
  • Routine eye exam children
  • Routine hearing tests
  • Urgent Care
Excluded Benefits
  • Acupuncture
  • Bariatric surgery
  • Cosmetic surgery
  • Dental care adult
  • Hearing Aid
  • Infertility treatment
  • Long Term Care
  • Private duty nursing
  • Routine foot care
  • Weight loss program

What To Know

  • This is an ACA (Obamacare) compliant health plan.
  • This plan is eligible for a tax credit subsidy

Physician Directory

List of doctors that accepts BlueEssentialsPlus $2500 Silver Obamacare Plan in Nebraska

/
JESSEN, PETER
5404 AMES AVENUE
OMAHA, NE 68104
JARZYNKA, MICHELE
1905 N 54TH ST
OMAHA, NE 68104
CURRAN, JODIE
6032 VILLE DE SANTE DR
OMAHA, NE 68104
PRICKETT, WESLEY
1513 N 60TH ST
OMAHA, NE 68104
IDE HELVIE, DANA
105 S 49TH ST
OMAHA, NE 68132
SPECHT, PAT
119 N 51ST ST
OMAHA, NE 68132
BABCOCK, NITA
6508 DAVENPORT PLZ
OMAHA, NE 68132
OLIVETO, JENNIFER
988095 NEBRASKA MEDICAL CTR
OMAHA, NE 68198
WILLIAMS, CHERYL
988102 NEBRASKA MEDICAL CTR
OMAHA, NE 68198
MORRIS, CHARLES
988102 NEBRASKA MEDICAL CTR
OMAHA, NE 68198
ANDERSEN, COLENE
988095 NEBRASKA MEDICAL CTR
OMAHA, NE 68198
WALKER, CRAIG
988102 NEBRASKA MEDICAL CTR
OMAHA, NE 68198
PETERSON, MARCIE
988102 NEBRASKA MEDICAL CTR
OMAHA, NE 68198
POAGE, DAVID
988102 NEBRASKA MEDICAL CTR
OMAHA, NE 68198
MOORE, TIMOTHY
988102 NEBRASKA MEDICAL CTR
OMAHA, NE 68198
ORTON, DONALD
988102 NEBRASKA MEDICAL CTR
OMAHA, NE 68198
DENTON, CHARLES
988102 NEBRASKA MEDICAL CTR
OMAHA, NE 68198
HUSSAIN, SHAHID
988102 NEBRASKA MEDICAL CTR
OMAHA, NE 68198
DRAKE, MARY
988102 NEBRASKA MEDICAL CTR
OMAHA, NE 68198
GRIER, CANDACE
988102 NEBRASKA MEDICAL CTR
OMAHA, NE 68198
LAMBERTY, LARRY
EMILE @ 42ND STREET
OMAHA, NE 68198
ANDERSON, JOSEPH
988102 NEBRASKA MEDICAL CTR
OMAHA, NE 68198
WAHL, ANDREW
988102 NEBRASKA MEDICAL CTR
OMAHA, NE 68198
THOMPSON, ROBERT
EMILE 42ND ST
OMAHA, NE 68198
LIN, CHI
988102 NEBRASKA MEDICAL CTR
OMAHA, NE 68198
Details
PETER JESSEN, DDS
Phone Number
(402) 451-3126
Office Locations
5404 AMES AVENUE
OMAHA, NE 68104
5404 AMES AVENUE OMAHA NE, 68104

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